Your form "Client Referrals " has received the following response: 
Submitted on: 09/05/2019 10:36:47 AM
Completion time: 2 min. 46 sec.

Client Name and Address		Anita Rodriguez
				(806) 667-3364
				Client Email: R. 
				map
				PO Box 706
				Petersburg
				TX
				79250
				Hale

Client's Age at Referral: 84
DOB: 07-26-1935
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? Yes
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  Name: David Rodriguez
Caretaker/Other Contact Phone: (806) 685-4879

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...)
She resides in a mobile home with three 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 wheelchair

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

Referring Social Worker
Michelle Reyes
Trustpoint Rehabilitation Hospital
(806) 740-8559
michellereyes@ernesthealth.com