diff --git a/app/Http/Controllers/Care/SpecialtyModuleController.php b/app/Http/Controllers/Care/SpecialtyModuleController.php
index 2972898..092ddba 100644
--- a/app/Http/Controllers/Care/SpecialtyModuleController.php
+++ b/app/Http/Controllers/Care/SpecialtyModuleController.php
@@ -637,7 +637,8 @@ class SpecialtyModuleController extends Controller
         $services = $shell->provisionedServices($organization, $module);
 
         $permissions = app(\App\Services\Care\CarePermissions::class);
-        // Match every ability that mutate routes actually check — module canManage alone is not enough.
+        // Ability-based for every role (doctor, nurse, receptionist, lab, pharmacist, …).
+        // Module canManage alone is not enough — flags must match what mutate routes authorize.
         $canConsult = $permissions->can($member, 'consultations.manage') && $canManageSpecialty;
         $canAdvanceStage = $canConsult;
         $canStartConsultation = $canConsult;
diff --git a/tests/Feature/CareSpecialtyAccessTest.php b/tests/Feature/CareSpecialtyAccessTest.php
index 87cd975..0521b52 100644
--- a/tests/Feature/CareSpecialtyAccessTest.php
+++ b/tests/Feature/CareSpecialtyAccessTest.php
@@ -13,6 +13,7 @@ use App\Models\Practitioner;
 use App\Models\User;
 use App\Services\Care\SpecialtyModuleService;
 use Illuminate\Foundation\Testing\RefreshDatabase;
+use PHPUnit\Framework\Attributes\DataProvider;
 use Tests\TestCase;
 
 class CareSpecialtyAccessTest extends TestCase
@@ -397,33 +398,115 @@ class CareSpecialtyAccessTest extends TestCase
         return [$user, $member, $visit];
     }
 
-    public function test_nurse_on_dentistry_does_not_see_consultation_mutate_actions(): void
+    /**
+     * @return array{0: \App\Models\User, 1: Member, 2: \App\Models\Visit}
+     */
+    protected function emergencyVisitForRole(string $role, string $suffix): array
     {
-        [$nurseUser, $nurseMember, $visit] = $this->dentistryVisitForRole('nurse', 'den-nurse');
+        [$user, $member] = $this->makeStaff($role, $suffix);
 
-        $this->assertTrue($this->modules->memberCanManage($this->organization, $nurseMember, 'dentistry'));
-        $this->assertFalse(app(\App\Services\Care\CarePermissions::class)->can($nurseMember, 'consultations.manage'));
+        $dept = Department::query()->where('type', 'emergency')->firstOrFail();
+        $patient = Patient::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'P-ER-'.$suffix,
+            'first_name' => 'Kojo',
+            'last_name' => 'Floor',
+            'gender' => 'male',
+            'date_of_birth' => '1988-01-01',
+        ]);
+        $visit = \App\Models\Visit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $patient->id,
+            'status' => \App\Models\Visit::STATUS_IN_PROGRESS,
+            'checked_in_at' => now(),
+            'specialty_stage' => 'arrival',
+        ]);
+        Appointment::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $patient->id,
+            'department_id' => $dept->id,
+            'visit_id' => $visit->id,
+            'type' => Appointment::TYPE_WALK_IN,
+            'status' => Appointment::STATUS_WAITING,
+            'scheduled_at' => now(),
+            'checked_in_at' => now(),
+            'waiting_at' => now(),
+        ]);
 
-        $html = $this->actingAs($nurseUser)
-            ->get(route('care.specialty.workspace', ['module' => 'dentistry', 'visit' => $visit, 'tab' => 'overview']))
+        return [$user, $member, $visit];
+    }
+
+    /**
+     * Roles that can manage a specialty module but lack consultations.manage must not see
+     * Start / stage / chart-mutate CTAs. Gating is ability-based — not nurse-hardcoded.
+     *
+     * @return list<array{0: string, 1: string, 2: string}>
+     */
+    public static function floorRolesWithoutConsultManage(): array
+    {
+        return [
+            ['nurse', 'dentistry', 'floor-nurse-den'],
+            ['receptionist', 'dentistry', 'floor-recv-den'],
+            ['lab_technician', 'emergency', 'floor-lab-er'],
+            ['pharmacist', 'emergency', 'floor-rx-er'],
+        ];
+    }
+
+    #[DataProvider('floorRolesWithoutConsultManage')]
+    public function test_floor_roles_without_consult_do_not_see_mutate_ctas(
+        string $role,
+        string $module,
+        string $suffix,
+    ): void {
+        [$user, $member, $visit] = $module === 'dentistry'
+            ? $this->dentistryVisitForRole($role, $suffix)
+            : $this->emergencyVisitForRole($role, $suffix);
+
+        $permissions = app(\App\Services\Care\CarePermissions::class);
+        $this->assertTrue($this->modules->memberCanManage($this->organization, $member, $module));
+        $this->assertFalse($permissions->can($member, 'consultations.manage'));
+        // Prove gating is not nurse-only: same CTA rules for every floor role without consult.
+        $this->assertNotSame('hospital_admin', $member->role);
+
+        $html = $this->actingAs($user)
+            ->get(route('care.specialty.workspace', ['module' => $module, 'visit' => $visit, 'tab' => 'overview']))
             ->assertOk()
-            ->assertSee('Efua Boateng')
             ->assertSee('consultation access')
             ->assertDontSee('Seat at chair')
-            ->assertDontSee('Register / book')
+            ->assertDontSee('Start triage')
             ->assertSee('Back to queue')
             ->assertSee('Patient chart')
             ->getContent();
 
-        $this->assertStringContainsString('Waiting', $html);
         $this->assertStringNotContainsString(
-            route('care.specialty.dentistry.stage', $visit, absolute: false),
-            $html,
-        );
-        $this->assertStringNotContainsString(
-            route('care.specialty.consultation.start', ['module' => 'dentistry', 'visit' => $visit], absolute: false),
+            route('care.specialty.consultation.start', ['module' => $module, 'visit' => $visit], absolute: false),
             $html,
         );
+
+        if ($module === 'dentistry') {
+            $this->assertStringNotContainsString(
+                route('care.specialty.dentistry.stage', $visit, absolute: false),
+                $html,
+            );
+            $this->assertStringContainsString('Waiting', $html);
+        } else {
+            $this->assertStringNotContainsString(
+                route('care.specialty.emergency.stage', $visit, absolute: false),
+                $html,
+            );
+        }
+
+        if ($permissions->can($member, 'appointments.manage')) {
+            $this->assertStringContainsString('Register / book', $html);
+        } else {
+            $this->assertStringNotContainsString('Register / book', $html);
+        }
     }
 
     public function test_nurse_dentistry_mutate_posts_are_forbidden(): void
@@ -446,6 +529,42 @@ class CareSpecialtyAccessTest extends TestCase
             ->assertForbidden();
     }
 
+    public function test_receptionist_dentistry_mutate_posts_are_forbidden(): void
+    {
+        [$user, , $visit] = $this->dentistryVisitForRole('receptionist', 'den-recv-post');
+
+        $this->actingAs($user)
+            ->post(route('care.specialty.dentistry.stage', $visit), ['stage' => 'chair'])
+            ->assertForbidden();
+
+        $this->actingAs($user)
+            ->post(route('care.specialty.consultation.start', ['module' => 'dentistry', 'visit' => $visit]))
+            ->assertForbidden();
+    }
+
+    public function test_lab_technician_and_pharmacist_emergency_mutate_posts_are_forbidden(): void
+    {
+        foreach (['lab_technician' => 'lab-er-post', 'pharmacist' => 'rx-er-post'] as $role => $suffix) {
+            [$user, , $visit] = $this->emergencyVisitForRole($role, $suffix);
+
+            $this->actingAs($user)
+                ->post(route('care.specialty.emergency.stage', $visit), ['stage' => 'treatment'])
+                ->assertForbidden();
+
+            $this->actingAs($user)
+                ->post(route('care.specialty.consultation.start', ['module' => 'emergency', 'visit' => $visit]))
+                ->assertForbidden();
+
+            $this->actingAs($user)
+                ->post(route('care.specialty.emergency.vitals', $visit), [
+                    'bp_systolic' => 120,
+                    'bp_diastolic' => 80,
+                    'pulse' => 72,
+                ])
+                ->assertForbidden();
+        }
+    }
+
     public function test_doctor_on_dentistry_sees_and_can_advance_stage(): void
     {
         [$doctorUser, $doctorMember, $visit] = $this->dentistryVisitForRole('doctor', 'den-doc');
@@ -467,6 +586,74 @@ class CareSpecialtyAccessTest extends TestCase
         $this->assertSame('chair', $visit->fresh()->specialty_stage);
     }
 
+    public function test_gp_with_consult_ability_but_no_module_manage_hides_mutate_ctas(): void
+    {
+        [$doctor, $member] = $this->makeStaff('doctor', 'gp-no-manage');
+        Practitioner::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'member_id' => $member->id,
+            'user_ref' => $doctor->public_id,
+            'name' => 'Dr GP No Manage',
+            'specialty' => 'General Practice',
+            'is_active' => true,
+        ]);
+
+        $permissions = app(\App\Services\Care\CarePermissions::class);
+        $this->assertTrue($permissions->can($member, 'consultations.manage'));
+        $this->assertFalse($this->modules->memberCanManage($this->organization, $member, 'cardiology'));
+        $this->assertSame('refer', $this->modules->memberAccessLevel($this->organization, $member, 'cardiology'));
+
+        $dept = Department::query()->where('type', 'cardiology')->firstOrFail();
+        $patient = Patient::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'P-GP-NM',
+            'first_name' => 'Yaw',
+            'last_name' => 'ReferOnly',
+            'gender' => 'male',
+            'date_of_birth' => '1975-01-01',
+        ]);
+        $visit = \App\Models\Visit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $patient->id,
+            'status' => \App\Models\Visit::STATUS_IN_PROGRESS,
+            'checked_in_at' => now(),
+        ]);
+        Appointment::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $patient->id,
+            'department_id' => $dept->id,
+            'visit_id' => $visit->id,
+            'type' => Appointment::TYPE_WALK_IN,
+            'status' => Appointment::STATUS_WAITING,
+            'scheduled_at' => now(),
+            'checked_in_at' => now(),
+            'waiting_at' => now(),
+        ]);
+
+        $html = $this->actingAs($doctor)
+            ->get(route('care.specialty.workspace', ['module' => 'cardiology', 'visit' => $visit, 'tab' => 'overview']))
+            ->assertOk()
+            ->assertSee('view + refer')
+            ->assertDontSee('consultation access')
+            ->assertDontSee('Seat at chair')
+            ->assertDontSee('Start triage')
+            ->getContent();
+
+        $this->assertStringNotContainsString(
+            route('care.specialty.consultation.start', ['module' => 'cardiology', 'visit' => $visit], absolute: false),
+            $html,
+        );
+        $this->assertStringNotContainsString('>Start</button>', $html);
+    }
+
     public function test_admin_on_dentistry_sees_mutate_actions(): void
     {
         $dept = Department::query()->where('type', 'dental')->firstOrFail();