Application of Harry Miller to JCRS, 1906 July 5

Item

Identifier: B002.01.0097.0172.00002

Staff Only

Abstract

Application for admittance to JCRS filled out by hand for Harry Miller and is dated Jul 5, 1906. Information on the form includes his age, birth place, occupation, residence, marital status, children's ages, nearest relatives, and signed Harry Miller. 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. 259, Case #182, Application of Harry Miller, July 5/06, Date of Admission, August 26 1906, Date of Discharge, Oct 21 1906, Died Nov. 17/06. Buried at Rose hill Cemetery, Block 84 Lot 6. (handwritten)."

Dates

1906 July 5

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: "259 (underlined)." Stamped in blue ink, at bottom left-hand corner: "Received Jul 5 1906, Accepted Aug 24, 06, Admitted Aug. 26, 06, Discharged, Left Oct 21/06, Died."