Your form "Client Referrals " has received the following response: 
Submitted on: 08/15/2019 10:50:21 AM
Completion time: 4 min. 37 sec.

Client Name and Address 	Miklo Ramirez
				806-438-6904
				Client Email
				213 43rd St
				TX
				Lubbock
				79404
				Lubbock

Client's Age at Referral: 21
DOB: 09-21-1997
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
Mary Ramirez		(806) 438-6904

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

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

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 is a complete paraplegic with spinal cord injury who will be wheelchair bound 
and living with grandparents. 

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

Referring Social Worker 
Sara Schaefer
Trustpoint Rehabilition Hospital 
(806) 319-0259
saraschaefer@ernesthealth.com