Application of Herman Protas to JCRS, 1906 January 23

Item

Identifier: B002.01.0097.0111.00003

Staff Only

Abstract

Application for admittance to JCRS filled out by hand for Herman Protas and is dated Jan 23, 1906. Information on the form includes his age, birth place, occupation, residence, marital status, children's ages, nearest relatives, and signed Herman Protas.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. 187, Case # 106, Application of, Herman Protas, Jan 26/06, Date of Admission January 27, 1906, Date of Discharge April 6, 1906, Handwritten below: 'Disch April 5th 06, 3-28-06'."

Dates

1906 January 23

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 31 x 22 centimeters

General

reformatted digital

title supplied by archivist

Inscription and Marks

Handwritten note, top of page: "187." Stamped in blue ink at the top, is the following: "Received Jan 26 1906, Accepted Jan 26 1906, Admitted Jan 27, 1906, Discharged, Left, Died."