Your form "Client Referrals " has received the following response: 
Submitted on: 08/16/2019 12:53:41 PM
Completion time: 3 min. 4 sec.

Client Name and Address		Luteria Flores
				(806) 448-0328
				Client Email R. 
				2390 CR 332
				TX
				Anton
				79313
				Lamb

Client's Age at Referral:78
DOB: 02-20-1941
Client's Gender: Female
Client's Ethnicity: Hispanic

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? Yes

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
Richard Flores		 (806) 448-0326

Where is the ramp needed? (Be specific: front of house, side door, etc...) 
front of the house. 3 large steps to get inside the home. 

Provide a brief description of the obstacle(s) 
(e.g. a door threshold, a single step, a mobile home with three steps, etc...) 
3 large steps

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.
patient had major colon recession and has limited mobility

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

Referring Social Worker Information
Sara Schaefer
Trustpoint 
(806) 740-8557
saraschaefer@ernesthealth.com