Application of Harry Fine to JCRS, 1905 December 29

Item

Identifier: B002.01.0097.0102.00003

Staff Only

Abstract

Application for admittance to JCRS filled out by hand for Harry Fine and dated December 29, 1905. Information on the form includes his age, birthplace, occupation, residence, marital status, nearest relatives, and signed H. Fine. The back of the form has sections titled "Report of Medical Advisory Board," and "Report of Executive Committee," blank. The middle section of the back is a form filled out by hand. It reads, "Application No. 175, Case No. 103, Application of H. Fine, Dec 29/05. Date of admission January 11, 1906. Died, Feb 6, 1906."

Dates

1905 December 29

Creator

Jewish Consumptives' Relief Society (U.S.) (Producer, Organization)

Rights and Usage Statement

This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). http://rightsstatements.org/vocab/InC-EDU/1.0/

Extent

1 Items (application)

Additional Description

Scope and Contents

From the Series:

This series of patient records includes medical reports and histories, statistical data of patients, x-rays, and death certificates. The patient files include applications, correspondence and some may also contain photographs and personal items.

Physical Characteristics and Technical Requirements

Fair 30 x 22 centimeters

General

reformatted digital

Title supplied by archivist.

Inscription and Marks

Handwritten at the top, "175," File Rec'd Dec 29-". A blue ink stamped form filled out by hand in black ink reads, "Received: Dec 29 -05; Accepted: Jan 11 1906; Admitted: Jan 18 -06; Died: Feb 6th 1906."