Application of Mike Perlman to JCRS, 1906 August 14

Item

Identifier: B002.01.0097.0193.00002

Staff Only

Abstract

Application for admittance to JCRS filled out by hand for Mike Perlman and is dated Aug 14, 1906. Information on the form includes his age, birth place, occupation, residence, marital status, children's ages, nearest relatives, and signed Mike Perlman. 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. 289, Case #187, Application of Mike Perlman, Aug 14/06, Date of Admission, Sep 9 1906, Date of Discharge (crossed out) Died, January 2 1907, Buried in Mount Nebo Cemetery 1/2/07 Sec. 25 Lot 6. (handwritten)."

Dates

1906 August 14

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 black ink, at top of page: "289." Handwritten in pencil, at top right-hand page: "admitted 9/8/06." Handwritten in black ink, at top right-hand page: "Aug 14, 1906 (circled)." Stamped in blue ink, at bottom left-hand corner: "Received Aug 14 1906, Accepted, Admitted Sep 9 1906 (stamped twice, one upside down and crossed out, second right side up), Discharged, Left, Died."