USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 31
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death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
JUN 2 01960 ẬM
OR MASS
i
File
-
R-301A 1
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) 157 Circuit
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS TYCH STANDARD
CERTIFICATE OF DEATH
Registered No.
137
§(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
f(Was deceased a
U. S. War Veteran,
NO
(a) Residence. . No. (Usual place of abode)
Length of stay: In place of death .....
1
.years .....
8
months
.days. In place of residence.
.......
(If nonresident, give city or town and State)
1
.years ....
8 .months .. .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
June.
17.
1960
DEATH
(Month)
(Day) >
(Year)
4 L HEREBY
CERTIFY. That I attended deceased from
January
1859
19
60
to ...
June 17
I last saw heardlive on
June-17
, 1900, death is said to
have occurred on the date stated above, at
11:20 Pm.
INTERVAL
BETWEEN
ONSET AND
DEATH
14 YR
11 IF STILLBORN, enter that fact here.
12
AGE ...
84 Years.
.. Months.
.Days
If under 24 hours
Hours ..........
Minutes
13 Usual/
Occupation :
Nome maker
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Massachusers
17 NAME OF
FATHER
WILLIAM Chasingi
18 BIRTHPLACE OF
FATHER (City)
(State or country)
MASSACHUSETTS
19 MAIDEN NAME
OF MOTHER
Mary Frances vores
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Massachus.,, J
21
Informant
(Address)
is feirer for livingall Mass
7 NAME OF
FUNERAL DIRECTOR
Edenbach
ADDRESS 375Broadway Newport R T
Received and filed JUNE 20, 1960
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify
(Signed)
Julin F.Collins
M. D.
(PRINT OR TYPE SIGNATURE)
(Address)
MASS
Date.
17 June 060
St. Columba
6
Middletom R.I.
(City or Town)
Place of Burial or Cremation
June 20
DATE OF BURIAL
19
I HEREBY CERTIFY tbat a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: ralph E. Sirianni . (Signature of Agent of Board of Health or otber)
HO
att June 18,19 ha
(Date of Issue of Permit)
(Official Designation)
X
I TIONS F 1 IRTIFICATE
ging CDEATH enter t.n one ar each 1 and (c)
e not mean of dying, ho't failure, et It means der compli- th caused
if any, rise to cae (a), tì under- cae last. this contrib- du's but not t terminal naion given
Cipter 137, 95 requires sprint or lause or f eath on tifates, and 48 Acts of uis Physi- per: or type fer gnature. e
6-55 2 5686
-
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Arterioscleratic
Heart Disease
Due
To Generalized
(b)
Arteriosclercas
4 Yr
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis ?
Physical Finding
3
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
PATRICK NOS:1/4 DEylAN
(or) WIFE of
8 SEX
7
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
WIDOweg
(If deceased is a married, widowed or divorced woman, give also maiden name.)
157 Curent Rd
St.
Winthrop
[if so specify WAR)
Mass
2 FULL NAME
No. Julia M Boylan (Christmas)
Road
To be filed for burial permit with Board of Health or its Agent.
FALL P Via
FALL Puer
FALL River
(Husband's name in full"
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : (1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of
1/ 09610 & Nnhury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
THROP
9
....
1
. ..
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, . but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- . tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
IT
PLACE OF DEATH
SUFFOLK. (County) WINTHROP (City or Town) 896 SHIRLEY ST.
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
138
[(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
((Was deceased a {U. S. War Veteran, [if so specify WAR) NO
(a) Residence. No.
896 SHIRLEY ST
St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death 6 years.
........ months
days. In place of residence.
6 years.
months ..
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED VIDOWES
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 41 Years.
Months.
.Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupatio
STOCK RUIM CLERK
(Kind of work done during most of working life)
14 Industry
BANKING CO.
or Business :
15 Social Security No.
031633103A
16 BIRTHPLACE (City)
(State or country)
MD,
17 NAME OF
FATHER
ADAM GLOCK
18 BIRTHPLACE OF
FATHER (City)
(State or country)
GERMANY
19 MAIDEN NAME
M. D.
OF MOTHER
SUSAN URLRICH
20 BIRTHPLACE
MOTHER (City)
(State or country)
MP
FREDERICKS COUNTY
21
MRS HENRY GLOCK
Informant
(Address)
894 SHIRLEY ST WINTHROP.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: -Talet 10 Artistas, 1
(Signature of Agent of Board of Health or other)
6/20/GC
(Official Designation)
(Date of Issue of Permit)
L
-
(Signed)
myson n. King
MYRON IN. KING MOD
(PRINT OR TYPE SIGNATURE)
322 PLEASANT ST
6/19
1,60
(Address) . WINTHROPDate ...
6
MT. HUBURY
CAMBRIDGE
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
JUNE 20
19 60.
7 NAME OF
FUNERAL DIRECTOR
MAURICE W. KIRBY
ADDRESS
WINTHROP.
Received and filed JUNE 23, 19 60
(Registrar)
6 YRS
Due To
CONGESTIVE HEART
(c)
FAILURE
& Mo.
OTHER
SIGNIFICANT
CONDITIONS
NONE
Was autopsy performed?
No
What test confirmed diagnosis ?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased Na. If so, specify ..
PARENTS
JUNE
17
1960
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY
That I attended deceased from
19.60
JUNE 10
54
to ...
JUNE 17
last saw himMalive on
JUNE 17
.. 1960
death is said to
have occurred on the date stated above, at
530 Pm.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
BRONCHO PNEUMONIA -TERING
INTERVAL
BETWEEN
ONSET AND
DEATH
₹-301A 1
ITIONS
ERTIFICATE
ging DEATH enter un one 1. each land (c)
e not mean pf dying, u't failure, t It means sor compli- caused
if any, rise to de (a), {} under- de last.
this contrib- ar but not t terminal nuion given
al pter 137, s requires s print or ause or f cath on tifates, and 48 Acts of uis Physi- or: or type erignature. 3
-5525686
No.
2 FULL NAME.
WILLIAM H. GLOCK
(If deceased is a married, widowed or divorced woman, give also maiden name.)
3 DATE OF
DEATH
NEPHRO SCLEROSIS À ARTERIA-
Due To
(b)
SCLEROTIE AND HYPERTENSIVE
HEART DISEASE WITH
BERTHY
CHUTE
GRACEHAN
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook -- hotel, etc. For a person who had no occupation whatever write none.
WY 09618 % NAS
ate
A
1 PLACE OF DEATH
Suffolk 1 (County) Winthrop
(City or Town)
Winthrop Community Hospital
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. 139
2 FULL NAME
Ida Fineberg Ladinsky
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
15 Grovers Ave.
St.
Winthrop
(Usual place of abode)
4hRS. 19 miN.
30 year
Length of stay: In place of death ....
months.
days. In place of residence.
... months.
.........
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
W
10 SINGLE
Married
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY_
That I attended deceased from
Nav.
1952, to
June 18
1960
I last saw h.EY alive on
Tune
18
1960, death is said to
have occurred on the date stated above, at ....
10:20A.m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Hypertensive-Arteriosclerotic
Heart Disease.
INTERVAL
BETWEEN
ONSET AND
DEATH
Jours
11 IF STILLBORN, enter that fact here.
12
AGE
78 Years
Months ............
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
House wife
(Kind of work done during most of working life)
14 Industry
or Business :
AT Horne own Home.
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Max Fineberg
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Millie C.BL
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21
Informant
(Address)
46 PALPit RUL Marble head
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other) , t
(Date of Issue of Permit)
(Official Designation)
-59 ?5686
₹-301A 1
ITIONS
CITIFICATE
ging DEATH Menter tin one # each ₺ and (c)
not mean 'of dying, tet failure, tu It means r compli- At caused
ns if any, am rise to are (a), th under- a' last. tio contrib- en but not ti terminal nd on given
-
Due To (c)
OTHER
Acute Pulmonary Edema
6 hrs.
Was autopsy performed?
No
What test confirmed diagnosis ? .
Clinical
5 Was disease or injury in any way related to occupation of deceased? Ar If so, specify
(Signed)
Chistes Liberman M. D.
CHARLES LIBERMAN,
(Address)
6 Roxbury Lodge Place' of Burial or Cremation DATE OF BURIAL
W. Roxbury
(City or Town)
June 19
19.60
7 NAME OF
FUNERAL DIRECTOR
TORE funeral Service In
ADDRESS 151 Washington Ave Chelsea
Received and filed
JUNE -20 19 60
(Registrar)
PARENTS
10a If married, widowed, or divorced
Ida Fineberg
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Israel Ladinsky
(Husband's name in full)
3 DATE OF
DEATH
JUNE
18
1960
(Month)
(Day)
(Year)
[(If death occurred in a hospital or institution,
St. Į give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
[(Was deceased a
¿ U. S. War Veteran,
(if so specify WAR)
No
(If nonresident, give city or town and State)
Due To (b)
......
SIGNIFICANT
CONDITIONS
(PRINT OR TYRE, SIGNATURE) Winthrop, Mass Date. 6/18/ 1960
HAROLD LADD
Choter 137, st requires IS print or luse or f eath on tifi tes, and 48 Acts of uu; Physi- ori. or type ergnature.
No.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
H: 09610 & Nnr
X
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
No. 8 Atlantic .... St
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
140
S(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME.
Hazel E .Kirley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 8 Atlantic St.
St.
(If nonresident, give city or town and State)
Length of stay : In place of death ..
.years ....
.. months.
. . days. In place of residence ..
35 ... years ........ ... months ..
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIWMarried
(write the word)
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
June 15, 1960
19
19
to ... June .... 21 ....... 1960
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
I last saw Her .. alive on
June 21, 1960, 19.
.......... , death is said to
have occurred on the date stated above, at
9:30 P. M.
(or) WIFE of
Patrick F.
Kirley
(Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Coronary thrombosis
11 IF STILLBORN, enter that fact here.
INTERVAL
BETWEEN
ONSET AND
DEATH
10 day SAGE 63
.Years.
12
Months ...
.Days
If under 24 hours
Hours.
Minutes
Due To
(b)
Aortic stenosis
over
(Kind of work done during most of working life)
2 years14 Industry
or Business :
Own Home
Due To
(c)
Hypertension
over
2 years,
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
Thomas Cody
18 BIRTHPLACE OF
St Johns
FATHER (City)
(State or country)
N. B.
19 MAIDEN NAME
Data 7 Cuelina ML
M. D.
OF MOTHER
Mary E. Doyle
John F. Collins, N.D.
(PRINT OR 'TYPE SIGNATURE)
(Address)
27 Pennington St.
Date.AIune ... 22, .19.60
(State or country)
Ma88
6
Winthrop. Cemetery Winthrop Ma 88 21
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
June
24
1960
Informant
(Address)
8 Atlantic St., Winthrop
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS
Winthrop Mass
Received and filed JUN 24 1960 19
(Registrar)
PARENTS
20 BIRTHPLACE OF
MOTHER (City)
Ea.s.t .... B.o.s.ton
Patrick F. Kirley
I HEREBY .CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other) Dechile Choix
(Official Designation)
(Date of Issue of Permit)
V
V.B.
I TIONS
ERTIFICATE
ging DEATH enter t.n one r each à. and (c)
e not mean of dying, hurt failure, 21 It means r compli- th caused
if any, rise to de (a), få under- de last.
tus contrib- er but not 1: terminal mion given
Clpter 137, 95 requires print or ause or f eath on tilates, and 48 Acts of uis Physi- ong or type er gnature.
1
-592 5686
₹-301A 1
(Signed)
5 Was disease or injury in any way related to occupation of deceased ? ....... If so, specify
Revere Ma88
15 Social Security No. East Boston
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis ?EKG ... and .... clinical
13 Usual
Occupation :
Housewife
3 DATE OF
June 21, 1960
( Cody )
[(Was deceased a
U. S. War Veteran,
{ if so specify WAR)
No
( Usual place of abode)
Registered No.
PHYSICIAN - IMPORTANT
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following les of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
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