Your form "Client Referrals " has received the following response: 
Submitted on: 03/29/2019 04:21:17 PM
Completion time: 1 hr. 4 min. 39 sec.

Client Name and Address		Prudencio Subia
				(806) 744-0885
				Client Email: R. 
				717 31st	
				TX
				Lubbock
				79404
				Lubbock

Client's Age at Referral: 69
DOB: 02-19-1950
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

Is there a financial need, based on your agency's guidelines? No
Does the Client Own or Rent their home? Own

Caretaker /Other Contact  Name: Gloria Subia
Caretaker/Other Contact Phone: (806) 744-0885

Where is the ramp needed? (Be specific: front of house, side door, etc...)
hand rails are needed at east side of the home and north side front porch. 
No ramp is needed at this time.

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

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 is prone to falls and uses a cane/walker

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

Referring Social Worker Full Name: Lisa Gonzales
Name of Referring Agency: ASPAG- Area Agency of Aging
Referring Social Worker's Phone: (806) 687-0940
Referring Social Worker's Email: lgonzales@spag.org