diff --git a/src/app/api/medications/extract/__tests__/route.test.ts b/src/app/api/medications/extract/__tests__/route.test.ts
index a570df213..34006be4a 100644
--- a/src/app/api/medications/extract/__tests__/route.test.ts
+++ b/src/app/api/medications/extract/__tests__/route.test.ts
@@ -43,6 +43,14 @@ vi.mock("@/lib/ai/provider", () => ({
   resolveProviderChain: vi.fn(async () => []),
 }));
 
+// v1.12.1 — free-text medication extraction egresses PHI to the operator's
+// server-managed key, so it now passes through the consent gate. Mock it to a
+// no-op here; the gate's own fail-closed behaviour is covered by
+// `consent-guard.test.ts`.
+vi.mock("@/lib/ai/consent-guard", () => ({
+  assertConsentForChain: vi.fn(async () => undefined),
+}));
+
 vi.mock("@/lib/ai/provider-runner", async () => {
   const actual =
     await vi.importActual<typeof import("@/lib/ai/provider-runner")>(
@@ -69,6 +77,7 @@ import {
   resolveProviderChain,
 } from "@/lib/ai/provider";
 import { runRawCompletionWithFallback } from "@/lib/ai/provider-runner";
+import { assertConsentForChain } from "@/lib/ai/consent-guard";
 
 function postReq(body: unknown): NextRequest {
   return new NextRequest("http://localhost/api/medications/extract", {
@@ -175,6 +184,11 @@ describe("POST /api/medications/extract — happy path", () => {
       doseUnit: "mg",
       cadenceKind: "everyNWeeks",
     });
+    // The PHI free-text egress is gated on an active consent receipt for the
+    // coach surface before the provider chain runs.
+    expect(assertConsentForChain).toHaveBeenCalledWith(
+      expect.objectContaining({ surface: "coach" }),
+    );
   });
 
   it("strips a hallucinated name that is absent from the user's text", async () => {
diff --git a/src/app/api/medications/extract/route.ts b/src/app/api/medications/extract/route.ts
index 34994079d..901456274 100644
--- a/src/app/api/medications/extract/route.ts
+++ b/src/app/api/medications/extract/route.ts
@@ -57,6 +57,7 @@ import {
   runRawCompletionWithFallback,
 } from "@/lib/ai/provider-runner";
 import { resolveProvider, resolveProviderChain } from "@/lib/ai/provider";
+import { assertConsentForChain } from "@/lib/ai/consent-guard";
 
 import {
   buildDateKey,
@@ -167,6 +168,11 @@ async function handleExtract(request: NextRequest): Promise<Response> {
     chain.push({ providerType: "admin-openai", instance: legacy });
   }
 
+  // Free-text medication input is PHI. If the resolved chain could egress
+  // via the operator's server-managed key, an active consent receipt is
+  // required first — same gate as the Coach (which shares this chain).
+  await assertConsentForChain({ userId, chain, surface: "coach" });
+
   const today = todayOverride ?? buildDateKey();
   const { systemPrompt, userPrompt } = buildMedicationExtractionPrompt({
     text,