Your form "Client Referrals " has received the following response: 
Submitted on: 09/27/2019 09:31:05 AM
Completion time: 45 min. 1 sec.

Client Name and Address		Aurelia Luna
				(806) 466-2984
				Client Email R. 
				514 E 37th St
				Lubbock
				TX
				79452
				Lubbock

Client's Age at Referral: 6
DOB: 03-26-2013
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? No

Is there a financial need, based on your agency's guidelines? Yes
Does the Client Own or Rent their home? Own

Caretaker /Other Contact
Magdalenda Garza        (806) 466-2984

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

Provide a brief description of the obstacle(s) 
(e.g. a door threshold, a single step, a mobile home with three steps, etc...)
 There are three steps from the ground to the porch. Aurelia is in a wheel chair due to 
a foot fracture. Her caregiver is unable to manage the wheel chair and 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.
Manual wheel chair that cannot be navigated independently by a 6 year old. 
Aurelia's caregiver is 57 years old with an old back injury that makes it 
impossible for her to get Aurelia up and down the steps without a third party assisting them.

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

Referring Social Worker
Connie Stewart, RN, BSN
Superior Health Plan MCO for Medicaid Kids
(325) 728-0832
Connie.stewart@superiorhealthplan.com