Your form "Client Referrals " has received the following response: 
Submitted on: 06/11/2019 01:01:03 PM
Completion time: 10 min. 15 sec.

Client Name and Address 	Lillian Franklin
				(806) 894-6919
				Client Email
				1212 9th
				TX
				Levelland
				79336
				Hockley

Client's Age at Referral: 87
DOB: 01-08-1932
Client's Gender: Female
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
Shawn Franklin		(806) 300-3840

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

Provide a brief description of the obstacle(s) 
(e.g. a door threshold, a single step, a mobile home with three steps, etc...)
Steps down to front of sidewalk. Two steps on front 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.
Uses walker and wheelchair.

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

Referring Social Worker Information
Stacey Adams-Can
Noble Care Solutioins
(806) 791-2829
staceyladams@outlook.com