Application of Malvin Roth to JCRS, 1906 March 12

Item

Identifier: B002.01.0097.0126.00001

Staff Only

Abstract

Application for admittance to JCRS filled out by hand for Malvin Roth and is dated March 12, 1906. Information on the form includes his age, birth place, occupation, residence, marital status, children's ages, nearest relatives, and signed Miss Malvin Roth. 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. 206, Case # 140, Application of, Malvin Roth, March 20/06, Date of Admission, May 20 1906, Date of Discharge (crossed out) Died November 24 1906, Died Nob 24, 1906, Buried in Mount Nebo Cemetery 11/24/06. Sec. L. Lot 54. (handwritten)."

Dates

1906 March 12

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 in black ink, at top of page: "206." Stamped in blue ink at bottom left-hand corner: "Received Mar 20 1906, Accepted May 17, 1906, Admitted May 20 1906, Discharged, Left, Died." Handwritten in pencil at bottom left-hand corner: "[Illegible] note."