Application of Samuel Klein to JCRS, 1906 May 25

Item

Identifier: B002.01.0097.0152.00001

Staff Only

Abstract

Application for admittance to JCRS filled out by hand for Samuel Klein and is dated May 25, 1906. Information on the form includes his age, birth place, occupation, residence, marital status, children's ages, nearest relatives, and signed Samuel Klein. 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. 236, Case #156 (crossed out) 155, Application of Samuel Klein, May 25/06, Date of Admission, June 10 1906, Date of Discharge (crossed out) leaving, Jul 16 1907, Second application Old " no. 125 (handwritten)."

Dates

1906 May 25

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

Stamped in blue ink, at bottom left-hand corner: "Received May 25 1906, Accepted June 9/06, Admitted June 10,06., Discharged, Left July 16/06., Died." Stamped in blue ink, at bottom right-hand corner: Received, Accepted, Admitted, Discharged, Left, Died."