Application of Carrie Hruschka to JCRS, 1906 May 30

Item

Identifier: B002.01.0097.0154.00002

Staff Only

Abstract

Application for admittance to JCRS filled out by hand for Carrie Hruschka and is dated May 30, 1906. Information on the form includes her age, birth place, occupation, residence, marital status, children's ages, nearest relatives, and signed Carrie Hruschka. 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. 238, Case #159 (crossed out) 158, Application of Carrie Hruschka, May 30/06, Date of Admission, June 19 1906, Date of Discharge, Sep 25 1907 (stamped in blue ink), Note-She married Barney Kokush-an ex patient-(handwritten)."

Dates

1906 May 30

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 Large tear near middle of page. 31 x 22 centimeters

General

reformatted digital

title supplied by archivist

Inscription and Marks

Handwritten in pen, at top left-hand corner: "Please attend at once D [illegible] name." Handwritten in pen, at top of page: "238 (underlined)." Stamped in blue ink, at bottom left-hand corner: "Received May 30 1906, Accepted June 15/06, Admitted June 19, 06, Discharged, Left, Died." Handwritten in pen, at bottom of page: "Miss Hruschka is temporarily located at 1473 Lates St. She is very (underlined) poor, and quite sick, and greatly depend on a speedy admission at the Sanatorium. I can highly recommend her, and fully support her application [illegible] signature."