Another prop document from the Arkham Sanitarium Project, this is a basic admission form covering the patient's personal information, administrative contacts, and the history leading up to their stay at the sanitarium. The PDF includes an embedded typewriter font (the excellent "Chunk Type" from John Bruce) so the form can be filled out before printing.
A few notes on some of the entries:
"Next of Kin/Guardian" would be a family member or legal guardian.
"Personal Physician" is the patient's normal medical doctor and not their Psychiatrist at the Sanitarium, unless the two are one and the same.
"Agent" is the patient's legal representative. In an age of genteel madness it wasn't unusual for the family law firm to handle all the details of a stay for the well off.
"Tel." is the old-style telephone number where the contact can be reached. Consists of a word based on the letters of the exchange followed by the individual line number. Slaves to realism will find the Telephone EXchange Name Project a handy reference.
The various admission styles might be a little confusing.
"Voluntary" means the patient willingly checked in for treatment. This includes everything from the typical Lovecraftian vict...er, protagonist who wants to put his shattered mind back together to kindly old matrons suffering from hypochondria.
"Committed" means the patient was involuntarily put under the hospital's care. Two doctors swore Certificates of Insanity and a judge then issued a Commitment Warrant allowing designated law enforcement or health professionals to escort the patient to the facility and confine him against his or her will. If the admission form notes a commital copies of the commitment papers will be included in the patient's file.
"Transfer from" is used for patients moved to Arkham from another facility, be it a hospital, mental hospital, or jail.
"Criminal" means the patient committed a crime. As a private facility Arkham Sanitarium wouldn't normally handle criminally or violently insane patients from the state, except for emergencies or research purposes. Cases cared for at the behest of their families or private benefactors aren't unheard of.
Everything else shouldn't be difficult to figure out.
You can download the PDF from Google Documents.