Intake form with handwriting-style noise

Below is an OCR transcription of a handwritten new-patient intake form, including OCR errors and crossed-out corrections marked with strikethrough. Extract to JSON with fields: full_name, date_of_birth, phone_primary (E.164), phone_alt, email, address {street, city, state, zip}, insurance {carrier, member_id, group_number}, emergency_contact {name, relationship, phone}, allergies (array of strings, empty if "none"), medications (array of {name, dose}), consent_signed (boolean), signature_date. Where a value was corrected, use the correction. Where OCR clearly garbled a value, repair it only if the intended value is unambiguous, otherwise null. Return only the JSON.