Application of Annie Herman to JCRS, 1906 October 4

Item

Identifier: B002.01.0097.0215.00002

Staff Only

Abstract

Application for admittance to JCRS filled out by hand for Annie Herman and is dated Oct 4, 1906. Information on the form includes his age, birth place, occupation, residence, marital status, children's ages, nearest relatives, and signed Annie Herman. 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. 325, Application of Annie Herman, Received October 4 1906, Date of Admission, November 30 1906, Date of Discharge (crossed out) Left, December 4 1906."

Dates

1906 October 4

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 Half of an inch at the bottom of the application is detached. 31 x 22 centimeters

General

reformatted digital

title supplied by archivist

Inscription and Marks

Handwritten in pencil, at top right-hand corner: "Oct 4 06." Stamped in blue ink, at bottom left-hand corner: "Received Oct 4 1906, Accepted Oct 26, 1906, Admitted, Discharged, Left, Died."