Application of Sam Goldberg to JCRS, 1906 January 20

Item

Identifier: B002.01.0097.0109.00003

Staff Only

Abstract

Application for admittance to JCRS filled out by hand for Sam Goldberg and is dated Jan 20, 1906. Information on the form includes his age, birth place, occupation, residence, marital status, children's ages, nearest relatives, and signed Sam Goldberg [illegible co-signer]. Handwritten note, top of page: "185." The back of the form has sections titled "Report of Medical Advisory Board" and "Report of Executive Committee," both are blank. The middle section of the back is a form filled out by hand. It reads, "No. 184, Case # 109, Application of, Sam Goldberg, Jan 25/06, Date of Admission Feb 13, 1906, Date of Discharge April 18, 1906, Discharge April 20 1906 (crossed out)."

Dates

1906 January 20

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

Poor Bottom of paper is torn and creased in multiple spots 31 x 22 centimeters

General

reformatted digital

title supplied by archivist

Inscription and Marks

Stamped on the front in blue ink, is the following: "Received Jan 20 1906, Accepted Feb 9th 1906, Admitted Feb 31/1906, Discharged, Left April 18 1906, Died."