Application of M. Montezinos to JCRS, 1906 September 17

Item

Identifier: B002.01.0097.0211.00001

Staff Only

Abstract

Application for admittance to JCRS filled out by hand for M. Montezinos and is dated Sep 17, 1906. Information on the form includes his age, birth place, occupation, residence, marital status, children's ages, nearest relatives, and signed Mr. M. Montezinos. 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. 316, Application of M. Montezinos, Received September 17/06, Date of Admission, November 13 1906, Date of Discharge (crossed out) Left November 21 1906, accept 10/21/06, asked for by ms. Kaichen 10/21/06, C.D.S. (handwritten)."

Dates

1906 September 17

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: "316, Sept 17, 1906.) Stamped in blue ink, at bottom left-hand corner: "Received Sep 17 1906, Accepted Oct 22 1906 (crossed out) Nov 10/06, Admitted Nov. 13, 1906, Discharged, Left Nov. 21/06, Died." Handwritten in black ink, at bottom left-hand corner: "Endorsed by Mrs. Kaichen."