Your form "Client Referrals " has received the following response: 
Submitted on: 07/12/2019 10:57:45 AM
Completion time: 13 min. 35 sec.

Client Name and Address
	Linda Carraway
	(512) 897-8786
	Client Email
	3302 COUNTY ROAD 5830
	TX
	Lubbock
	79415
	Lubbock

Client's Age at Referral: 78
DOB: 06-13-1941
Client's Gender: Female
Client's Ethnicity: Caucasian

Is this a hospice patient? No
Is this a dialysis patient? No
Is this a handicapped person living alone? No
Did this person serve in the military? No

Is there a financial need, based on your agency's guidelines? Yes
Does the Client Own or Rent their home? Own

Caretaker/Other Contact Information
TG Carraway
(512) 922-0824

Where is the ramp needed? (Be specific: front of house, side door, etc...)
Client has a ramp but it is in need of repairs. It is located in the front of home.

Provide a brief description of the obstacle(s) 
(e.g. a door threshold, a single step, a mobile home with three steps, 
Client is unable to walk without 

Provide details of the client's mobility that are relevant to a ramp 
(e.g. walking, assisted walking, manual wheelchair, powered wheelchair, etc.). 
Also include a prognosis if this is expected to change.
Client sleeps and eats in a recliner due to her mobility issues. The existing ramp is aged. 
Client struggles to leave her home for doctor appointments.

Is there an existing dangerous ramp at the client's home? Yes

Referring Social Worker Information
Referring Social Worker Full Name: Esmeralda Varela,(Not licensed SW)
Name of Referring Agency: Adult Protective Services
Referring Social Worker's Phone: (806) 773-1549
Referring Social Worker's Email: esmeralda.varela@dfps.state.tx.us