{"0":{"name":"Name","value":"Joy Covey","id":0,"type":"name","first":"Joy","middle":"","last":"Covey"},"3":{"name":"Phone","value":"+18605937506","id":3,"type":"phone"},"1":{"name":"Email","value":"jcovey@chrhealth.org","id":1,"type":"email"},"4":{"name":"Insurance Carrier","value":"n\/a","id":4,"type":"text"},"2":{"name":"Comment or Message","value":"Hello,\r\nI am a community support worker from CHR, Community Health Resources.  I am assisting a parent in our area who believes she attended your program years ago.  I wanted to know how to go about obtaining her records in order for her to apply to Social Security.  I am able to send a release, but wanted to see  if there's any additional info I may need to send.\r\nThank you for your time and assistance.\r\nJoy","id":2,"type":"textarea"}}