Submitted at: 8/28/2012 9:29:23 PM

Client's name: Romana T. Rodriguez
Address: 1814 9th Street
City: Levelland
State: TX
Zip code: 79336
County: Hockley
Client's phone: (806) 894-5529

Caretaker name or other contact: Felicita Coe
Caretaker/contact phone(s): (806) 894-6363
Client's date of birth: 11/14/1936


Where is the ramp needed? (Be specific: front of house, side door, etc...)
Eastside front entrance of permanent mobile home

Provide a brief description of the obstacle(s) 
(e.g. a door threshold, a single step, a mobile home with three steps, etc...)
Mobile home has existing porch with three steps and a non-compliant ramp.  
Ramp has inappropriate incline and not suitable for the electric wheelchair or walker descent.  
Threshold to current sliding door does not allow client to use walker or wheelchair with ease.  
Current sliding door needs to be replaced due to heaviness of opening and closing.

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 has degenerative back disc and depending on the severity of her back pain is assisted to walk, 
use walker, and at times uses a powered wheelchair.  Client is at this time able to walk for short 
periods but steps are a difficult process.  Client is not expected to change due to her back pain.  
Client is currently on pain management with her physician due to ongoing muscle spasms.  Assistance 
with a ramp will diffently benefit this client in that it will allow her to continue her mobility 
whether walking or wheelchair bound. 

Is this a hospice patient? No
Is this a dialysis patient? No
Is this a handicapped person living alone? Yes
Is there a financial need, based on your agency's guidelines? Yes
Did this person serve in the military? No

Name of referring social worker: Gabriela Contreras-Enchintan
Referring agency: Superior
Referring social worker's phone(s): 8066980267
Referring social worker's e-mail: prcoe@windstream.net