Your form "Client Referrals " has received the following response:
12/5/2018 13:10
Completion time: 9 min. 3 sec.

Client Name and Address
				Joe Martinez
				(806) 762-0532
				Client Email
				2304 2nd Place
				Lubbock
				TX
				79415
				Lubbock

Additional Client Information
Client's Age at Referral: 74
DOB: 4/9/1934
Client's Gender: Male
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

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
Henry Martinez  (806) 762-0532

Ramp Information
Where is the ramp needed? Patient's drive goes right up to front door, there are about 2 steps 
down from front porch to drive way. Would also need a rail to hold onto.
Description of obstacles(s): Front porch 2 steps down I believe, 3 at the most.

Details of mobility
Pt diagnosed with bone cancer affecting back and leg. Currently wearing a hard body brace and a leg brace. 
Right leg dragging somewhat, using cane and walker.

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

Referring Social Worker Information
Stacey Adams-Cain
Noble Carte Solutions
(806) 548-2824
staceyladams@outlook.com