Blank Forms
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Babies' Pure Milk Station
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Form 10,000 5-11, 8-11, a blank form printed in English for recording individualized milk formulas for infants receiving aid from the New York Milk Committee's Babies' Pure Milk Stations. Ingredients to be used include milk top; whole milk; lime water; milk sugar; boiled water; barley water; and oatmeal water. Space for the prescription of formula and for the establishment of a feeding schedule is also provided.
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Babies' Pure Milk Station (Yiddish)
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A blank form printed in Yiddish for recording individualized milk formulas for infants receiving aid from the New York Milk Committee's Babies' Pure Milk Stations. Ingredients to be used include milk top; whole milk; lime water; milk sugar; boiled water; barley water; and oatmeal water. Space for the prescription of formula and for the establishment of a feeding schedule is also provided.
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Case History Card: Conditions Previous to Admittance
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New York Milk Committee form H-8-29-11-5000, a blank card for recording data about an infant's health and health history, housing situation, and nationality. Additionally, an area for the recording of economic information about the infant's parents is also provided.
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Eligible Baby
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New York Milk Committee form L-9-11-11-5000, a blank card for recording details about a single infant and family to whom milk assistance was delivered. Of primary concern is the infant's milk and food consumption, source of the milk provided, and periodic updates on the infant's status.
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Expectant Mother
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Blank form for use by the Committee for the Reduction of Infant Mortality, a division of the New York Milk Committee, on which the personal and physical details of an expectant mother -- work situation, information about previous pregnancies, miscarriages, and infant feeding methods -- is recorded.
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Institutional Case
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New York Milk Committee form C. 6-1-11-2000, a blank form for recording details of an institutional case in which an infant is reciveiving milk assistance at a health care facility or through a foster home.
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Nurse's Daily Report
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Form N-5-1-11-5000, 7-31-11-5000, a blank form for recording the details of a New York Milk Committee nurse's daily case activity; including the number of cases seen, the kinds of instructions issued, and the quantity of milk delivered. Additionally, the form records infant health, the number of mothers requesting assistance, and the number of those requests that were accepted or refused.
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Registered Baby
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New York Milk Committee form M-6-28-11-5000, a blank printed card for recording the results of infant/family attendance at medical consultations and of home visits made by Committe nurses. The back side of the card is a continuation of the form found on the front.
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Request for Relief
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New York Milk Committee form RR-5-13-11-2000, a blank card for recording information about the economic and social status of an individual family seeking milk and welfare assistance from the Committee. Aditional space is provided for the reporting nurse to record notes or observations.
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Stazione di latte pei bambini
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A blank form printed in Italian for recording individualized milk formulas for infants receiving aid from the New York Milk Committee's Babies' Pure Milk Stations. Ingredients to be used include milk top; whole milk; lime water; milk sugar; boiled water; barley water; and oatmeal water. Space for the prescription of formula and for the establishment of a feeding schedule is also provided.
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To the Wet Nurse Registry of the N.Y. Milk Committee
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Blank application card for a woman seeking a position as a wet nurse with the New York Milk Committee. Applicants are asked to provide their age, nationality, age of any children they may have, their current location, and whether or not any referrals have been made on their behalf.
