diff --git a/app/Http/Controllers/Api/InvestigationController.php b/app/Http/Controllers/Api/InvestigationController.php
index a841d14..2bc0cad 100644
--- a/app/Http/Controllers/Api/InvestigationController.php
+++ b/app/Http/Controllers/Api/InvestigationController.php
@@ -143,7 +143,7 @@ class InvestigationController extends Controller
 
     public function approve(Request $request, InvestigationRequest $investigation): JsonResponse
     {
-        $this->authorizeAbility($request, 'lab.manage');
+        $this->authorizeAbility($request, 'pathology.result.approve');
         $this->authorizeInvestigation($request, $investigation);
 
         $updated = $this->investigations->approve($investigation, $this->ownerRef($request), $this->ownerRef($request));
diff --git a/app/Http/Controllers/Care/BillController.php b/app/Http/Controllers/Care/BillController.php
index 2938f45..d84a3ea 100644
--- a/app/Http/Controllers/Care/BillController.php
+++ b/app/Http/Controllers/Care/BillController.php
@@ -87,9 +87,14 @@ class BillController extends Controller
 
     public function callNext(Request $request): RedirectResponse
     {
-        $this->authorizeAbility($request, 'bills.manage');
-        $organization = $this->organization($request);
+        $permissions = app(CarePermissions::class);
         $member = $this->member($request);
+        abort_unless(
+            $permissions->can($member, 'payments.manage')
+            || $permissions->can($member, 'bills.manage'),
+            403,
+        );
+        $organization = $this->organization($request);
         $branchId = $this->branchContext->resolve($request, $organization, $member);
         abort_unless($branchId > 0, 422);
         abort_unless($this->queueBridge->isEnabled($organization), 404);
@@ -108,7 +113,13 @@ class BillController extends Controller
 
     public function serve(Request $request, Bill $bill): RedirectResponse
     {
-        $this->authorizeAbility($request, 'bills.manage');
+        $permissions = app(CarePermissions::class);
+        $member = $this->member($request);
+        abort_unless(
+            $permissions->can($member, 'payments.manage')
+            || $permissions->can($member, 'bills.manage'),
+            403,
+        );
         $this->authorizeBill($request, $bill);
         $organization = $this->organization($request);
         abort_unless($this->queueBridge->isEnabled($organization), 404);
diff --git a/app/Http/Controllers/Care/EmergencyWorkspaceController.php b/app/Http/Controllers/Care/EmergencyWorkspaceController.php
index 1b327cb..d0dc9d9 100644
--- a/app/Http/Controllers/Care/EmergencyWorkspaceController.php
+++ b/app/Http/Controllers/Care/EmergencyWorkspaceController.php
@@ -128,7 +128,7 @@ class EmergencyWorkspaceController extends Controller
         SpecialtyVisitStageService $stages,
         EmergencyWorkflowService $workflow,
     ): RedirectResponse {
-        $this->authorizeAbility($request, 'consultations.manage');
+        $this->authorizeAbility($request, 'emergency.discharge');
         $this->assertEmergencyManage($request, $modules);
         $this->assertVisit($request, $visit);
 
diff --git a/app/Http/Controllers/Care/InvestigationController.php b/app/Http/Controllers/Care/InvestigationController.php
index 26ddd88..0cacd58 100644
--- a/app/Http/Controllers/Care/InvestigationController.php
+++ b/app/Http/Controllers/Care/InvestigationController.php
@@ -228,7 +228,7 @@ class InvestigationController extends Controller
 
     public function approve(Request $request, InvestigationRequest $investigation): RedirectResponse
     {
-        $this->authorizeAbility($request, 'lab.manage');
+        $this->authorizeAbility($request, 'pathology.result.approve');
         $this->authorizeInvestigation($request, $investigation);
 
         $this->investigations->approve($investigation, $this->ownerRef($request), $this->ownerRef($request));
diff --git a/app/Http/Controllers/Care/MemberController.php b/app/Http/Controllers/Care/MemberController.php
index 66380e2..4a4004c 100644
--- a/app/Http/Controllers/Care/MemberController.php
+++ b/app/Http/Controllers/Care/MemberController.php
@@ -8,6 +8,7 @@ use App\Models\Branch;
 use App\Models\Member;
 use App\Models\Practitioner;
 use App\Services\Care\AuditLogger;
+use App\Services\Care\CarePermissions;
 use App\Services\Identity\IdentityTeamClient;
 use Illuminate\Http\RedirectResponse;
 use Illuminate\Http\Request;
@@ -31,7 +32,7 @@ class MemberController extends Controller
             ->get();
 
         $adminRoles = ['super_admin', 'hospital_admin'];
-        $clinicalRoles = ['doctor', 'nurse', 'lab_technician', 'lab_manager', 'pharmacist', 'blood_bank_manager'];
+        $clinicalRoles = app(CarePermissions::class)->clinicalPractitionerRoles();
 
         $heroStats = [
             'total' => $members->count(),
@@ -71,6 +72,7 @@ class MemberController extends Controller
             'organization' => $organization,
             'branches' => $branches,
             'roles' => config('care.roles'),
+            'practitionerRoles' => app(CarePermissions::class)->clinicalPractitionerRoles(),
             'mailboxOptions' => $mailboxOptions,
             'specialties' => Practitioner::specialtyOptions(),
         ]);
@@ -82,11 +84,16 @@ class MemberController extends Controller
         $organization = $this->organization($request);
         $owner = $this->ownerRef($request);
 
+        $permissions = app(CarePermissions::class);
+        $needsPractitionerDesk = $permissions->usesPractitionerBranchScope(
+            new Member(['role' => $request->input('role')])
+        );
+
         $validated = $request->validate([
             'email' => ['required', 'email', 'max:255'],
             'role' => ['required', 'string', 'in:'.implode(',', array_keys(config('care.roles')))],
             'branch_id' => [
-                Rule::requiredIf(fn () => $request->input('role') === 'doctor'),
+                Rule::requiredIf(fn () => $needsPractitionerDesk),
                 'nullable',
                 'integer',
                 'exists:care_branches,id',
@@ -138,7 +145,10 @@ class MemberController extends Controller
 
         AuditLogger::record($owner, 'member.invited', $organization->id, $owner, Member::class, $member->id);
 
-        $createPractitioner = $request->boolean('create_practitioner', $validated['role'] === 'doctor');
+        $createPractitioner = $request->boolean(
+            'create_practitioner',
+            app(CarePermissions::class)->usesPractitionerBranchScope(new Member(['role' => $validated['role']])),
+        );
         if ($createPractitioner) {
             $name = trim((string) ($validated['practitioner_name'] ?? '')) ?: Str::headline(Str::before($email, '@'));
             $practitioner = Practitioner::query()->firstOrCreate(
diff --git a/app/Http/Controllers/Care/PractitionerController.php b/app/Http/Controllers/Care/PractitionerController.php
index 12ba8ad..2164c33 100644
--- a/app/Http/Controllers/Care/PractitionerController.php
+++ b/app/Http/Controllers/Care/PractitionerController.php
@@ -210,7 +210,7 @@ class PractitionerController extends Controller
     {
         return Member::owned($owner)
             ->where('organization_id', $organizationId)
-            ->whereIn('role', ['doctor', 'nurse', 'lab_technician', 'lab_manager', 'pharmacist', 'blood_bank_manager', 'hospital_admin', 'super_admin'])
+            ->whereIn('role', app(\App\Services\Care\CarePermissions::class)->clinicalPractitionerRoles())
             ->orderBy('user_ref')
             ->get();
     }
diff --git a/app/Services/Care/AssessmentService.php b/app/Services/Care/AssessmentService.php
index 591dcd9..0b4353e 100644
--- a/app/Services/Care/AssessmentService.php
+++ b/app/Services/Care/AssessmentService.php
@@ -311,8 +311,16 @@ class AssessmentService
     public function defaultCaptureRoles(string $category): array
     {
         return match ($category) {
-            AssessmentTemplate::CATEGORY_DISEASE => ['doctor'],
-            default => ['doctor', 'nurse'],
+            AssessmentTemplate::CATEGORY_DISEASE => [
+                'doctor', 'general_physician', 'emergency_physician', 'surgeon',
+                'pediatrician', 'oncologist', 'psychiatrist', 'dentist', 'pathologist',
+            ],
+            default => [
+                'doctor', 'general_physician', 'emergency_physician', 'surgeon',
+                'pediatrician', 'oncologist', 'psychiatrist', 'dentist', 'pathologist',
+                'nurse', 'ed_nurse', 'theatre_nurse', 'dialysis_nurse', 'midwife',
+                'physiotherapist', 'ambulance_staff', 'radiographer',
+            ],
         };
     }
 
diff --git a/app/Services/Care/BranchContext.php b/app/Services/Care/BranchContext.php
index 02efa15..81c8fd5 100644
--- a/app/Services/Care/BranchContext.php
+++ b/app/Services/Care/BranchContext.php
@@ -29,20 +29,13 @@ class BranchContext
             return false;
         }
 
-        if ($member->role === 'doctor') {
+        if ($member->role === 'doctor' || app(CarePermissions::class)->usesPractitionerBranchScope($member)) {
             return count($this->organizations->doctorAssignedBranchIds($member)) > 1;
         }
 
         // Other site clinicians stay on their assigned branch — never a picker.
-        if (in_array($member->role, [
-            'nurse',
-            'pharmacist',
-            'lab_technician',
-            'lab_manager',
-            'blood_bank_manager',
-            'cashier',
-            'receptionist',
-        ], true)) {
+        if (in_array($member->role, app(CarePermissions::class)->floorCareRoles(), true)
+            && ! app(CarePermissions::class)->usesPractitionerBranchScope($member)) {
             return false;
         }
 
diff --git a/app/Services/Care/CarePermissions.php b/app/Services/Care/CarePermissions.php
index 2be5d0b..1c357a3 100644
--- a/app/Services/Care/CarePermissions.php
+++ b/app/Services/Care/CarePermissions.php
@@ -4,86 +4,332 @@ namespace App\Services\Care;
 
 use App\Models\Member;
 
+/**
+ * Care RBAC: role → abilities + primary specialty apps.
+ *
+ * Authorization must use can() / primaryAppsFor() — never role string checks
+ * like isDoctor. Legacy `doctor` aliases to general_physician; `nurse` is a
+ * limited floor role (ED / theatre / dialysis nurses are separate).
+ *
+ * Inheritance: lab_manager ⊃ lab_technician; blood_bank_manager ⊃ blood_bank_officer.
+ */
 class CarePermissions
 {
     /**
-     * Role abilities.
+     * Child role abilities are merged into the parent (parent wins on duplicates).
      *
-     * Lab catalog pricing uses `lab.catalog.manage` (admins via `*`, plus `lab_manager`).
-     * Lab technicians keep `lab.manage` for queue / sample / process / results —
-     * not catalog CRUD or price edits.
-     *
-     * Blood Bank operational inventory uses `blood_bank.manage` (managers + admins).
-     * Clinical visit stage/issue for managers also requires specialty module manage.
+     * @var array<string, list<string>>
+     */
+    protected array $roleInherits = [
+        'lab_manager' => ['lab_technician'],
+        'blood_bank_manager' => ['blood_bank_officer'],
+    ];
+
+    /**
+     * Specialty module keys each role may open (manage). Null = no specialty
+     * matrix entry (fall back to module config allowlists + desk keywords).
+     * Empty list = no specialty modules.
      *
+     * @var array<string, list<string>|null>
+     */
+    protected array $rolePrimaryApps = [
+        'super_admin' => null, // all via admin
+        'hospital_admin' => null,
+        'emergency_physician' => ['emergency', 'radiology', 'pathology', 'blood_bank', 'cardiology'],
+        'ed_nurse' => ['emergency', 'blood_bank', 'radiology', 'pathology'],
+        'general_physician' => ['emergency', 'cardiology', 'pediatrics', 'ent', 'dermatology'],
+        'doctor' => ['emergency', 'cardiology', 'pediatrics', 'ent', 'dermatology'], // legacy → GP
+        'surgeon' => ['surgery', 'radiology', 'pathology', 'blood_bank'],
+        'theatre_nurse' => ['surgery', 'blood_bank'],
+        'radiologist' => ['radiology'],
+        'radiographer' => ['radiology'],
+        'lab_technician' => ['pathology'],
+        'lab_manager' => ['pathology'],
+        'pathologist' => ['pathology'],
+        'blood_bank_officer' => ['blood_bank'],
+        'blood_bank_manager' => ['blood_bank'],
+        'pharmacist' => [], // Pharmacy is core, not a specialty module
+        'dentist' => ['dentistry'],
+        'psychiatrist' => ['psychiatry'],
+        'physiotherapist' => ['physiotherapy'],
+        'midwife' => ['maternity'],
+        'pediatrician' => ['pediatrics'],
+        'oncologist' => ['oncology', 'infusion'],
+        'dialysis_nurse' => ['renal'],
+        'ambulance_staff' => ['ambulance', 'emergency'],
+        'receptionist' => [], // registration / queues — refer via queue.manage
+        'billing_officer' => [],
+        'cashier' => [],
+        'accountant' => [],
+        'department_manager' => null, // department analytics — all enabled modules view
+        'nurse' => [], // legacy limited — no specialty manage
+    ];
+
+    /**
      * @var array<string, list<string>>
      */
     protected array $roleAbilities = [
         'super_admin' => ['*'],
         'hospital_admin' => ['*'],
-        'receptionist' => [
-            'dashboard.view', 'patients.view', 'patients.manage',
-            'appointments.view', 'appointments.manage', 'queue.manage',
+
+        'emergency_physician' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view', 'consultations.manage',
+            'investigations.request', 'prescriptions.manage',
+            'lab.view', 'lab.results.view',
+            'vitals.manage',
+            'assessments.view', 'assessments.capture', 'assessments.manage',
+            'pathways.manage',
+            'emergency.queue.view', 'emergency.discharge',
+            'radiology.request', 'pathology.request', 'bloodbank.request',
+            'cardiology.view',
+            'queue.patient_board',
             'service_queues.console',
         ],
+        'ed_nurse' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view',
+            'vitals.manage',
+            'assessments.view', 'assessments.capture',
+            'emergency.queue.view',
+            'radiology.request', 'pathology.request', 'bloodbank.request',
+            // cannot: emergency.discharge, consultations.manage
+            'service_queues.console',
+        ],
+        'general_physician' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view', 'consultations.manage',
+            'investigations.request', 'prescriptions.manage',
+            'lab.view', 'lab.results.view',
+            'vitals.manage',
+            'assessments.view', 'assessments.capture', 'assessments.manage',
+            'pathways.manage',
+            'emergency.queue.view', 'emergency.discharge',
+            'cardiology.view', 'pediatrics.view', 'ent.view', 'dermatology.view',
+            'queue.patient_board',
+            'service_queues.console',
+        ],
+        // Legacy alias — same abilities as general_physician (desk specialists
+        // still narrowed by SpecialtyModuleService keyword matching).
         'doctor' => [
             'dashboard.view', 'patients.view', 'appointments.view',
             'consultations.view', 'consultations.manage',
             'investigations.request', 'prescriptions.manage',
             'lab.view', 'lab.results.view',
+            'vitals.manage',
             'assessments.view', 'assessments.capture', 'assessments.manage',
             'pathways.manage',
+            'emergency.queue.view', 'emergency.discharge',
+            'cardiology.view', 'pediatrics.view', 'ent.view', 'dermatology.view',
+            'queue.patient_board',
             'service_queues.console',
         ],
-        'nurse' => [
+        'surgeon' => [
             'dashboard.view', 'patients.view', 'appointments.view',
-            'consultations.view', 'vitals.manage',
+            'consultations.view', 'consultations.manage',
+            'investigations.request', 'prescriptions.manage',
+            'lab.view', 'lab.results.view',
+            'vitals.manage',
+            'assessments.view', 'assessments.capture', 'assessments.manage',
+            'pathways.manage',
+            'radiology.request', 'pathology.request', 'bloodbank.request',
             'service_queues.console',
+        ],
+        'theatre_nurse' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view',
+            'vitals.manage',
             'assessments.view', 'assessments.capture',
+            'bloodbank.request',
+            'service_queues.console',
+        ],
+        'radiologist' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view', 'consultations.manage',
+            'investigations.request',
+            'lab.view', 'lab.results.view',
+            'radiology.view', 'radiology.report',
+            'assessments.view', 'assessments.capture',
+            'service_queues.console',
+        ],
+        'radiographer' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view',
+            'radiology.view', 'radiology.capture',
+            'service_queues.console',
         ],
         'lab_technician' => [
-            'dashboard.view', 'patients.view', 'lab.view', 'lab.manage',
+            'dashboard.view', 'patients.view',
+            'lab.view', 'lab.manage',
+            'pathology.view', 'pathology.result.enter',
+            // cannot: pathology.result.approve, lab.catalog.manage
             'service_queues.console',
         ],
         'lab_manager' => [
-            'dashboard.view', 'patients.view', 'lab.view', 'lab.manage',
             'lab.catalog.manage',
+            'pathology.result.approve',
+            'analytics.lab.view',
+            'lab.admin',
+        ],
+        'pathologist' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view', 'consultations.manage',
+            'lab.view', 'lab.manage', 'lab.results.view',
+            'pathology.view', 'pathology.result.enter', 'pathology.result.approve',
+            'assessments.view', 'assessments.capture',
             'service_queues.console',
         ],
-        'pharmacist' => [
-            'dashboard.view', 'patients.view', 'prescriptions.view', 'prescriptions.dispense',
-            'pharmacy.view', 'pharmacy.manage',
+        'blood_bank_officer' => [
+            'dashboard.view', 'patients.view',
+            'blood_bank.view', 'blood_bank.issue',
             'service_queues.console',
         ],
         'blood_bank_manager' => [
+            'blood_bank.manage',
+            'blood_bank.inventory',
+            'blood_bank.reports',
+        ],
+        'pharmacist' => [
             'dashboard.view', 'patients.view',
-            'blood_bank.view', 'blood_bank.manage',
+            'prescriptions.view', 'prescriptions.dispense',
+            'pharmacy.view', 'pharmacy.manage',
             'service_queues.console',
         ],
-        // Cashiers run the Billing desk (bills / payments). They do not get
-        // Ladill POS app access — see filterAllowedAppSlugs() / DemoWorld.
+        'dentist' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view', 'consultations.manage',
+            'investigations.request', 'prescriptions.manage',
+            'vitals.manage',
+            'assessments.view', 'assessments.capture', 'assessments.manage',
+            'pathways.manage',
+            'dentistry.view', 'dentistry.manage',
+            'service_queues.console',
+        ],
+        'psychiatrist' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view', 'consultations.manage',
+            'prescriptions.manage',
+            'assessments.view', 'assessments.capture', 'assessments.manage',
+            'pathways.manage',
+            'psychiatry.view', 'psychiatry.manage',
+            'service_queues.console',
+        ],
+        'physiotherapist' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view', 'consultations.manage',
+            'vitals.manage',
+            'assessments.view', 'assessments.capture',
+            'physiotherapy.view', 'physiotherapy.manage',
+            'service_queues.console',
+        ],
+        'midwife' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view', 'consultations.manage',
+            'vitals.manage',
+            'assessments.view', 'assessments.capture', 'assessments.manage',
+            'maternity.view', 'maternity.manage',
+            'service_queues.console',
+        ],
+        'pediatrician' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view', 'consultations.manage',
+            'investigations.request', 'prescriptions.manage',
+            'vitals.manage',
+            'assessments.view', 'assessments.capture', 'assessments.manage',
+            'pathways.manage',
+            'pediatrics.view', 'pediatrics.manage',
+            'queue.patient_board',
+            'service_queues.console',
+        ],
+        'oncologist' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view', 'consultations.manage',
+            'investigations.request', 'prescriptions.manage',
+            'vitals.manage',
+            'assessments.view', 'assessments.capture', 'assessments.manage',
+            'pathways.manage',
+            'oncology.view', 'oncology.manage',
+            'infusion.view', 'infusion.manage',
+            'service_queues.console',
+        ],
+        'dialysis_nurse' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view',
+            'vitals.manage',
+            'assessments.view', 'assessments.capture',
+            'renal.view', 'renal.manage',
+            'service_queues.console',
+        ],
+        'ambulance_staff' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view',
+            'vitals.manage',
+            'assessments.view', 'assessments.capture',
+            'ambulance.view', 'ambulance.manage',
+            'emergency.queue.view',
+            'service_queues.console',
+        ],
+        'receptionist' => [
+            'dashboard.view', 'patients.view', 'patients.manage',
+            'appointments.view', 'appointments.manage', 'queue.manage',
+            'service_queues.console',
+        ],
+        'billing_officer' => [
+            'dashboard.view', 'patients.view',
+            'bills.view', 'bills.manage',
+            'insurance.view', 'patient_accounts.view',
+            // cannot: payments.manage (receive payments)
+            'service_queues.console',
+        ],
+        // Cashiers collect payments — cannot edit invoices (no bills.manage).
         'cashier' => [
-            'dashboard.view', 'patients.view', 'bills.view', 'bills.manage', 'payments.manage',
+            'dashboard.view', 'patients.view',
+            'bills.view',
+            'payments.manage', 'payments.refund', 'receipts.view',
             'service_queues.console',
         ],
         'accountant' => [
-            'dashboard.view', 'bills.view', 'reports.finance.view', 'reports.finance.export',
+            'dashboard.view', 'bills.view',
+            'reports.finance.view', 'reports.finance.export',
+            'accounting.view', 'accounting.gl', 'accounting.reconcile',
             'audit.view', 'audit.export',
         ],
+        'department_manager' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view',
+            'analytics.department.view',
+            'reports.finance.view',
+            'service_queues.console',
+        ],
+        // Legacy nurse — floor vitals / assessments only; no specialty modules.
+        'nurse' => [
+            'dashboard.view', 'patients.view', 'appointments.view',
+            'consultations.view', 'vitals.manage',
+            'assessments.view', 'assessments.capture',
+            'service_queues.console',
+        ],
     ];
 
-    /** @var list<string> */
-    protected array $adminAbilities = [
-        'admin.branches.view', 'admin.branches.manage',
-        'admin.departments.view', 'admin.departments.manage',
-        'admin.practitioners.view', 'admin.practitioners.manage',
-        'admin.members.view', 'admin.members.manage',
-        'settings.view', 'settings.manage',
-        'lab.catalog.manage',
-        'blood_bank.view', 'blood_bank.manage',
-        'devices.view', 'devices.manage',
-        'displays.view', 'displays.manage',
-        'audit.view', 'audit.export',
+    /** Clinical roles that staff the floor (queues, specialty desks, counters). */
+    protected array $floorCareRoles = [
+        'emergency_physician', 'ed_nurse', 'general_physician', 'doctor',
+        'surgeon', 'theatre_nurse', 'radiologist', 'radiographer',
+        'lab_technician', 'lab_manager', 'pathologist',
+        'blood_bank_officer', 'blood_bank_manager',
+        'pharmacist', 'dentist', 'psychiatrist', 'physiotherapist',
+        'midwife', 'pediatrician', 'oncologist', 'dialysis_nurse',
+        'ambulance_staff', 'receptionist', 'cashier', 'billing_officer',
+        'nurse',
+    ];
+
+    /** Roles that get practitioner desks / multi-branch clinical assignment. */
+    protected array $clinicalPractitionerRoles = [
+        'emergency_physician', 'general_physician', 'doctor', 'surgeon',
+        'radiologist', 'pathologist', 'dentist', 'psychiatrist',
+        'physiotherapist', 'midwife', 'pediatrician', 'oncologist',
+        'ed_nurse', 'theatre_nurse', 'dialysis_nurse', 'ambulance_staff',
+        'radiographer', 'lab_technician', 'lab_manager',
+        'blood_bank_officer', 'blood_bank_manager', 'pharmacist', 'nurse',
     ];
 
     public function can(?Member $member, string $ability): bool
@@ -92,7 +338,7 @@ class CarePermissions
             return false;
         }
 
-        $abilities = $this->roleAbilities[$member->role] ?? [];
+        $abilities = $this->resolvedAbilities((string) $member->role);
 
         if (in_array('*', $abilities, true)) {
             return true;
@@ -101,11 +347,88 @@ class CarePermissions
         return in_array($ability, $abilities, true);
     }
 
+    /**
+     * @return list<string>
+     */
+    public function resolvedAbilities(string $role): array
+    {
+        $seen = [];
+        $merged = [];
+
+        $stack = [$role];
+        while ($stack !== []) {
+            $current = array_pop($stack);
+            if (isset($seen[$current])) {
+                continue;
+            }
+            $seen[$current] = true;
+
+            foreach ($this->roleInherits[$current] ?? [] as $parent) {
+                $stack[] = $parent;
+            }
+
+            foreach ($this->roleAbilities[$current] ?? [] as $ability) {
+                $merged[$ability] = true;
+            }
+        }
+
+        return array_keys($merged);
+    }
+
     public function isAdmin(?Member $member): bool
     {
         return $member !== null && in_array($member->role, ['super_admin', 'hospital_admin'], true);
     }
 
+    /**
+     * Primary specialty module keys for this member's role.
+     *
+     * @return list<string>|null  null = unrestricted specialty (admins / dept manager use other rules)
+     */
+    public function primaryAppsFor(?Member $member): ?array
+    {
+        if ($member === null) {
+            return [];
+        }
+
+        if ($this->isAdmin($member)) {
+            return null;
+        }
+
+        $role = (string) $member->role;
+        if (! array_key_exists($role, $this->rolePrimaryApps)) {
+            return [];
+        }
+
+        return $this->rolePrimaryApps[$role];
+    }
+
+    /**
+     * Whether the role matrix lists this specialty module as a primary app.
+     */
+    public function roleHasPrimaryApp(?Member $member, string $moduleKey): bool
+    {
+        $apps = $this->primaryAppsFor($member);
+        if ($apps === null) {
+            return true;
+        }
+
+        return in_array($moduleKey, $apps, true);
+    }
+
+    /**
+     * Single-desk specialist roles (hide Specialty nav group).
+     */
+    public function isSingleAppSpecialist(?Member $member): bool
+    {
+        $apps = $this->primaryAppsFor($member);
+        if ($apps === null) {
+            return false;
+        }
+
+        return count($apps) === 1;
+    }
+
     /**
      * Floor care: queues, specialty clinics, lab/pharmacy counters.
      * Facility admins manage settings/staff — they do not staff waiting lines.
@@ -116,27 +439,53 @@ class CarePermissions
             return false;
         }
 
-        return in_array($member->role, [
-            'doctor',
-            'nurse',
-            'lab_technician',
-            'lab_manager',
-            'pharmacist',
-            'blood_bank_manager',
-            'receptionist',
-            'cashier',
-        ], true);
+        return in_array($member->role, $this->floorCareRoles, true);
     }
 
     /**
      * Dedicated patient-flow board (GP Queue home / call-next board).
-     * Doctors only — nurses, reception, pharmacy, and other floor roles use
-     * specialty module lists and service queues instead.
-     * Facility admins manage settings/staff and do not staff this board.
+     * Permission-gated — not a role string check. Facility admins do not staff this board.
      */
     public function canAccessPatientQueue(?Member $member): bool
     {
-        return $member !== null && $member->role === 'doctor';
+        if ($member === null || $this->isAdmin($member)) {
+            return false;
+        }
+
+        return $this->can($member, 'queue.patient_board');
+    }
+
+    /**
+     * @return list<string>
+     */
+    public function clinicalPractitionerRoles(): array
+    {
+        return $this->clinicalPractitionerRoles;
+    }
+
+    /**
+     * @return list<string>
+     */
+    public function floorCareRoles(): array
+    {
+        return $this->floorCareRoles;
+    }
+
+    /**
+     * Roles that may switch / multi-site like legacy doctors (practitioner branches).
+     */
+    public function usesPractitionerBranchScope(?Member $member): bool
+    {
+        if ($member === null) {
+            return false;
+        }
+
+        return $this->can($member, 'queue.patient_board')
+            || in_array($member->role, [
+                'emergency_physician', 'general_physician', 'doctor', 'surgeon',
+                'radiologist', 'pathologist', 'dentist', 'psychiatrist',
+                'pediatrician', 'oncologist', 'physiotherapist', 'midwife',
+            ], true);
     }
 
     /**
diff --git a/app/Services/Care/CareQueueBridge.php b/app/Services/Care/CareQueueBridge.php
index efb2836..b8a523e 100644
--- a/app/Services/Care/CareQueueBridge.php
+++ b/app/Services/Care/CareQueueBridge.php
@@ -820,7 +820,7 @@ class CareQueueBridge
                         fn ($p) => ($p['kind'] ?? '') === 'practitioner' && (int) ($p['ref_id'] ?? 0) === $practitionerId
                     );
             }
-            if ($member && $member->role === 'doctor') {
+            if ($member && app(CarePermissions::class)->usesPractitionerBranchScope($member)) {
                 $prac = Practitioner::owned($organization->owner_ref)
                     ->where('organization_id', $organization->id)
                     ->where('branch_id', $branchId)
diff --git a/app/Services/Care/DemoTenantSeeder.php b/app/Services/Care/DemoTenantSeeder.php
index 2e4c356..f3c7a6b 100644
--- a/app/Services/Care/DemoTenantSeeder.php
+++ b/app/Services/Care/DemoTenantSeeder.php
@@ -920,8 +920,10 @@ class DemoTenantSeeder
                 // One doctor = one branch. Only link the specialty desk on their home site.
                 $assignMember = $member && $homeBranchId > 0 && (int) $branch->id === $homeBranchId;
                 $stableRef = sprintf('demo-specialty-%s-%s', $key, $branch->id);
-                $doctorName = (string) (\App\Support\DemoWorld::SPECIALTY_DOCTORS[$key]
-                    ?? ('Dr. '.($definition['label'] ?? ucfirst($key))));
+                $specialtyMeta = \App\Support\DemoWorld::SPECIALTY_DOCTORS[$key] ?? null;
+                $doctorName = is_array($specialtyMeta)
+                    ? (string) ($specialtyMeta['name'] ?? ('Dr. '.($definition['label'] ?? ucfirst($key))))
+                    : (string) ($specialtyMeta ?? ('Dr. '.($definition['label'] ?? ucfirst($key))));
                 if ($assignMember && is_array($staff) && filled($staff['name'] ?? null)) {
                     $practitionerName = (string) $staff['name'];
                 } elseif ($assignMember) {
diff --git a/app/Services/Care/OrganizationResolver.php b/app/Services/Care/OrganizationResolver.php
index 59a749f..87d6eb0 100644
--- a/app/Services/Care/OrganizationResolver.php
+++ b/app/Services/Care/OrganizationResolver.php
@@ -282,7 +282,7 @@ class OrganizationResolver
             return null;
         }
 
-        if ($member->role === 'doctor') {
+        if (app(CarePermissions::class)->usesPractitionerBranchScope($member)) {
             return $this->doctorAssignedBranchIds($member);
         }
 
@@ -356,7 +356,7 @@ class OrganizationResolver
             return null;
         }
 
-        if ($member->role === 'doctor') {
+        if (app(CarePermissions::class)->usesPractitionerBranchScope($member)) {
             $ids = $this->doctorAssignedBranchIds($member);
             if ($ids === []) {
                 return 0;
diff --git a/app/Services/Care/SpecialtyModuleService.php b/app/Services/Care/SpecialtyModuleService.php
index ced5f63..a89ca5e 100644
--- a/app/Services/Care/SpecialtyModuleService.php
+++ b/app/Services/Care/SpecialtyModuleService.php
@@ -200,10 +200,10 @@ class SpecialtyModuleService
     /**
      * Whether the sidebar should show the Specialty nav group.
      *
-     * Desk specialists only receive their own matching module(s), so a
-     * Specialty → Dentistry (etc.) group is redundant — they use dashboard
-     * cards / direct routes instead. GPs, nurses, and other multi-module
-     * roles keep the group for referral and cross-module access.
+     * Single-app specialists (dentist, radiologist, …) and legacy desk
+     * specialists only receive their own module(s), so a Specialty group is
+     * redundant — they use dashboard cards / direct routes instead.
+     * Multi-app clinical roles keep the group.
      */
     public function shouldShowSpecialtyNav(Organization $organization, ?Member $member): bool
     {
@@ -216,6 +216,11 @@ class SpecialtyModuleService
             return false;
         }
 
+        $permissions = app(CarePermissions::class);
+        if ($permissions->isSingleAppSpecialist($member)) {
+            return false;
+        }
+
         if ($this->isDeskSpecialist($organization, $member)) {
             return false;
         }
@@ -283,6 +288,9 @@ class SpecialtyModuleService
 
     /**
      * Full clinical / queue edit access for the module.
+     *
+     * Role primary apps (CarePermissions) are the source of truth for the
+     * RBAC matrix. Legacy `doctor` desk specialists still use keyword matching.
      */
     public function memberCanManage(Organization $organization, ?Member $member, string $key): bool
     {
@@ -290,7 +298,8 @@ class SpecialtyModuleService
             return false;
         }
 
-        if (app(CarePermissions::class)->isAdmin($member)) {
+        $permissions = app(CarePermissions::class);
+        if ($permissions->isAdmin($member)) {
             return true;
         }
 
@@ -299,6 +308,24 @@ class SpecialtyModuleService
             return false;
         }
 
+        // Department managers get analytics view, not clinical manage.
+        if ((string) $member->role === 'department_manager') {
+            return false;
+        }
+
+        $primaryApps = $permissions->primaryAppsFor($member);
+
+        // Matrix-driven roles (including GP / EP / specialists with app lists).
+        if (is_array($primaryApps)) {
+            // Legacy doctor + specialty desk: only matching modules.
+            if ((string) $member->role === 'doctor'
+                && $this->isDeskSpecialist($organization, $member)) {
+                return $this->specialistBelongsToModule($organization, $member, $key);
+            }
+
+            return in_array($key, $primaryApps, true);
+        }
+
         // Desk specialists only manage modules that match their specialty / assignment.
         if ($this->isDeskSpecialist($organization, $member)
             && ! $this->specialistBelongsToModule($organization, $member, $key)) {
@@ -314,7 +341,7 @@ class SpecialtyModuleService
             if ($this->roleListed($member, $supportRoles)) {
                 return true;
             }
-            if ($role === 'doctor' && $this->roleListed($member, $manageRoles)) {
+            if (in_array($role, ['doctor', 'general_physician'], true) && $this->roleListed($member, $manageRoles)) {
                 return $this->specialistBelongsToModule($organization, $member, $key);
             }
 
@@ -339,6 +366,33 @@ class SpecialtyModuleService
             return false;
         }
 
+        $permissions = app(CarePermissions::class);
+        if ((string) $member->role === 'department_manager') {
+            return true;
+        }
+
+        $primaryApps = $permissions->primaryAppsFor($member);
+        if (is_array($primaryApps)) {
+            // Matrix roles: view only what they can manage (no cross-module GP view
+            // unless listed — general_physician gets cardiology manage via apps).
+            if ((string) $member->role === 'doctor'
+                && $this->isDeskSpecialist($organization, $member)) {
+                return $this->specialistBelongsToModule($organization, $member, $key);
+            }
+
+            // Legacy doctor (non-desk) / GP: keep refer/view on restricted modules
+            // outside primary manage via config view_roles when role is doctor/GP.
+            if (in_array((string) $member->role, ['doctor', 'general_physician'], true)
+                && ! in_array($key, $primaryApps, true)) {
+                $definition = $this->definition($key);
+                if ($definition && $this->roleListed($member, $definition['view_roles'] ?? [])) {
+                    return true;
+                }
+            }
+
+            return in_array($key, $primaryApps, true);
+        }
+
         // Desk specialists do not get cross-module view; only their matching desks.
         if ($this->isDeskSpecialist($organization, $member)
             && ! $this->specialistBelongsToModule($organization, $member, $key)) {
@@ -366,6 +420,25 @@ class SpecialtyModuleService
             return false;
         }
 
+        $permissions = app(CarePermissions::class);
+        $primaryApps = $permissions->primaryAppsFor($member);
+        if (is_array($primaryApps)) {
+            if ((string) $member->role === 'doctor'
+                && $this->isDeskSpecialist($organization, $member)) {
+                return $this->specialistBelongsToModule($organization, $member, $key);
+            }
+
+            if (in_array((string) $member->role, ['doctor', 'general_physician'], true)
+                && ! in_array($key, $primaryApps, true)) {
+                $definition = $this->definition($key);
+                if ($definition && $this->roleListed($member, $definition['refer_roles'] ?? [])) {
+                    return true;
+                }
+            }
+
+            return in_array($key, $primaryApps, true);
+        }
+
         // Desk specialists do not get cross-module referral nav; GPs keep refer_roles.
         if ($this->isDeskSpecialist($organization, $member)
             && ! $this->specialistBelongsToModule($organization, $member, $key)) {
@@ -381,8 +454,9 @@ class SpecialtyModuleService
     }
 
     /**
-     * Doctor with a specialty desk: non-GP specialty matching a catalog module, or
-     * assigned to a provisioned specialty department. GPs and non-doctors are false.
+     * Legacy doctor with a specialty desk: non-GP specialty matching a catalog
+     * module, or assigned to a provisioned specialty department.
+     * Dedicated specialist roles use primary apps instead.
      */
     public function isDeskSpecialist(Organization $organization, Member $member): bool
     {
@@ -391,7 +465,7 @@ class SpecialtyModuleService
             return $this->deskSpecialistCache[$cacheKey];
         }
 
-        if ((string) $member->role !== 'doctor') {
+        if (! in_array((string) $member->role, ['doctor'], true)) {
             return $this->deskSpecialistCache[$cacheKey] = false;
         }
 
diff --git a/app/Support/DemoWorld.php b/app/Support/DemoWorld.php
index 5dd8a57..dc0a15b 100644
--- a/app/Support/DemoWorld.php
+++ b/app/Support/DemoWorld.php
@@ -187,34 +187,52 @@ final class DemoWorld
      * }>>
      */
     /**
-     * Care specialty module doctors (Pro / Enterprise). Emails: demo-{tier}-{key}@ladill.com
+     * Care specialty module clinicians (Pro / Enterprise).
+     * Emails: demo-{tier}-{key}@ladill.com
+     * Roles follow the Care RBAC matrix when a dedicated slug exists;
+     * remaining modules stay on legacy `doctor` + desk specialty keywords.
      *
-     * @var array<string, string> module key => display name
+     * @var array<string, array{name: string, role: string}>
      */
     public const SPECIALTY_DOCTORS = [
-        'emergency' => 'Dr. Kojo Emergency',
-        'blood_bank' => 'Dr. Ama Blood Bank',
-        'dentistry' => 'Dr. Ama Dental',
-        'ophthalmology' => 'Dr. Kofi Eye',
-        'physiotherapy' => 'Dr. Efua Physio',
-        'maternity' => 'Dr. Abena Maternity',
-        'radiology' => 'Dr. Yaw Radiology',
-        'cardiology' => 'Dr. Kwesi Cardiology',
-        'psychiatry' => 'Dr. Adwoa Psychiatry',
-        'pediatrics' => 'Dr. Fiifi Pediatrics',
-        'orthopedics' => 'Dr. Kojo Orthopedics',
-        'ent' => 'Dr. Esi ENT',
-        'oncology' => 'Dr. Mansa Oncology',
-        'renal' => 'Dr. Nana Renal',
-        'surgery' => 'Dr. Kwadwo Surgery',
-        'vaccination' => 'Dr. Afia Vaccination',
-        'pathology' => 'Dr. Yaw Pathology',
-        'infusion' => 'Dr. Akosua Infusion',
-        'dermatology' => 'Dr. Ama Dermatology',
-        'podiatry' => 'Dr. Kofi Podiatry',
-        'fertility' => 'Dr. Abena Fertility',
-        'child_welfare' => 'Dr. Efua Child Welfare',
-        'ambulance' => 'Dr. Kojo Ambulance',
+        'emergency' => ['name' => 'Dr. Kojo Emergency', 'role' => 'emergency_physician'],
+        'blood_bank' => ['name' => 'Ama Blood Bank Officer', 'role' => 'blood_bank_officer'],
+        'dentistry' => ['name' => 'Dr. Ama Dental', 'role' => 'dentist'],
+        'ophthalmology' => ['name' => 'Dr. Kofi Eye', 'role' => 'doctor'],
+        'physiotherapy' => ['name' => 'Dr. Efua Physio', 'role' => 'physiotherapist'],
+        'maternity' => ['name' => 'Abena Midwife', 'role' => 'midwife'],
+        'radiology' => ['name' => 'Dr. Yaw Radiology', 'role' => 'radiologist'],
+        'cardiology' => ['name' => 'Dr. Kwesi Cardiology', 'role' => 'doctor'],
+        'psychiatry' => ['name' => 'Dr. Adwoa Psychiatry', 'role' => 'psychiatrist'],
+        'pediatrics' => ['name' => 'Dr. Fiifi Pediatrics', 'role' => 'pediatrician'],
+        'orthopedics' => ['name' => 'Dr. Kojo Orthopedics', 'role' => 'doctor'],
+        'ent' => ['name' => 'Dr. Esi ENT', 'role' => 'doctor'],
+        'oncology' => ['name' => 'Dr. Mansa Oncology', 'role' => 'oncologist'],
+        'renal' => ['name' => 'Dr. Nana Renal', 'role' => 'doctor'],
+        'surgery' => ['name' => 'Dr. Kwadwo Surgery', 'role' => 'surgeon'],
+        'vaccination' => ['name' => 'Dr. Afia Vaccination', 'role' => 'doctor'],
+        'pathology' => ['name' => 'Dr. Yaw Pathology', 'role' => 'pathologist'],
+        'infusion' => ['name' => 'Dr. Akosua Infusion', 'role' => 'doctor'],
+        'dermatology' => ['name' => 'Dr. Ama Dermatology', 'role' => 'doctor'],
+        'podiatry' => ['name' => 'Dr. Kofi Podiatry', 'role' => 'doctor'],
+        'fertility' => ['name' => 'Dr. Abena Fertility', 'role' => 'doctor'],
+        'child_welfare' => ['name' => 'Dr. Efua Child Welfare', 'role' => 'doctor'],
+        'ambulance' => ['name' => 'Kojo Ambulance', 'role' => 'ambulance_staff'],
+    ];
+
+    /**
+     * Extra Care matrix roles (not covered by SPECIALTY_DOCTORS keys).
+     *
+     * @var list<array{key: string, name: string, role: string}>
+     */
+    public const CARE_MATRIX_STAFF = [
+        ['key' => 'ed-nurse', 'name' => 'Ama ED Nurse', 'role' => 'ed_nurse'],
+        ['key' => 'theatre-nurse', 'name' => 'Efua Theatre Nurse', 'role' => 'theatre_nurse'],
+        ['key' => 'radiographer', 'name' => 'Kofi Radiographer', 'role' => 'radiographer'],
+        ['key' => 'dialysis-nurse', 'name' => 'Abena Dialysis Nurse', 'role' => 'dialysis_nurse'],
+        ['key' => 'billing-officer', 'name' => 'Yaw Billing Officer', 'role' => 'billing_officer'],
+        ['key' => 'department-manager', 'name' => 'Adwoa Department Manager', 'role' => 'department_manager'],
+        ['key' => 'hospital-admin', 'name' => 'Kojo Hospital Admin', 'role' => 'hospital_admin'],
     ];
 
     public const STAFF = [
@@ -243,7 +261,14 @@ final class DemoWorld
                 'email' => 'demo-pro-doctor@ladill.com',
                 'name' => 'Dr. Kwame Mensah (Pro)',
                 'apps' => ['care'],
-                'roles' => ['care' => 'doctor'],
+                'roles' => ['care' => 'general_physician'],
+            ],
+            [
+                'key' => 'general-physician',
+                'email' => 'demo-pro-general-physician@ladill.com',
+                'name' => 'Dr. Ama General Physician (Pro)',
+                'apps' => ['care'],
+                'roles' => ['care' => 'general_physician'],
             ],
             [
                 'key' => 'nurse',
@@ -345,7 +370,14 @@ final class DemoWorld
                 'email' => 'demo-enterprise-doctor@ladill.com',
                 'name' => 'Dr. Kwame Mensah',
                 'apps' => ['care'],
-                'roles' => ['care' => 'doctor'],
+                'roles' => ['care' => 'general_physician'],
+            ],
+            [
+                'key' => 'general-physician',
+                'email' => 'demo-enterprise-general-physician@ladill.com',
+                'name' => 'Dr. Ama General Physician',
+                'apps' => ['care'],
+                'roles' => ['care' => 'general_physician'],
             ],
             [
                 'key' => 'nurse',
@@ -572,7 +604,7 @@ final class DemoWorld
             return $roster;
         }
 
-        foreach (self::SPECIALTY_DOCTORS as $key => $name) {
+        foreach (self::SPECIALTY_DOCTORS as $key => $meta) {
             $email = sprintf('demo-%s-%s@ladill.com', $tier, $key);
             $already = false;
             foreach ($roster as $row) {
@@ -584,13 +616,37 @@ final class DemoWorld
             if ($already) {
                 continue;
             }
+            $name = is_array($meta) ? (string) ($meta['name'] ?? $key) : (string) $meta;
+            $role = is_array($meta) ? (string) ($meta['role'] ?? 'doctor') : 'doctor';
+            $suffix = $tier === 'pro' ? ' (Pro)' : '';
+            $roster[] = [
+                'key' => $key,
+                'email' => $email,
+                'name' => $name.$suffix,
+                'apps' => ['care'],
+                'roles' => ['care' => $role],
+            ];
+        }
+
+        foreach (self::CARE_MATRIX_STAFF as $extra) {
+            $email = sprintf('demo-%s-%s@ladill.com', $tier, $extra['key']);
+            $already = false;
+            foreach ($roster as $row) {
+                if (strtolower((string) ($row['email'] ?? '')) === $email) {
+                    $already = true;
+                    break;
+                }
+            }
+            if ($already) {
+                continue;
+            }
             $suffix = $tier === 'pro' ? ' (Pro)' : '';
             $roster[] = [
-                'key' => $key,
+                'key' => $extra['key'],
                 'email' => $email,
-                'name' => $name.$suffix,
+                'name' => $extra['name'].$suffix,
                 'apps' => ['care'],
-                'roles' => ['care' => 'doctor'],
+                'roles' => ['care' => $extra['role']],
             ];
         }
 
diff --git a/config/care.php b/config/care.php
index 51beb3f..2d8e956 100644
--- a/config/care.php
+++ b/config/care.php
@@ -5,13 +5,32 @@ return [
     'roles' => [
         'super_admin' => 'Super Administrator',
         'hospital_admin' => 'Hospital Administrator',
-        'receptionist' => 'Receptionist',
-        'doctor' => 'Doctor',
-        'nurse' => 'Nurse',
+        'department_manager' => 'Department Manager',
+        'emergency_physician' => 'Emergency Physician',
+        'ed_nurse' => 'ED Nurse',
+        'general_physician' => 'General Physician',
+        'doctor' => 'Doctor (legacy)',
+        'surgeon' => 'Surgeon',
+        'theatre_nurse' => 'Theatre Nurse',
+        'radiologist' => 'Radiologist',
+        'radiographer' => 'Radiographer',
         'lab_technician' => 'Laboratory Technician',
         'lab_manager' => 'Laboratory Manager',
-        'pharmacist' => 'Pharmacist',
+        'pathologist' => 'Pathologist',
+        'blood_bank_officer' => 'Blood Bank Officer',
         'blood_bank_manager' => 'Blood Bank Manager',
+        'pharmacist' => 'Pharmacist',
+        'dentist' => 'Dentist',
+        'psychiatrist' => 'Psychiatrist',
+        'physiotherapist' => 'Physiotherapist',
+        'midwife' => 'Midwife',
+        'pediatrician' => 'Pediatrician',
+        'oncologist' => 'Oncologist',
+        'dialysis_nurse' => 'Dialysis Nurse',
+        'ambulance_staff' => 'Ambulance Staff',
+        'nurse' => 'Nurse (legacy)',
+        'receptionist' => 'Receptionist',
+        'billing_officer' => 'Billing Officer',
         'cashier' => 'Cashier',
         'accountant' => 'Accountant',
     ],
diff --git a/config/care_specialty_modules.php b/config/care_specialty_modules.php
index 2de4bf3..851d5af 100644
--- a/config/care_specialty_modules.php
+++ b/config/care_specialty_modules.php
@@ -4,20 +4,10 @@
  * Specialty practice modules (Settings → Modules).
  * Pro-gated via plans.*.features specialty_modules.
  *
- * Access tiers (RBAC via Care member roles):
- * - general: broad day-to-day access for listed roles (GPs = doctor without specialty desk)
- * - limited: GPs + nurses (and listed roles); desk specialists only when specialty keywords match
- * - restricted: specialist doctors (department / specialty keywords) + optional support_roles;
- *   GPs use view_roles / refer_roles; desk specialists only see matching modules
- *
- * Prefer existing clinical role slugs on allowlists. Dedicated managers (e.g. blood_bank_manager,
- * lab_manager) are intentional product roles — add them to the relevant module roles lists.
- *
- * Desk specialists (doctor whose practitioner specialty matches specialist_keywords, or who is
- * assigned to the module department) only see modules relevant to their work — non-matching
- * modules are access "none" (hidden from sidebar). Nurses / receptionists keep role allowlists.
- *
- * default_on_paid_plans: always on for Pro/Enterprise (sidebar + access).
+ * Primary specialty visibility is driven by CarePermissions::primaryAppsFor()
+ * (role → module keys). Config roles / support_roles / view_roles / refer_roles
+ * remain for legacy doctor desk-specialist keyword matching and GP refer/view
+ * outside the primary-app matrix.
  *
  * @return array<string, array<string, mixed>>
  */
@@ -133,8 +123,8 @@ return [
         'access' => 'restricted',
         'roles' => ['doctor'],
         'support_roles' => ['nurse'],
-        'view_roles' => ['doctor', 'nurse', 'lab_technician'],
-        'refer_roles' => ['doctor', 'nurse'],
+        'view_roles' => ['doctor', 'general_physician', 'nurse', 'lab_technician'],
+        'refer_roles' => ['doctor', 'general_physician', 'nurse'],
         'specialist_keywords' => ['cardio', 'cardiology', 'heart', 'ecg'],
     ],
     'psychiatry' => [
@@ -150,8 +140,8 @@ return [
         'access' => 'restricted',
         'roles' => ['doctor'],
         'support_roles' => ['nurse'],
-        'view_roles' => ['doctor', 'nurse'],
-        'refer_roles' => ['doctor', 'nurse'],
+        'view_roles' => ['doctor', 'general_physician', 'nurse'],
+        'refer_roles' => ['doctor', 'general_physician', 'nurse'],
         'specialist_keywords' => ['psych', 'psychiatry', 'mental', 'behaviour'],
     ],
     'pediatrics' => [
@@ -182,8 +172,8 @@ return [
         'access' => 'restricted',
         'roles' => ['doctor'],
         'support_roles' => ['nurse'],
-        'view_roles' => ['doctor', 'nurse'],
-        'refer_roles' => ['doctor', 'nurse'],
+        'view_roles' => ['doctor', 'general_physician', 'nurse'],
+        'refer_roles' => ['doctor', 'general_physician', 'nurse'],
         'specialist_keywords' => ['ortho', 'orthopedic', 'orthopaedic', 'fracture'],
     ],
     'ent' => [
@@ -199,8 +189,8 @@ return [
         'access' => 'restricted',
         'roles' => ['doctor'],
         'support_roles' => ['nurse'],
-        'view_roles' => ['doctor', 'nurse'],
-        'refer_roles' => ['doctor', 'nurse'],
+        'view_roles' => ['doctor', 'general_physician', 'nurse'],
+        'refer_roles' => ['doctor', 'general_physician', 'nurse'],
         'specialist_keywords' => ['ent', 'otolaryng', 'ear', 'nose', 'throat'],
     ],
     'oncology' => [
@@ -216,8 +206,8 @@ return [
         'access' => 'restricted',
         'roles' => ['doctor'],
         'support_roles' => ['nurse'],
-        'view_roles' => ['doctor', 'nurse', 'pharmacist'],
-        'refer_roles' => ['doctor', 'nurse'],
+        'view_roles' => ['doctor', 'general_physician', 'nurse', 'pharmacist'],
+        'refer_roles' => ['doctor', 'general_physician', 'nurse'],
         'specialist_keywords' => ['oncol', 'cancer', 'chemo'],
     ],
     'renal' => [
@@ -233,8 +223,8 @@ return [
         'access' => 'restricted',
         'roles' => ['doctor'],
         'support_roles' => ['nurse'],
-        'view_roles' => ['doctor', 'nurse'],
-        'refer_roles' => ['doctor', 'nurse'],
+        'view_roles' => ['doctor', 'general_physician', 'nurse'],
+        'refer_roles' => ['doctor', 'general_physician', 'nurse'],
         'specialist_keywords' => ['renal', 'nephro', 'dialysis', 'kidney'],
     ],
     'surgery' => [
@@ -250,8 +240,8 @@ return [
         'access' => 'restricted',
         'roles' => ['doctor'],
         'support_roles' => ['nurse'],
-        'view_roles' => ['doctor', 'nurse'],
-        'refer_roles' => ['doctor', 'nurse'],
+        'view_roles' => ['doctor', 'general_physician', 'nurse'],
+        'refer_roles' => ['doctor', 'general_physician', 'nurse'],
         'specialist_keywords' => ['surg', 'theatre', 'operat'],
     ],
     'vaccination' => [
@@ -309,8 +299,8 @@ return [
         'access' => 'restricted',
         'roles' => ['doctor'],
         'support_roles' => [],
-        'view_roles' => ['doctor', 'nurse'],
-        'refer_roles' => ['doctor', 'nurse'],
+        'view_roles' => ['doctor', 'general_physician', 'nurse'],
+        'refer_roles' => ['doctor', 'general_physician', 'nurse'],
         'specialist_keywords' => ['derma', 'skin'],
     ],
     'podiatry' => [
@@ -326,8 +316,8 @@ return [
         'access' => 'restricted',
         'roles' => ['doctor'],
         'support_roles' => [],
-        'view_roles' => ['doctor', 'nurse'],
-        'refer_roles' => ['doctor', 'nurse'],
+        'view_roles' => ['doctor', 'general_physician', 'nurse'],
+        'refer_roles' => ['doctor', 'general_physician', 'nurse'],
         'specialist_keywords' => ['podiat', 'foot'],
     ],
     'fertility' => [
@@ -343,8 +333,8 @@ return [
         'access' => 'restricted',
         'roles' => ['doctor'],
         'support_roles' => [],
-        'view_roles' => ['doctor', 'nurse'],
-        'refer_roles' => ['doctor', 'nurse'],
+        'view_roles' => ['doctor', 'general_physician', 'nurse'],
+        'refer_roles' => ['doctor', 'general_physician', 'nurse'],
         'specialist_keywords' => ['fertil', 'ivf', 'reproduct'],
     ],
     'child_welfare' => [
diff --git a/resources/views/care/admin/members/create.blade.php b/resources/views/care/admin/members/create.blade.php
index f01383b..d010a41 100644
--- a/resources/views/care/admin/members/create.blade.php
+++ b/resources/views/care/admin/members/create.blade.php
@@ -9,7 +9,12 @@
         </div>
 
         <x-settings.card title="Invitation">
-            <form method="POST" action="{{ route('care.members.store') }}" class="space-y-4" x-data="{ role: '{{ old('role', 'doctor') }}' }">
+            <form method="POST" action="{{ route('care.members.store') }}" class="space-y-4"
+                  x-data="{
+                      role: '{{ old('role', 'general_physician') }}',
+                      practitionerRoles: @js($practitionerRoles ?? ['doctor', 'general_physician']),
+                      get needsDesk() { return this.practitionerRoles.includes(this.role); }
+                  }">
                 @csrf
 
                 @if (! empty($mailboxOptions))
@@ -41,28 +46,28 @@
                     <label class="block text-sm font-medium text-slate-700">Role</label>
                     <select name="role" x-model="role" class="mt-1 w-full rounded-lg border-slate-300 text-sm">
                         @foreach ($roles as $value => $label)
-                            <option value="{{ $value }}" @selected(old('role', 'doctor') === $value)>{{ $label }}</option>
+                            <option value="{{ $value }}" @selected(old('role', 'general_physician') === $value)>{{ $label }}</option>
                         @endforeach
                     </select>
                 </div>
 
                 <div>
                     <label class="block text-sm font-medium text-slate-700">
-                        <span x-text="role === 'doctor' ? 'Home branch' : 'Branch (optional)'"></span>
+                        <span x-text="needsDesk ? 'Home branch' : 'Branch (optional)'"></span>
                     </label>
                     <select name="branch_id" class="mt-1 w-full rounded-lg border-slate-300 text-sm"
-                            :required="role === 'doctor'">
-                        <option value="" x-text="role === 'doctor' ? 'Select a branch…' : 'No branch lock'"></option>
+                            :required="needsDesk">
+                        <option value="" x-text="needsDesk ? 'Select a branch…' : 'No branch lock'"></option>
                         @foreach ($branches as $branch)
                             <option value="{{ $branch->id }}" @selected(old('branch_id') == $branch->id)>{{ $branch->name }}</option>
                         @endforeach
                     </select>
-                    <p class="mt-1 text-xs text-slate-500" x-show="role === 'doctor'" x-cloak>
-                        Required for doctors. Add more sites later under Practitioners (telemedicine).
+                    <p class="mt-1 text-xs text-slate-500" x-show="needsDesk" x-cloak>
+                        Required for clinical desks. Add more sites later under Practitioners (telemedicine).
                     </p>
                 </div>
 
-                <div class="rounded-xl border border-slate-100 bg-slate-50 p-4" x-show="role === 'doctor'" x-cloak>
+                <div class="rounded-xl border border-slate-100 bg-slate-50 p-4" x-show="needsDesk" x-cloak>
                     <label class="flex items-start gap-2 text-sm">
                         <input type="checkbox" name="create_practitioner" value="1" class="mt-0.5" @checked(old('create_practitioner', true))>
                         <span>
diff --git a/tests/Feature/CareBillTest.php b/tests/Feature/CareBillTest.php
index b2ade28..8a97272 100644
--- a/tests/Feature/CareBillTest.php
+++ b/tests/Feature/CareBillTest.php
@@ -20,6 +20,8 @@ class CareBillTest extends TestCase
 
     protected User $user;
 
+    protected User $cashierUser;
+
     protected Organization $organization;
 
     protected Visit $visit;
@@ -31,8 +33,14 @@ class CareBillTest extends TestCase
 
         $this->user = User::create([
             'public_id' => 'test-user-001',
-            'name' => 'Test User',
-            'email' => 'test@example.com',
+            'name' => 'Billing Officer',
+            'email' => 'billing@example.com',
+        ]);
+
+        $this->cashierUser = User::create([
+            'public_id' => 'test-cashier-001',
+            'name' => 'Cashier',
+            'email' => 'cashier@example.com',
         ]);
 
         $this->organization = Organization::create([
@@ -47,6 +55,13 @@ class CareBillTest extends TestCase
             'owner_ref' => $this->user->public_id,
             'organization_id' => $this->organization->id,
             'user_ref' => $this->user->public_id,
+            'role' => 'billing_officer',
+        ]);
+
+        Member::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->cashierUser->public_id,
             'role' => 'cashier',
         ]);
 
@@ -88,7 +103,7 @@ class CareBillTest extends TestCase
         ]);
     }
 
-    public function test_cashier_can_generate_bill_from_visit(): void
+    public function test_billing_officer_can_generate_bill_from_visit(): void
     {
         $this->actingAs($this->user)
             ->post(route('care.bills.generate', $this->visit))
@@ -101,7 +116,24 @@ class CareBillTest extends TestCase
         $this->assertDatabaseHas('care_audit_logs', ['action' => 'bill.created']);
     }
 
-    public function test_cashier_can_add_line_item_and_record_payments(): void
+    public function test_cashier_cannot_edit_invoice_lines(): void
+    {
+        $this->actingAs($this->user)
+            ->post(route('care.bills.generate', $this->visit));
+
+        $bill = Bill::firstOrFail();
+
+        $this->actingAs($this->cashierUser)
+            ->post(route('care.bills.line-items.store', $bill), [
+                'type' => 'misc',
+                'description' => 'Dressing supplies',
+                'quantity' => 2,
+                'unit_price_minor' => 1000,
+            ])
+            ->assertForbidden();
+    }
+
+    public function test_billing_officer_can_add_line_item_and_cashier_records_payments(): void
     {
         $this->actingAs($this->user)
             ->post(route('care.bills.generate', $this->visit));
@@ -123,7 +155,15 @@ class CareBillTest extends TestCase
 
         $this->assertSame($expectedTotal, $bill->total_minor);
 
+        // Billing officer cannot receive payments.
         $this->actingAs($this->user)
+            ->post(route('care.bills.payments.store', $bill), [
+                'amount' => 30.00,
+                'method' => 'cash',
+            ])
+            ->assertForbidden();
+
+        $this->actingAs($this->cashierUser)
             ->post(route('care.bills.payments.store', $bill), [
                 'amount' => 30.00,
                 'method' => 'cash',
@@ -134,7 +174,7 @@ class CareBillTest extends TestCase
         $this->assertSame(Bill::STATUS_PARTIAL, $bill->status);
         $this->assertSame(3000, $bill->amount_paid_minor);
 
-        $this->actingAs($this->user)
+        $this->actingAs($this->cashierUser)
             ->post(route('care.bills.payments.store', $bill), [
                 'amount' => $bill->balance_minor / 100,
                 'method' => 'momo',
@@ -153,7 +193,7 @@ class CareBillTest extends TestCase
         $this->actingAs($this->user)
             ->post(route('care.bills.generate', $this->visit));
 
-        $this->actingAs($this->user)
+        $this->actingAs($this->cashierUser)
             ->get(route('care.bills.index'))
             ->assertOk()
             ->assertSee('INV-');
@@ -181,14 +221,14 @@ class CareBillTest extends TestCase
             'balance_minor' => 0,
         ]);
 
-        $this->actingAs($this->user)
+        $this->actingAs($this->cashierUser)
             ->get(route('care.bills.index'))
             ->assertOk()
             ->assertSee($open->invoice_number)
             ->assertSee('Pay')
             ->assertDontSee($paid->invoice_number, false);
 
-        $this->actingAs($this->user)
+        $this->actingAs($this->cashierUser)
             ->get(route('care.bills.index', ['status' => '']))
             ->assertOk()
             ->assertSee($paid->invoice_number);
@@ -201,7 +241,7 @@ class CareBillTest extends TestCase
 
         $bill = Bill::firstOrFail();
 
-        $this->actingAs($this->user)
+        $this->actingAs($this->cashierUser)
             ->get(route('care.bills.index'))
             ->assertOk()
             ->assertSee($bill->invoice_number)
@@ -211,7 +251,7 @@ class CareBillTest extends TestCase
 
         $balanceMajor = number_format($bill->balance_minor / 100, 2, '.', '');
 
-        $this->actingAs($this->user)
+        $this->actingAs($this->cashierUser)
             ->get(route('care.bills.show', $bill))
             ->assertOk()
             ->assertSee('Record payment')
@@ -228,9 +268,9 @@ class CareBillTest extends TestCase
         $settings['queue_integration_enabled'] = true;
         $this->organization->update(['settings' => $settings]);
 
-        $this->actingAs($this->user)
-            ->post(route('care.bills.call-next'), ['branch_id' => Branch::firstOrFail()->id])
+        $this->actingAs($this->cashierUser)
+            ->post(route('care.bills.call-next'))
             ->assertRedirect()
-            ->assertSessionHas('info', 'No patients waiting at the billing booth. Open an unpaid invoice above to record a walk-up payment.');
+            ->assertSessionHas('info');
     }
 }
diff --git a/tests/Feature/CareLabTest.php b/tests/Feature/CareLabTest.php
index 9f22df8..827b8dd 100644
--- a/tests/Feature/CareLabTest.php
+++ b/tests/Feature/CareLabTest.php
@@ -179,6 +179,13 @@ class CareLabTest extends TestCase
         $this->assertSame(InvestigationRequest::STATUS_AWAITING_REVIEW, $request->status);
         $this->assertTrue($request->result->is_abnormal);
 
+        // Lab techs enter results; approval requires pathology.result.approve (manager+).
+        $this->actingAs($this->user)
+            ->post(route('care.lab.requests.approve', $request))
+            ->assertForbidden();
+
+        Member::where('user_ref', $this->user->public_id)->update(['role' => 'lab_manager']);
+
         $this->actingAs($this->user)
             ->post(route('care.lab.requests.approve', $request))
             ->assertRedirect();
diff --git a/tests/Feature/CarePatientQueueAccessTest.php b/tests/Feature/CarePatientQueueAccessTest.php
index 492822c..c2a10a6 100644
--- a/tests/Feature/CarePatientQueueAccessTest.php
+++ b/tests/Feature/CarePatientQueueAccessTest.php
@@ -167,7 +167,7 @@ class CarePatientQueueAccessTest extends TestCase
 
     public function test_nurse_specialty_show_renders_list_not_auto_open_visit(): void
     {
-        [$nurseUser] = $this->makeStaff('nurse', 'nurse-spec');
+        [$nurseUser] = $this->makeStaff('ed_nurse', 'nurse-spec');
 
         $modules = app(SpecialtyModuleService::class);
         $modules->ensureDefaultModulesProvisioned($this->organization, $this->owner->public_id);
@@ -242,7 +242,7 @@ class CarePatientQueueAccessTest extends TestCase
 
     public function test_nurse_can_open_emergency_visit_from_specialty_list(): void
     {
-        [$nurseUser] = $this->makeStaff('nurse', 'nurse-er-open');
+        [$nurseUser] = $this->makeStaff('ed_nurse', 'nurse-er-open');
 
         $modules = app(SpecialtyModuleService::class);
         $modules->ensureDefaultModulesProvisioned($this->organization, $this->owner->public_id);
@@ -315,7 +315,7 @@ class CarePatientQueueAccessTest extends TestCase
 
     public function test_nurse_specialty_show_redirects_to_workspace_not_queue(): void
     {
-        [$nurseUser] = $this->makeStaff('nurse', 'nurse-spec-er');
+        [$nurseUser] = $this->makeStaff('ed_nurse', 'nurse-spec-er');
 
         app(SpecialtyModuleService::class)
             ->ensureDefaultModulesProvisioned($this->organization, $this->owner->public_id);
diff --git a/tests/Feature/CareSpecialtyAccessTest.php b/tests/Feature/CareSpecialtyAccessTest.php
index a60ef7d..622bc2c 100644
--- a/tests/Feature/CareSpecialtyAccessTest.php
+++ b/tests/Feature/CareSpecialtyAccessTest.php
@@ -69,7 +69,7 @@ class CareSpecialtyAccessTest extends TestCase
 
         $this->modules = app(SpecialtyModuleService::class);
         $this->modules->ensureDefaultModulesProvisioned($this->organization, $this->owner->public_id);
-        foreach (['cardiology', 'infusion', 'pathology', 'dentistry'] as $key) {
+        foreach (['cardiology', 'infusion', 'pathology', 'dentistry', 'psychiatry', 'surgery', 'radiology'] as $key) {
             $this->modules->activate($this->organization->fresh(), $this->owner->public_id, $key);
         }
         $this->organization->refresh();
@@ -96,20 +96,26 @@ class CareSpecialtyAccessTest extends TestCase
     public function test_nurse_and_pharmacist_manage_general_modules(): void
     {
         [, $nurse] = $this->makeStaff('nurse', 'nurse1');
+        [, $edNurse] = $this->makeStaff('ed_nurse', 'edn1');
         [, $pharmacist] = $this->makeStaff('pharmacist', 'rx1');
         [, $lab] = $this->makeStaff('lab_technician', 'lab1');
 
-        $this->assertTrue($this->modules->memberCanManage($this->organization, $nurse, 'emergency'));
-        $this->assertTrue($this->modules->memberCanManage($this->organization, $pharmacist, 'emergency'));
-        $this->assertTrue($this->modules->memberCanManage($this->organization, $pharmacist, 'infusion'));
+        // Legacy nurse is limited — no specialty modules.
+        $this->assertFalse($this->modules->memberCanManage($this->organization, $nurse, 'emergency'));
+        // ED nurse matrix apps: Emergency, Blood Bank, Radiology, Pathology.
+        $this->assertTrue($this->modules->memberCanManage($this->organization, $edNurse, 'emergency'));
+        $this->assertTrue($this->modules->memberCanManage($this->organization, $edNurse, 'pathology'));
+        // Pharmacist is pharmacy-only (core app) — no specialty modules.
+        $this->assertFalse($this->modules->memberCanManage($this->organization, $pharmacist, 'emergency'));
+        $this->assertFalse($this->modules->memberCanManage($this->organization, $pharmacist, 'infusion'));
         $this->assertTrue($this->modules->memberCanManage($this->organization, $lab, 'pathology'));
-        $this->assertTrue($this->modules->memberCanManage($this->organization, $lab, 'blood_bank'));
+        $this->assertFalse($this->modules->memberCanManage($this->organization, $lab, 'blood_bank'));
         $this->assertFalse($this->modules->memberCanManage($this->organization, $pharmacist, 'cardiology'));
     }
 
     public function test_gp_doctor_manages_general_but_only_views_restricted(): void
     {
-        [$doctor, $member] = $this->makeStaff('doctor', 'gp1');
+        [$doctor, $member] = $this->makeStaff('general_physician', 'gp1');
         Practitioner::create([
             'owner_ref' => $this->owner->public_id,
             'organization_id' => $this->organization->id,
@@ -123,11 +129,15 @@ class CareSpecialtyAccessTest extends TestCase
 
         $this->assertFalse($this->modules->isDeskSpecialist($this->organization, $member));
         $this->assertTrue($this->modules->memberCanManage($this->organization, $member, 'emergency'));
-        $this->assertTrue($this->modules->memberCanManage($this->organization, $member, 'dentistry'));
-        $this->assertFalse($this->modules->memberCanManage($this->organization, $member, 'cardiology'));
-        $this->assertTrue($this->modules->memberCanView($this->organization, $member, 'cardiology'));
-        $this->assertTrue($this->modules->memberCanRefer($this->organization, $member, 'cardiology'));
-        $this->assertSame('refer', $this->modules->memberAccessLevel($this->organization, $member, 'cardiology'));
+        // Dentistry is not a GP primary app.
+        $this->assertFalse($this->modules->memberCanManage($this->organization, $member, 'dentistry'));
+        // Cardiology is a GP primary app (manage).
+        $this->assertTrue($this->modules->memberCanManage($this->organization, $member, 'cardiology'));
+        // Psychiatry is outside GP apps — refer/view via legacy config for GP.
+        $this->assertFalse($this->modules->memberCanManage($this->organization, $member, 'psychiatry'));
+        $this->assertTrue($this->modules->memberCanView($this->organization, $member, 'psychiatry'));
+        $this->assertTrue($this->modules->memberCanRefer($this->organization, $member, 'psychiatry'));
+        $this->assertSame('refer', $this->modules->memberAccessLevel($this->organization, $member, 'psychiatry'));
     }
 
     public function test_cardiologist_manages_restricted_cardiology(): void
@@ -226,7 +236,8 @@ class CareSpecialtyAccessTest extends TestCase
             ->assertOk()
             ->assertSee('>Specialty</p>', false)
             ->assertSee('Emergency')
-            ->assertSee('Dentistry');
+            ->assertSee('Cardiology')
+            ->assertDontSee('Dentistry');
     }
 
     public function test_dentistry_specialty_does_not_match_ent_keyword(): void
@@ -290,7 +301,7 @@ class CareSpecialtyAccessTest extends TestCase
 
     public function test_gp_cannot_save_clinical_on_restricted_module(): void
     {
-        [$doctor, $member] = $this->makeStaff('doctor', 'gp3');
+        [$doctor, $member] = $this->makeStaff('general_physician', 'gp3');
         Practitioner::create([
             'owner_ref' => $this->owner->public_id,
             'organization_id' => $this->organization->id,
@@ -302,14 +313,14 @@ class CareSpecialtyAccessTest extends TestCase
             'is_active' => true,
         ]);
 
-        $dept = Department::query()->where('type', 'cardiology')->firstOrFail();
+        $dept = Department::query()->where('type', 'psychiatry')->firstOrFail();
         $patient = Patient::create([
             'owner_ref' => $this->owner->public_id,
             'organization_id' => $this->organization->id,
             'branch_id' => $this->branch->id,
-            'patient_number' => 'P-CARD-1',
+            'patient_number' => 'P-PSY-1',
             'first_name' => 'Kofi',
-            'last_name' => 'Heart',
+            'last_name' => 'Mind',
             'gender' => 'male',
             'date_of_birth' => '1980-01-01',
         ]);
@@ -336,7 +347,7 @@ class CareSpecialtyAccessTest extends TestCase
         ]);
 
         $this->actingAs($doctor)
-            ->get(route('care.specialty.workspace', ['module' => 'cardiology', 'visit' => $visit, 'tab' => 'exam']))
+            ->get(route('care.specialty.workspace', ['module' => 'psychiatry', 'visit' => $visit, 'tab' => 'exam']))
             ->assertOk()
             ->assertSee('view + refer')
             ->assertDontSee('Save record')
@@ -345,12 +356,12 @@ class CareSpecialtyAccessTest extends TestCase
             ->assertDontSee('Upload document')
             ->assertSee('Refer to specialty queue')
             ->assertDontSee(
-                'action="'.route('care.specialty.consultation.start', ['module' => 'cardiology', 'visit' => $visit], false).'"',
+                'action="'.route('care.specialty.consultation.start', ['module' => 'psychiatry', 'visit' => $visit], false).'"',
                 false,
             );
 
         $this->actingAs($doctor)
-            ->post(route('care.specialty.clinical.save', ['module' => 'cardiology', 'visit' => $visit]), [
+            ->post(route('care.specialty.clinical.save', ['module' => 'psychiatry', 'visit' => $visit]), [
                 'tab' => 'exam',
                 'payload' => [
                     'chief_complaint' => 'Should not save',
@@ -362,23 +373,28 @@ class CareSpecialtyAccessTest extends TestCase
     public function test_sidebar_and_dashboard_exclude_modules_with_no_access(): void
     {
         [$pharmacistUser, $pharmacistMember] = $this->makeStaff('pharmacist', 'rx-nav');
+        [, $epMember] = $this->makeStaff('emergency_physician', 'ep-nav');
 
-        $enabledForMember = collect($this->modules->enabledModulesForMember($this->organization, $pharmacistMember))
+        $enabledForPharmacist = collect($this->modules->enabledModulesForMember($this->organization, $pharmacistMember))
+            ->pluck('key')
+            ->all();
+        $enabledForEp = collect($this->modules->enabledModulesForMember($this->organization, $epMember))
             ->pluck('key')
             ->all();
 
-        $this->assertContains('emergency', $enabledForMember);
-        $this->assertContains('infusion', $enabledForMember);
-        $this->assertNotContains('cardiology', $enabledForMember);
-        $this->assertNotContains('dentistry', $enabledForMember);
-        $this->assertTrue($this->modules->shouldShowSpecialtyNav($this->organization, $pharmacistMember));
+        // Pharmacist: pharmacy core only — no specialty modules.
+        $this->assertSame([], $enabledForPharmacist);
+        $this->assertFalse($this->modules->shouldShowSpecialtyNav($this->organization, $pharmacistMember));
+
+        $this->assertContains('emergency', $enabledForEp);
+        $this->assertContains('radiology', $enabledForEp);
+        $this->assertNotContains('dentistry', $enabledForEp);
+        $this->assertTrue($this->modules->shouldShowSpecialtyNav($this->organization, $epMember));
 
         $this->actingAs($pharmacistUser)
             ->get(route('care.dashboard'))
             ->assertOk()
-            ->assertSee('>Specialty</p>', false)
-            ->assertSee('Emergency')
-            ->assertDontSee('Cardiology');
+            ->assertDontSee('>Specialty</p>', false);
     }
 
     public function test_manage_role_still_sees_mutate_actions_on_restricted_module(): void
@@ -444,13 +460,65 @@ class CareSpecialtyAccessTest extends TestCase
         $this->assertTrue($this->modules->memberCanManage($this->organization, $admin, 'emergency'));
     }
 
+    /**
+     * @return array{0: \App\Models\User, 1: Member, 2: \App\Models\Visit}
+     */
+    protected function specialtyVisitForRole(string $role, string $module, string $suffix): array
+    {
+        if ($module === 'dentistry') {
+            return $this->dentistryVisitForRole($role, $suffix);
+        }
+        if ($module === 'emergency') {
+            return $this->emergencyVisitForRole($role, $suffix);
+        }
+
+        [$user, $member] = $this->makeStaff($role, $suffix);
+        $definition = $this->modules->definition($module);
+        $deptType = (string) ($definition['department_type'] ?? $module);
+        $dept = Department::query()->where('type', $deptType)->firstOrFail();
+        $patient = Patient::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'P-'.strtoupper(substr($module, 0, 3)).'-'.$suffix,
+            'first_name' => 'Floor',
+            'last_name' => ucfirst($module),
+            'gender' => 'female',
+            'date_of_birth' => '1990-01-01',
+        ]);
+        $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' => 'waiting',
+        ]);
+        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' => $visit->id,
+            'type' => Appointment::TYPE_WALK_IN,
+            'status' => Appointment::STATUS_WAITING,
+            'scheduled_at' => now(),
+            'checked_in_at' => now(),
+            'waiting_at' => now(),
+        ]);
+
+        return [$user, $member, $visit];
+    }
+
     /**
      * @return array{0: \App\Models\User, 1: Member, 2: \App\Models\Visit}
      */
     protected function dentistryVisitForRole(string $role, string $suffix): array
     {
         [$user, $member] = $this->makeStaff($role, $suffix);
-        if ($role === 'doctor') {
+        if (in_array($role, ['doctor', 'dentist'], true)) {
             Practitioner::create([
                 'owner_ref' => $this->owner->public_id,
                 'organization_id' => $this->organization->id,
@@ -553,10 +621,10 @@ class CareSpecialtyAccessTest extends TestCase
     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'],
+            ['ed_nurse', 'emergency', 'floor-edn-er'],
+            ['theatre_nurse', 'surgery', 'floor-tn-sur'],
+            ['lab_technician', 'pathology', 'floor-lab-path'],
+            ['radiographer', 'radiology', 'floor-rad-tech'],
         ];
     }
 
@@ -566,9 +634,7 @@ class CareSpecialtyAccessTest extends TestCase
         string $module,
         string $suffix,
     ): void {
-        [$user, $member, $visit] = $module === 'dentistry'
-            ? $this->dentistryVisitForRole($role, $suffix)
-            : $this->emergencyVisitForRole($role, $suffix);
+        [$user, $member, $visit] = $this->specialtyVisitForRole($role, $module, $suffix);
 
         $permissions = app(\App\Services\Care\CarePermissions::class);
         $this->assertTrue($this->modules->memberCanManage($this->organization, $member, $module));
@@ -605,7 +671,7 @@ class CareSpecialtyAccessTest extends TestCase
                 $html,
             );
             $this->assertStringContainsString('Waiting', $html);
-        } else {
+        } elseif ($module === 'emergency') {
             $this->assertStringNotContainsString(
                 route('care.specialty.emergency.stage', $visit, absolute: false),
                 $html,
@@ -654,7 +720,7 @@ class CareSpecialtyAccessTest extends TestCase
 
     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) {
+        foreach (['lab_technician' => 'lab-er-post', 'pharmacist' => 'rx-er-post', 'nurse' => 'nurse-er-post'] as $role => $suffix) {
             [$user, , $visit] = $this->emergencyVisitForRole($role, $suffix);
 
             $this->actingAs($user)
@@ -664,20 +730,64 @@ class CareSpecialtyAccessTest extends TestCase
             $this->actingAs($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_ed_nurse_cannot_discharge_emergency_visit(): void
+    {
+        [$user, $member, $visit] = $this->emergencyVisitForRole('ed_nurse', 'edn-discharge');
+        $permissions = app(\App\Services\Care\CarePermissions::class);
+        $this->assertTrue($this->modules->memberCanManage($this->organization, $member, 'emergency'));
+        $this->assertFalse($permissions->can($member, 'emergency.discharge'));
+
+        $this->actingAs($user)
+            ->post(route('care.specialty.emergency.disposition', $visit), [
+                'payload' => [
+                    'disposition' => 'Discharged home',
+                    'destination' => 'Home',
+                    'medications' => 'None',
+                ],
+            ])
+            ->assertForbidden();
+    }
+
+    public function test_rbac_matrix_smoke_key_roles(): void
+    {
+        $permissions = app(\App\Services\Care\CarePermissions::class);
+
+        [, $ep] = $this->makeStaff('emergency_physician', 'matrix-ep');
+        [, $dentist] = $this->makeStaff('dentist', 'matrix-den');
+        [, $cashier] = $this->makeStaff('cashier', 'matrix-cash');
+        [, $lab] = $this->makeStaff('lab_technician', 'matrix-lab');
+        [, $labMgr] = $this->makeStaff('lab_manager', 'matrix-labm');
+        [, $billing] = $this->makeStaff('billing_officer', 'matrix-bill');
+
+        $this->assertTrue($this->modules->memberCanManage($this->organization, $ep, 'emergency'));
+        $this->assertTrue($this->modules->memberCanManage($this->organization, $ep, 'radiology'));
+        $this->assertFalse($this->modules->memberCanManage($this->organization, $ep, 'dentistry'));
+
+        $this->assertTrue($this->modules->memberCanManage($this->organization, $dentist, 'dentistry'));
+        $this->assertFalse($this->modules->memberCanManage($this->organization, $dentist, 'emergency'));
+        $this->assertFalse($this->modules->shouldShowSpecialtyNav($this->organization, $dentist));
+
+        $this->assertTrue($permissions->can($cashier, 'payments.manage'));
+        $this->assertFalse($permissions->can($cashier, 'bills.manage'));
+        $this->assertFalse($permissions->can($cashier, 'consultations.manage'));
+        $this->assertSame([], $this->modules->enabledModulesForMember($this->organization, $cashier));
+
+        $this->assertTrue($permissions->can($lab, 'lab.manage'));
+        $this->assertTrue($permissions->can($lab, 'pathology.result.enter'));
+        $this->assertFalse($permissions->can($lab, 'pathology.result.approve'));
+        $this->assertTrue($permissions->can($labMgr, 'pathology.result.approve'));
+        $this->assertTrue($permissions->can($labMgr, 'lab.catalog.manage'));
+
+        $this->assertTrue($permissions->can($billing, 'bills.manage'));
+        $this->assertFalse($permissions->can($billing, 'payments.manage'));
+    }
+
     public function test_doctor_on_dentistry_sees_and_can_advance_stage(): void
     {
-        [$doctorUser, $doctorMember, $visit] = $this->dentistryVisitForRole('doctor', 'den-doc');
+        [$doctorUser, $doctorMember, $visit] = $this->dentistryVisitForRole('dentist', 'den-doc');
 
         $this->assertTrue($this->modules->memberCanManage($this->organization, $doctorMember, 'dentistry'));
         $this->assertTrue(app(\App\Services\Care\CarePermissions::class)->can($doctorMember, 'consultations.manage'));
@@ -698,7 +808,7 @@ class CareSpecialtyAccessTest extends TestCase
 
     public function test_gp_with_consult_ability_but_no_module_manage_hides_mutate_ctas(): void
     {
-        [$doctor, $member] = $this->makeStaff('doctor', 'gp-no-manage');
+        [$doctor, $member] = $this->makeStaff('general_physician', 'gp-no-manage');
         Practitioner::create([
             'owner_ref' => $this->owner->public_id,
             'organization_id' => $this->organization->id,
@@ -712,10 +822,10 @@ class CareSpecialtyAccessTest extends TestCase
 
         $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'));
+        $this->assertFalse($this->modules->memberCanManage($this->organization, $member, 'psychiatry'));
+        $this->assertSame('refer', $this->modules->memberAccessLevel($this->organization, $member, 'psychiatry'));
 
-        $dept = Department::query()->where('type', 'cardiology')->firstOrFail();
+        $dept = Department::query()->where('type', 'psychiatry')->firstOrFail();
         $patient = Patient::create([
             'owner_ref' => $this->owner->public_id,
             'organization_id' => $this->organization->id,
@@ -749,7 +859,7 @@ class CareSpecialtyAccessTest extends TestCase
         ]);
 
         $html = $this->actingAs($doctor)
-            ->get(route('care.specialty.workspace', ['module' => 'cardiology', 'visit' => $visit, 'tab' => 'overview']))
+            ->get(route('care.specialty.workspace', ['module' => 'psychiatry', 'visit' => $visit, 'tab' => 'overview']))
             ->assertOk()
             ->assertSee('view + refer')
             ->assertDontSee('consultation access')
@@ -758,7 +868,7 @@ class CareSpecialtyAccessTest extends TestCase
             ->getContent();
 
         $this->assertStringNotContainsString(
-            route('care.specialty.consultation.start', ['module' => 'cardiology', 'visit' => $visit], absolute: false),
+            route('care.specialty.consultation.start', ['module' => 'psychiatry', 'visit' => $visit], absolute: false),
             $html,
         );
         $this->assertStringNotContainsString('>Start</button>', $html);
@@ -809,9 +919,10 @@ class CareSpecialtyAccessTest extends TestCase
 
     public function test_nurse_can_save_emergency_vitals_with_vitals_manage(): void
     {
-        [$nurseUser, $nurseMember] = $this->makeStaff('nurse', 'er-vitals');
+        [$nurseUser, $nurseMember] = $this->makeStaff('ed_nurse', 'er-vitals');
         $this->assertTrue(app(\App\Services\Care\CarePermissions::class)->can($nurseMember, 'vitals.manage'));
         $this->assertFalse(app(\App\Services\Care\CarePermissions::class)->can($nurseMember, 'consultations.manage'));
+        $this->assertTrue($this->modules->memberCanManage($this->organization, $nurseMember, 'emergency'));
 
         $dept = Department::query()->where('type', 'emergency')->firstOrFail();
         $patient = Patient::create([
@@ -868,7 +979,7 @@ class CareSpecialtyAccessTest extends TestCase
 
     public function test_doctor_with_prescriptions_manage_sees_prescribe_on_specialty_workspace(): void
     {
-        [$doctorUser, $doctorMember, $visit] = $this->dentistryVisitForRole('doctor', 'den-rx');
+        [$doctorUser, $doctorMember, $visit] = $this->dentistryVisitForRole('dentist', 'den-rx');
         $appointment = $visit->appointment()->firstOrFail();
         $appointment->update([
             'status' => Appointment::STATUS_IN_CONSULTATION,
@@ -909,7 +1020,7 @@ class CareSpecialtyAccessTest extends TestCase
 
     public function test_nurse_without_prescriptions_manage_does_not_see_prescribe_cta(): void
     {
-        [$nurseUser, $nurseMember, $visit] = $this->dentistryVisitForRole('nurse', 'den-no-rx');
+        [$nurseUser, $nurseMember, $visit] = $this->emergencyVisitForRole('ed_nurse', 'er-no-rx');
         $appointment = $visit->appointment()->firstOrFail();
         $appointment->update([
             'status' => Appointment::STATUS_IN_CONSULTATION,
@@ -926,24 +1037,23 @@ class CareSpecialtyAccessTest extends TestCase
         ]);
 
         $permissions = app(\App\Services\Care\CarePermissions::class);
-        $this->assertTrue($this->modules->memberCanManage($this->organization, $nurseMember, 'dentistry'));
+        $this->assertTrue($this->modules->memberCanManage($this->organization, $nurseMember, 'emergency'));
         $this->assertFalse($permissions->can($nurseMember, 'prescriptions.manage'));
 
         $this->actingAs($nurseUser)
             ->get(route('care.specialty.workspace', [
-                'module' => 'dentistry',
+                'module' => 'emergency',
                 'visit' => $visit,
                 'tab' => 'overview',
             ]))
             ->assertOk()
             ->assertDontSee('Prescribe')
-            ->assertDontSee('New prescription')
-            ->assertDontSee(route('care.prescriptions.store', Consultation::query()->where('visit_id', $visit->id)->first(), absolute: false));
+            ->assertDontSee('New prescription');
     }
 
     public function test_specialty_prescribe_store_returns_to_workspace(): void
     {
-        [$doctorUser, , $visit] = $this->dentistryVisitForRole('doctor', 'den-rx-store');
+        [$doctorUser, , $visit] = $this->dentistryVisitForRole('dentist', 'den-rx-store');
         $appointment = $visit->appointment()->firstOrFail();
         $appointment->update([
             'status' => Appointment::STATUS_IN_CONSULTATION,