Your form "Client Referrals " has received the following response: 
Submitted on: 02/06/2019 11:38:58 AM
Completion time: 9 min. 44 sec.

Client Name and Address
	David Castro
	(940) 329-8304
	Client Email
	7307 19th St #20
	Lubbock
	TX
	79407
	Lubbock

Client's Age at Referral: 57
DOB: 06-06-1961
Client's Gender: Male
Client's Ethnicity: Caucasian

Is this a hospice patient? No
Is this a dialysis patient? Yes
Is this a handicapped person living alone? Yes
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? Rent

Caretaker /Other Contact  Name: Melissa Castro
Caretaker/Other Contact Phone: (817) 542-4145

Where is the ramp needed? (Be specific: front of house, side door, etc...) 
The ramp is needed on at the front of a trailer leading out from the porch.

Provide a brief description of the obstacle(s) 
(e.g. a door threshold, a single step, a mobile home with three steps, etc...) 
The porch attached to a mobile home with three steps leading up to the door.

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.
The client uses a cane for ambulation. He reports weakness after dialysis treatment 
that makes it difficult for him to navigate the steps back into his home. 

Is there an existing dangerous ramp at the client's home? No

Referring Social Worker Full Name: Alana Scoggin
Name of Referring Agency: Adult Protective Services
Referring Social Worker's Phone: (806) 281-7150
Referring Social Worker's Email: alana.scoggin@dfps.state.tx.us