Created by gpt-4o-2024-11-20 on 2025-06-08

This image shows a pink medical record form related to tuberculosis, distributed by the City of Milwaukee's Department of Health. The form appears to track information about individuals diagnosed with tuberculosis for public health purposes.

The header includes "Form 2. T. B." and the phrase "City of Milwaukee – Department of Health." Below this, the prominent title reads "Tuberculosis" followed by spaces for recording personal details such as:

• Address, Name, Age, Sex, Color, and Nationality
• Date reported (including how the case was reported: card, phone, death certificate, lab exam, inspector, or complaint)
• Attending physician's name, address, and phone number
• Lines to document date assigned for inspection and date report returned
• Information regarding case outcome, including case removal details (location removed to, date, and disinfection)
• Spaces for noting whether the case was terminated due to death, recovery, or removal
• Details for disinfection, including date, number of rooms, area disinfected, and by whom

This form was presumably used during historical tuberculosis outbreaks for monitoring and managing cases. It is functional, with clearly defined areas for entries, ensuring organized record-keeping.

Created by gpt-4o-2024-08-06 on 2025-06-08

The image is of a vintage form used by the City of Milwaukee Department of Health for recording cases of tuberculosis. The form has a pink background and is titled in bold capital letters "TUBERCULOSIS:". It contains fields to be filled out with information about the patient and case management, including:

• Address
• Name
• Age
• Sex
• Color
• Nationality
• Date reported
• The method of report (card, phone, death certificate, lab exam, inspector, complaint)
• Attending physician details, including address and phone
• Date assigned for inspection
• Date report returned
• Location to which the case was removed, date of removal, and whether disinfected
• Outcome of the case (terminated in death, recovery, or removal) with the date
• Details of disinfection performed, including date, number of rooms, area, and by whom

The form also includes the label "Form 2. T. B." and is marked with the city seal and labeled at the top with "City of Milwaukee—Department of Health." There is a faint handwritten number "5" and another marking "57" at the top right corner. The form is blank, meant to be filled out with the relevant information.

Created by us.meta.llama3-2-90b-instruct-v1:0 on 2025-05-25

The image depicts a form titled "TUBERCULOSIS" in bold black text, with the subtitle "Address" below it. The form is divided into two sections: the top section contains fields for personal information, including name, age, sex, color, nationality, date reported, attending physician, address, phone number, and date assigned for inspection. The bottom section includes fields for case removal, disinfection, and termination details.

The form features a pink background with black text and is printed on a rectangular piece of paper. A small logo is visible at the top left corner, accompanied by the text "Form 2. T. B." and "City of Milwaukee - Department of Health" at the top center. The form appears to be a vintage document, likely from the early 20th century, given its design and content.

Created by us.meta.llama3-2-11b-instruct-v1:0 on 2025-05-25

The image presents a vintage medical form for tuberculosis, featuring a pinkish-red color and a rectangular shape. The form is divided into sections, each containing specific information related to the patient's condition.

• Title Section
  • The title "TUBERCULOSIS" is prominently displayed in large, bold text at the top left corner of the form.
  • Below the title, the words "City of Milwaukee - Department of Health" are written in smaller text.
• Patient Information Section
  • This section includes fields for the patient's name, age, sex, color, nationality, date reported, attending physician, address, date assigned for inspection, and date report returned.
  • The fields are separated by thin black lines, providing a clear and organized layout.
• Case Information Section
  • This section contains fields for the case removed to, case terminated in death; recovery; removal, disinfection performed, and date.
  • The fields are also separated by thin black lines, maintaining the form's overall structure and readability.
• Additional Information Section
  • This section includes fields for the number of rooms, area, and by.
  • The fields are again separated by thin black lines, ensuring that the form remains easy to read and understand.

In summary, the image showcases a vintage medical form designed for reporting tuberculosis cases, with a clear and organized layout that facilitates the collection of essential patient and case information.

Created by amazon.nova-lite-v1:0 on 2025-05-27

The image is of a pink-colored form titled "TUBERCULOSIS" from the City of Milwaukee Department of Health. The form appears to be a medical record or a health inspection form, used for documenting cases of tuberculosis. The form includes various sections and fields for recording details such as the patient's name, age, sex, color, nationality, address, and the attending physician's information. There are also sections for recording the date the case was reported, the method of reporting, the date assigned for inspection, and the date the report was returned. Additionally, there are fields for recording the disinfection status of the case, the date the case was terminated, and the method of disinfection. The form is filled with black text on a pink background, and it appears to be a standard form used for tracking and managing tuberculosis cases in the city of Milwaukee.

Created by amazon.nova-pro-v1:0 on 2025-05-27

The image is a pink form titled "TUBERCULOSIS" with various fields for information. It is labeled as "Form 2. T. B." and is associated with the "City of Milwaukee--Department of Health." The form includes fields for the patient's name, age, sex, color, nationality, and address. There are also fields for the date reported, the method of reporting (card, phone, death certificate, lab exam, inspector, complaint), and the attending physician's name and address.

Additional fields are provided for the date assigned for inspection, the date the report was returned, and the date the case was removed to a specific location. The form also has sections for noting when the case was terminated (in death, recovery, or removal), the date disinfection was performed, the number of rooms, the area, and the person responsible for the disinfection.

The form is structured with horizontal lines to separate different sections and fields, making it easy to fill out and read. The design is straightforward, focusing on collecting essential information related to tuberculosis cases for health department records.

Created by gemini-2.0-flash-lite on 2025-05-22

The image shows a vintage form titled "TUBERCULOSIS" issued by the "City of Milwaukee—Department of Health." The form is a pinkish-red color and is designed to record information about tuberculosis cases. It has several sections for filling in patient details:

• Personal Information: Includes fields for Name, Age, Sex, Color, and Nationality.
• Reporting Details: Sections for Date Reported, and how it was reported (card, phone, death certificate, lab exam, inspector, complaint)
• Medical Professionals: Space for Attending Physician, Address, and Phone.
• Administrative Dates: Fields for Date Assigned for Inspection and Date Report Returned.
• Case Tracking: "Case removed to," with space for a Date and a "Disinfected" field.
• Case Status: "Case terminated in death; recovery, removal" with space for Date.
• Disinfection Details: "Disinfection performed, Date," "No. Rooms," "Area," and "By" (for who performed the disinfection).

The form has a design that is typical of mid-20th century paperwork, with straight lines and organized blocks of information. There is a small logo near the top, and the form number "Form 2. T. B." is also present. The condition of the form indicates that it has likely been handled, adding to its historical context.

Created by gemini-2.0-flash on 2025-05-22

Here's a description of the image:

The image shows a pink form titled "TUBERCULOSIS" from the City of Milwaukee Department of Health. The form includes fields for information such as Name, Address, Age, Sex, Color, Nationality, Date reported, Attending physician, and contact details. It also tracks information about the case, including dates for inspection, removal, and when disinfection was performed, along with details about the area disinfected. The form is designed to record important data related to tuberculosis cases.

Created by us.mistral.pixtral-large-2502-v1:0 on 2025-05-25

The image depicts a historical form titled "Tuberculosis" from the City of Milwaukee Department of Health. This form appears to be used for tracking and managing cases of tuberculosis. Here is a detailed breakdown of the form:

1. Header Information:

   • The form is labeled "Form 2: T.B."
   • It is issued by the City of Milwaukee Department of Health.
   • The form number "159" is handwritten in the top right corner.

2. Patient Information:

   • Fields for the patient's name, address, age, sex, color (likely referring to race), and nationality.

3. Reporting Details:

   • Date reported.
   • Method of reporting: card, phone, death certificate, lab exam, inspector, or complaint.

4. Physician Information:

   • Name of the attending physician.
   • Address and phone number of the attending physician.

5. Inspection and Reporting:

   • Date assigned for inspection.
   • Date report returned.

6. Case Management:

   • Case removal details: location, date, and whether the case was disinfected.
   • Case termination details: reason for termination (death, recovery, removal) and date.

7. Disinfection Details:

   • Date disinfection was performed.
   • Number of rooms disinfected.
   • Area disinfected.
   • Person who performed the disinfection.

The form is printed on pink paper and appears to be a part of a larger document or file, as indicated by the perforated edge on the left side. This form would have been used to document and track the progress and management of tuberculosis cases within the city.