Application of Sam Simon to JCRS, 1905 December 15
Abstract
Application for admittance to JCRS filled out by hand for Sam Simon and dated December 15, 1905. Information on the form includes his age, birth place, occupation, residence, marital status, nearest relatives, and signed in Yiddish. The back of the form has sections titled "Report of Medical Advisory Board," blank, and "Report of Executive Committee," blank. The middle section of the back is a form filled out by hand. It reads, "No. 167, Case #120, Application of Sam Simon, Dec. 5, 1905. Date of Admission April 9, 1906. Left September 13, 1906."
Dates
- 1905 December 15
Creator
- Jewish Consumptives' Relief Society (U.S.) (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)
Scope and Contents
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 28 x 22 centimeters
General
reformatted digital
Title supplied by archivist.
Inscription and Marks
Stamped in blue ink on the upper right and filled out by hand, "Received: Dec 15 1905; Admitted Apr 9 1906; Left: Sep 13 1906."
Creator
- Jewish Consumptives' Relief Society (U.S.) (Organization)
Repository Details
Part of the Special Collections and Archives Repository