Your form "Client Referrals " has received the following response: 
Submitted on: 06/11/2019 03:11:50 PM
Completion time: 10 min. 21 sec.

Client Name and Address
				Linda Kulick
				(806) 239-3737
				Client Email
				123 Western Dr
				TX
				lubbock
				79403
				Lubbock

Client's Age at Referral: 62
DOB: 11-14-1956
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

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
bret Kulick
Caretaker/Other Contact Phone

Where is the ramp needed? (Be specific: front of house, side door, etc...) 
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, etc...) 
Lives in a mobile home which has an existing deck/ramp, but it is not stable. 
it is made of wood and sitting on cinder block

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 uses a walker as a wheelchair. 
The walker has wheels and she sits on the seat and pushes herself with the wheels. 
To get out of the house her spouse has to help her

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

Referring Social Worker Information
smeralda varela(not a license social worker)
Adult Protective Services
(806) 773-1549
esmeralda.varela@dfps.state.tx.us