Application of Sam Kibrik to JCRS, 1907 July 20
Application for admittance to JCRS filled out by hand for Sam Kibrik and dated July 20, 1907. Information on the form includes his age, birth place, occupation, residence, marital status, nearest relatives, and signed Sam Kibrik. The back of the form has sections titled "Report of Medical Examiner" and "Admission and Dismission Committee" are blank. The middle section of the back is a form filled out by hand. It reads, "Application No. 537, Case No. 360, Application of, Sam Kibrik, Address Denver, Colo., Received July 20 1907, Accepted August 1, 1907, Rejected, Admitted august 3 1907, Readmitted, Discharged, Left, Died October 29 1907, remarks Buried Mt. Nebo Cemetery Plot 25 Lot 63."
- 1907 July 20
- Jewish Consumptives' Relief Society (U.S.) (Producer, Organization)
Rights and Usage Statement
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1 items (application)
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 Left-hand side of application is fragile while deteriorating from fraying and tears. 31 x 22 centimeters
Title supplied by archivist