Your form "Client Referrals " has received the following response: 
Submitted on: 05/15/2019 02:34:38 PM
Completion time: 5 hr. 40 min. 53 sec.

Client Name and Address		Tressie Snider 
				(806) 438-2048
				Client Email: R.
				2208 38th St 
				TX
				Lubbock 
				79412
				Lubbock

Client's Age at Referral: 93
DOB: 05-09-1926
Client's Gender: Female
Client's Ethnicity: Caucasian

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 Information
Bonnie Arrant 		(806) 438-2048

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...) 
single step 

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.
Assisted walking with walker in home. Will benefit from Wheelchair and ramp 
per Physical Therapist 

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

Referring Social Worker Full Name
Melissa Garcia 
Covenant Medical Center 
(806) 725-1727
melissa.garcia2@stjoe.org