Your form "Client Referrals " has received the following response: 
Submitted on: 08/23/2019 04:20:40 PM
Completion time: 1 hr. 35 min. 1 sec.

Client Name and Address		Leroy Fields
				(806) 775-4654
				foxxi4248@gmail.com
				945 S Johnson St
				TX
				Slaton
				79364
				Lubbock

Client's Age at Referral: 75
DOB: 6-25-1944
Client's Gender: Male
Client's Ethnicity: African American

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

Client Financial Information
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
Angela McDowell 
(806) 775-4654

Where is the ramp needed? (Be specific: front of house, side door, etc...) 
Front of the house, the side of porch

Provide a brief description of the obstacle(s) 
(e.g. a door threshold, a single step, a mobile home with three steps, etc...) 
4-5 Steps concrete porch 

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.
He has become weakened in his mobility due to health issues 2 by passes and several 
other medical conditions his age of 75. His doctor Dr. Little is going to prescribe 
a powered wheelchair and so he needs assistance with a hanicap ramp. He has fallen 
a few times. 211 provided this site

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

Referring Social Worker
Crystal ysasaga
Adult protective Services 
(806) 392-0297
foxxi4248@gmail.com