Application of Ray Jacobson to JCRS, 1906 June 11

Item

Identifier: B002.01.0097.0161.00003

Staff Only

Abstract

Application for admittance to JCRS filled out by hand for Ray Jacobson and is dated Jun 11, 1906. Information on the form includes his age, birth place, occupation, residence, marital status, children's ages, nearest relatives, and signed Ray Jacobson. 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. 245, Case #160 (crossed out) 159, Application of Ray Jacobson, June 11/06, Date of Admission, June 27 1906, Date of Discharge, August 4 1907, Oct 2 1907 Dr. P. Hillkowitz reported that she died at her home [illegible] signature (handwritten)."

Dates

1906 June 11

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 in pen, at top of page: "245 (underlined)." Stamped in blue ink, at bottom left-hand corner: "Received Jun 11 1906, Accepted June 27/06, Admitted June 27/06., Discharged, Left, Died."