diff --git a/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.01-mixed.json.snap b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.01-mixed.json.snap
new file mode 100644
index 000000000..436ec3020
--- /dev/null
+++ b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.01-mixed.json.snap
@@ -0,0 +1,701 @@
+{
+  "status": 200,
+  "body": {
+    "data": {
+      "processed": 18,
+      "inserted": 6,
+      "updated": 2,
+      "duplicates": 3,
+      "skipped": [
+        {
+          "index": 0,
+          "reason": "medication_not_found"
+        },
+        {
+          "index": 1,
+          "reason": "intake_not_tracked"
+        },
+        {
+          "index": 2,
+          "reason": "unstable_external_id"
+        },
+        {
+          "index": 5,
+          "reason": "force_slot_invalid"
+        },
+        {
+          "index": 6,
+          "reason": "force_slot_occupied"
+        },
+        {
+          "index": 12,
+          "reason": "injection_site_not_allowed"
+        },
+        {
+          "index": 16,
+          "reason": "unstable_external_id"
+        }
+      ],
+      "entries": [
+        {
+          "index": 0,
+          "status": "skipped",
+          "reason": "medication_not_found"
+        },
+        {
+          "index": 1,
+          "status": "skipped",
+          "reason": "intake_not_tracked"
+        },
+        {
+          "index": 2,
+          "status": "skipped",
+          "reason": "unstable_external_id"
+        },
+        {
+          "index": 3,
+          "status": "updated",
+          "id": "<id:1>"
+        },
+        {
+          "index": 4,
+          "status": "inserted",
+          "id": "<id:2>"
+        },
+        {
+          "index": 5,
+          "status": "skipped",
+          "reason": "force_slot_invalid"
+        },
+        {
+          "index": 6,
+          "status": "skipped",
+          "reason": "force_slot_occupied"
+        },
+        {
+          "index": 7,
+          "status": "inserted",
+          "id": "<id:3>"
+        },
+        {
+          "index": 8,
+          "status": "duplicate",
+          "id": "<id:4>"
+        },
+        {
+          "index": 9,
+          "status": "inserted",
+          "id": "<id:5>"
+        },
+        {
+          "index": 10,
+          "status": "inserted",
+          "id": "<id:6>"
+        },
+        {
+          "index": 11,
+          "status": "duplicate",
+          "id": "<id:6>"
+        },
+        {
+          "index": 12,
+          "status": "skipped",
+          "reason": "injection_site_not_allowed"
+        },
+        {
+          "index": 13,
+          "status": "inserted",
+          "id": "<id:7>"
+        },
+        {
+          "index": 14,
+          "status": "duplicate",
+          "id": "<id:7>"
+        },
+        {
+          "index": 15,
+          "status": "inserted",
+          "id": "<id:8>"
+        },
+        {
+          "index": 16,
+          "status": "skipped",
+          "reason": "unstable_external_id"
+        },
+        {
+          "index": 17,
+          "status": "updated",
+          "id": "<id:6>"
+        }
+      ]
+    },
+    "error": null
+  },
+  "events": [
+    {
+      "status": 200,
+      "action": {
+        "name": "medications.intake.bulk.ingest"
+      },
+      "meta": {
+        "write_bucket": "own",
+        "medication_id": "<id:9>",
+        "units": 0,
+        "item_ids": [],
+        "auto_opened": 0,
+        "processed": 18,
+        "inserted": 6,
+        "updated": 2,
+        "duplicates": 3,
+        "skipped": 7,
+        "extra_doses_unscheduled": 1,
+        "external_id_rejected": 2,
+        "external_id_shapes": "object_description",
+        "external_id_surface": "medication.intake.bulk",
+        "sync_checkpoint_at": "<now>"
+      },
+      "warnings": null,
+      "error": null
+    }
+  ],
+  "effects": [
+    {
+      "effect": "queueMedicationIntakeSync",
+      "args": [
+        {
+          "userId": "<id:10>",
+          "originDeviceToken": null
+        }
+      ]
+    },
+    {
+      "effect": "countOutstandingDosesToday",
+      "args": [
+        "<id:10>",
+        "UTC"
+      ]
+    },
+    {
+      "effect": "dispatchMedicationIntakeWebClearBulk",
+      "args": [
+        {
+          "userId": "<id:10>",
+          "slots": [
+            {
+              "medicationId": "<id:11>",
+              "scheduledFor": "2026-10-15T08:00:00.000Z"
+            },
+            {
+              "medicationId": "<id:11>",
+              "scheduledFor": "2026-10-13T08:00:00.000Z"
+            },
+            {
+              "medicationId": "<id:11>",
+              "scheduledFor": "2026-10-15T20:00:00.000Z"
+            },
+            {
+              "medicationId": "<id:11>",
+              "scheduledFor": "2026-10-16T08:00:00.000Z"
+            },
+            {
+              "medicationId": "<id:12>",
+              "scheduledFor": "2026-10-15T10:00:00.000Z"
+            },
+            {
+              "medicationId": "<id:9>",
+              "scheduledFor": "2026-10-15T09:00:00.000Z"
+            },
+            {
+              "medicationId": "<id:9>",
+              "scheduledFor": "2026-10-14T09:30:00.000Z"
+            }
+          ],
+          "badgeCount": 2
+        }
+      ]
+    }
+  ],
+  "stored": {
+    "medications": [
+      {
+        "id": "<id:9>",
+        "userId": "<id:10>",
+        "name": "Apple mirror",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": "APPLE_HEALTH",
+        "externalId": "hk-concept-0001",
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:12>",
+        "userId": "<id:10>",
+        "name": "As-needed pen",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": true,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "INJECTION",
+        "trackInjectionSites": true,
+        "allowedInjectionSites": [
+          "ABDOMEN_LEFT",
+          "ABDOMEN_RIGHT"
+        ],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:13>",
+        "userId": "<id:10>",
+        "name": "Record only",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": false,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:11>",
+        "userId": "<id:10>",
+        "name": "Twice daily",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "schedules": [
+      {
+        "id": "<id:14>",
+        "medicationId": "<id:13>",
+        "windowStart": "07:00",
+        "windowEnd": "08:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "07:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:15>",
+        "medicationId": "<id:11>",
+        "windowStart": "08:00",
+        "windowEnd": "10:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "08:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:16>",
+        "medicationId": "<id:9>",
+        "windowStart": "09:00",
+        "windowEnd": "11:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "09:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:17>",
+        "medicationId": "<id:11>",
+        "windowStart": "20:00",
+        "windowEnd": "22:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "20:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      }
+    ],
+    "revisions": [],
+    "pauseEras": [],
+    "courses": [],
+    "intakes": [
+      {
+        "id": "<id:2>",
+        "userId": "<id:10>",
+        "medicationId": "<id:11>",
+        "scheduledFor": "2026-10-13T08:00:00.000Z",
+        "takenAt": "2026-10-13T11:00:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "USER_PIN",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:18>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:19>",
+        "userId": "<id:10>",
+        "medicationId": "<id:9>",
+        "scheduledFor": "2026-10-14T09:00:00.000Z",
+        "takenAt": "2026-10-14T09:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": "hk-dose-0000",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:8>",
+        "userId": "<id:10>",
+        "medicationId": "<id:9>",
+        "scheduledFor": "2026-10-14T09:30:00.000Z",
+        "takenAt": "2026-10-14T09:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0002",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:4>",
+        "userId": "<id:10>",
+        "medicationId": "<id:11>",
+        "scheduledFor": "2026-10-14T20:00:00.000Z",
+        "takenAt": "2026-10-14T20:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:1>",
+        "userId": "<id:10>",
+        "medicationId": "<id:11>",
+        "scheduledFor": "2026-10-15T08:00:00.000Z",
+        "takenAt": "2026-10-15T08:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:18>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:7>",
+        "userId": "<id:10>",
+        "medicationId": "<id:9>",
+        "scheduledFor": "2026-10-15T09:00:00.000Z",
+        "takenAt": "2026-10-15T09:20:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0001",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:6>",
+        "userId": "<id:10>",
+        "medicationId": "<id:12>",
+        "scheduledFor": "2026-10-15T10:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": "bulk-key-0001",
+        "createdAt": "<createdAt>",
+        "injectionSite": "ABDOMEN_LEFT",
+        "doseTaken": "0.5 pen",
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:3>",
+        "userId": "<id:10>",
+        "medicationId": "<id:11>",
+        "scheduledFor": "2026-10-15T20:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:5>",
+        "userId": "<id:10>",
+        "medicationId": "<id:11>",
+        "scheduledFor": "2026-10-16T08:00:00.000Z",
+        "takenAt": null,
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      }
+    ],
+    "doseChanges": [],
+    "inventoryItems": [
+      {
+        "id": "<id:18>",
+        "userId": "<id:10>",
+        "medicationId": "<id:11>",
+        "state": "IN_USE",
+        "containerType": "OTHER",
+        "unitsTotal": "30",
+        "unitsRemaining": "28",
+        "firstUseAt": "2026-10-15T08:30:00.000Z",
+        "expiresAt": null,
+        "printedExpiry": null,
+        "purchasedAt": "2026-10-01T06:00:00.000Z",
+        "manufacturer": null,
+        "doseStrength": null,
+        "notes": null,
+        "notesEncrypted": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "inventoryEvents": [],
+    "categories": [],
+    "ingredients": [],
+    "audit": [
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:10>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 6,
+          "updated": 2,
+          "duplicates": 3,
+          "skipped": 7
+        },
+        "ipAddress": null
+      }
+    ],
+    "idempotency": []
+  },
+  "extra": {
+    "lastSyncedAt": "<now>",
+    "arrivals": [
+      {
+        "type": "MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": "foreground",
+        "lastNewSampleAt": "<now>",
+        "lastBackgroundAt": null,
+        "lastSeenDuplicateAt": null
+      }
+    ]
+  }
+}
diff --git a/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.02-mixed-again.json.snap b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.02-mixed-again.json.snap
new file mode 100644
index 000000000..3cb7d5b8a
--- /dev/null
+++ b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.02-mixed-again.json.snap
@@ -0,0 +1,702 @@
+{
+  "status": 200,
+  "body": {
+    "data": {
+      "processed": 18,
+      "inserted": 0,
+      "updated": 5,
+      "duplicates": 6,
+      "skipped": [
+        {
+          "index": 0,
+          "reason": "medication_not_found"
+        },
+        {
+          "index": 1,
+          "reason": "intake_not_tracked"
+        },
+        {
+          "index": 2,
+          "reason": "unstable_external_id"
+        },
+        {
+          "index": 5,
+          "reason": "force_slot_invalid"
+        },
+        {
+          "index": 6,
+          "reason": "force_slot_occupied"
+        },
+        {
+          "index": 12,
+          "reason": "injection_site_not_allowed"
+        },
+        {
+          "index": 16,
+          "reason": "unstable_external_id"
+        }
+      ],
+      "entries": [
+        {
+          "index": 0,
+          "status": "skipped",
+          "reason": "medication_not_found"
+        },
+        {
+          "index": 1,
+          "status": "skipped",
+          "reason": "intake_not_tracked"
+        },
+        {
+          "index": 2,
+          "status": "skipped",
+          "reason": "unstable_external_id"
+        },
+        {
+          "index": 3,
+          "status": "updated",
+          "id": "<id:1>"
+        },
+        {
+          "index": 4,
+          "status": "updated",
+          "id": "<id:2>"
+        },
+        {
+          "index": 5,
+          "status": "skipped",
+          "reason": "force_slot_invalid"
+        },
+        {
+          "index": 6,
+          "status": "skipped",
+          "reason": "force_slot_occupied"
+        },
+        {
+          "index": 7,
+          "status": "updated",
+          "id": "<id:3>"
+        },
+        {
+          "index": 8,
+          "status": "duplicate",
+          "id": "<id:4>"
+        },
+        {
+          "index": 9,
+          "status": "updated",
+          "id": "<id:5>"
+        },
+        {
+          "index": 10,
+          "status": "duplicate",
+          "id": "<id:6>"
+        },
+        {
+          "index": 11,
+          "status": "duplicate",
+          "id": "<id:6>"
+        },
+        {
+          "index": 12,
+          "status": "skipped",
+          "reason": "injection_site_not_allowed"
+        },
+        {
+          "index": 13,
+          "status": "duplicate",
+          "id": "<id:7>"
+        },
+        {
+          "index": 14,
+          "status": "duplicate",
+          "id": "<id:7>"
+        },
+        {
+          "index": 15,
+          "status": "duplicate",
+          "id": "<id:8>"
+        },
+        {
+          "index": 16,
+          "status": "skipped",
+          "reason": "unstable_external_id"
+        },
+        {
+          "index": 17,
+          "status": "updated",
+          "id": "<id:6>"
+        }
+      ]
+    },
+    "error": null
+  },
+  "events": [
+    {
+      "status": 200,
+      "action": {
+        "name": "medications.intake.bulk.ingest"
+      },
+      "meta": {
+        "write_bucket": "own",
+        "processed": 18,
+        "inserted": 0,
+        "updated": 5,
+        "duplicates": 6,
+        "skipped": 7,
+        "extra_doses_unscheduled": 0,
+        "external_id_rejected": 2,
+        "external_id_shapes": "object_description",
+        "external_id_surface": "medication.intake.bulk",
+        "sync_checkpoint_at": "<now>"
+      },
+      "warnings": null,
+      "error": null
+    }
+  ],
+  "effects": [
+    {
+      "effect": "queueMedicationIntakeSync",
+      "args": [
+        {
+          "userId": "<id:9>",
+          "originDeviceToken": null
+        }
+      ]
+    },
+    {
+      "effect": "countOutstandingDosesToday",
+      "args": [
+        "<id:9>",
+        "UTC"
+      ]
+    },
+    {
+      "effect": "dispatchMedicationIntakeWebClearBulk",
+      "args": [
+        {
+          "userId": "<id:9>",
+          "slots": [
+            {
+              "medicationId": "<id:10>",
+              "scheduledFor": "2026-10-15T08:00:00.000Z"
+            },
+            {
+              "medicationId": "<id:10>",
+              "scheduledFor": "2026-10-13T08:00:00.000Z"
+            },
+            {
+              "medicationId": "<id:10>",
+              "scheduledFor": "2026-10-15T20:00:00.000Z"
+            },
+            {
+              "medicationId": "<id:10>",
+              "scheduledFor": "2026-10-16T08:00:00.000Z"
+            },
+            {
+              "medicationId": "<id:11>",
+              "scheduledFor": "2026-10-15T10:00:00.000Z"
+            }
+          ],
+          "badgeCount": 2
+        }
+      ]
+    }
+  ],
+  "stored": {
+    "medications": [
+      {
+        "id": "<id:12>",
+        "userId": "<id:9>",
+        "name": "Apple mirror",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": "APPLE_HEALTH",
+        "externalId": "hk-concept-0001",
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:11>",
+        "userId": "<id:9>",
+        "name": "As-needed pen",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": true,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "INJECTION",
+        "trackInjectionSites": true,
+        "allowedInjectionSites": [
+          "ABDOMEN_LEFT",
+          "ABDOMEN_RIGHT"
+        ],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:13>",
+        "userId": "<id:9>",
+        "name": "Record only",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": false,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:10>",
+        "userId": "<id:9>",
+        "name": "Twice daily",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "schedules": [
+      {
+        "id": "<id:14>",
+        "medicationId": "<id:13>",
+        "windowStart": "07:00",
+        "windowEnd": "08:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "07:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:15>",
+        "medicationId": "<id:10>",
+        "windowStart": "08:00",
+        "windowEnd": "10:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "08:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:16>",
+        "medicationId": "<id:12>",
+        "windowStart": "09:00",
+        "windowEnd": "11:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "09:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:17>",
+        "medicationId": "<id:10>",
+        "windowStart": "20:00",
+        "windowEnd": "22:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "20:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      }
+    ],
+    "revisions": [],
+    "pauseEras": [],
+    "courses": [],
+    "intakes": [
+      {
+        "id": "<id:2>",
+        "userId": "<id:9>",
+        "medicationId": "<id:10>",
+        "scheduledFor": "2026-10-13T08:00:00.000Z",
+        "takenAt": "2026-10-13T11:00:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "USER_PIN",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:18>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:19>",
+        "userId": "<id:9>",
+        "medicationId": "<id:12>",
+        "scheduledFor": "2026-10-14T09:00:00.000Z",
+        "takenAt": "2026-10-14T09:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": "hk-dose-0000",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:8>",
+        "userId": "<id:9>",
+        "medicationId": "<id:12>",
+        "scheduledFor": "2026-10-14T09:30:00.000Z",
+        "takenAt": "2026-10-14T09:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0002",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:4>",
+        "userId": "<id:9>",
+        "medicationId": "<id:10>",
+        "scheduledFor": "2026-10-14T20:00:00.000Z",
+        "takenAt": "2026-10-14T20:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:1>",
+        "userId": "<id:9>",
+        "medicationId": "<id:10>",
+        "scheduledFor": "2026-10-15T08:00:00.000Z",
+        "takenAt": "2026-10-15T08:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:18>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:7>",
+        "userId": "<id:9>",
+        "medicationId": "<id:12>",
+        "scheduledFor": "2026-10-15T09:00:00.000Z",
+        "takenAt": "2026-10-15T09:20:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0001",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:6>",
+        "userId": "<id:9>",
+        "medicationId": "<id:11>",
+        "scheduledFor": "2026-10-15T10:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": "bulk-key-0001",
+        "createdAt": "<createdAt>",
+        "injectionSite": "ABDOMEN_LEFT",
+        "doseTaken": "0.5 pen",
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:3>",
+        "userId": "<id:9>",
+        "medicationId": "<id:10>",
+        "scheduledFor": "2026-10-15T20:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:5>",
+        "userId": "<id:9>",
+        "medicationId": "<id:10>",
+        "scheduledFor": "2026-10-16T08:00:00.000Z",
+        "takenAt": null,
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      }
+    ],
+    "doseChanges": [],
+    "inventoryItems": [
+      {
+        "id": "<id:18>",
+        "userId": "<id:9>",
+        "medicationId": "<id:10>",
+        "state": "IN_USE",
+        "containerType": "OTHER",
+        "unitsTotal": "30",
+        "unitsRemaining": "28",
+        "firstUseAt": "2026-10-15T08:30:00.000Z",
+        "expiresAt": null,
+        "printedExpiry": null,
+        "purchasedAt": "2026-10-01T06:00:00.000Z",
+        "manufacturer": null,
+        "doseStrength": null,
+        "notes": null,
+        "notesEncrypted": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "inventoryEvents": [],
+    "categories": [],
+    "ingredients": [],
+    "audit": [
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:9>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 0,
+          "updated": 5,
+          "duplicates": 6,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:9>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 6,
+          "updated": 2,
+          "duplicates": 3,
+          "skipped": 7
+        },
+        "ipAddress": null
+      }
+    ],
+    "idempotency": []
+  },
+  "extra": {
+    "lastSyncedAt": "<now>",
+    "arrivals": [
+      {
+        "type": "MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": "foreground",
+        "lastNewSampleAt": "<now>",
+        "lastBackgroundAt": null,
+        "lastSeenDuplicateAt": "<now>"
+      }
+    ]
+  }
+}
diff --git a/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.03a-background.json.snap b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.03a-background.json.snap
new file mode 100644
index 000000000..eebf4724a
--- /dev/null
+++ b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.03a-background.json.snap
@@ -0,0 +1,607 @@
+{
+  "status": 200,
+  "body": {
+    "data": {
+      "processed": 1,
+      "inserted": 1,
+      "updated": 0,
+      "duplicates": 0,
+      "skipped": [],
+      "entries": [
+        {
+          "index": 0,
+          "status": "inserted",
+          "id": "<id:1>"
+        }
+      ]
+    },
+    "error": null
+  },
+  "events": [
+    {
+      "status": 200,
+      "action": {
+        "name": "medications.intake.bulk.ingest"
+      },
+      "meta": {
+        "write_bucket": "own",
+        "medication_id": "<id:2>",
+        "units": 0,
+        "item_ids": [],
+        "auto_opened": 0,
+        "processed": 1,
+        "inserted": 1,
+        "updated": 0,
+        "duplicates": 0,
+        "skipped": 0,
+        "extra_doses_unscheduled": 0,
+        "sync_checkpoint_at": "<now>"
+      },
+      "warnings": null,
+      "error": null
+    }
+  ],
+  "effects": [
+    {
+      "effect": "queueMedicationIntakeSync",
+      "args": [
+        {
+          "userId": "<id:3>",
+          "originDeviceToken": null
+        }
+      ]
+    },
+    {
+      "effect": "countOutstandingDosesToday",
+      "args": [
+        "<id:3>",
+        "UTC"
+      ]
+    },
+    {
+      "effect": "dispatchMedicationIntakeWebClearBulk",
+      "args": [
+        {
+          "userId": "<id:3>",
+          "slots": [
+            {
+              "medicationId": "<id:2>",
+              "scheduledFor": "2026-10-13T09:00:00.000Z"
+            }
+          ],
+          "badgeCount": 2
+        }
+      ]
+    }
+  ],
+  "stored": {
+    "medications": [
+      {
+        "id": "<id:2>",
+        "userId": "<id:3>",
+        "name": "Apple mirror",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": "APPLE_HEALTH",
+        "externalId": "hk-concept-0001",
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:4>",
+        "userId": "<id:3>",
+        "name": "As-needed pen",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": true,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "INJECTION",
+        "trackInjectionSites": true,
+        "allowedInjectionSites": [
+          "ABDOMEN_LEFT",
+          "ABDOMEN_RIGHT"
+        ],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:5>",
+        "userId": "<id:3>",
+        "name": "Record only",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": false,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:6>",
+        "userId": "<id:3>",
+        "name": "Twice daily",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "schedules": [
+      {
+        "id": "<id:7>",
+        "medicationId": "<id:5>",
+        "windowStart": "07:00",
+        "windowEnd": "08:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "07:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:8>",
+        "medicationId": "<id:6>",
+        "windowStart": "08:00",
+        "windowEnd": "10:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "08:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:9>",
+        "medicationId": "<id:2>",
+        "windowStart": "09:00",
+        "windowEnd": "11:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "09:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:10>",
+        "medicationId": "<id:6>",
+        "windowStart": "20:00",
+        "windowEnd": "22:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "20:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      }
+    ],
+    "revisions": [],
+    "pauseEras": [],
+    "courses": [],
+    "intakes": [
+      {
+        "id": "<id:11>",
+        "userId": "<id:3>",
+        "medicationId": "<id:6>",
+        "scheduledFor": "2026-10-13T08:00:00.000Z",
+        "takenAt": "2026-10-13T11:00:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "USER_PIN",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:12>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:1>",
+        "userId": "<id:3>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-13T09:00:00.000Z",
+        "takenAt": "2026-10-13T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0003",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:13>",
+        "userId": "<id:3>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-14T09:00:00.000Z",
+        "takenAt": "2026-10-14T09:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": "hk-dose-0000",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:14>",
+        "userId": "<id:3>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-14T09:30:00.000Z",
+        "takenAt": "2026-10-14T09:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0002",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:15>",
+        "userId": "<id:3>",
+        "medicationId": "<id:6>",
+        "scheduledFor": "2026-10-14T20:00:00.000Z",
+        "takenAt": "2026-10-14T20:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:16>",
+        "userId": "<id:3>",
+        "medicationId": "<id:6>",
+        "scheduledFor": "2026-10-15T08:00:00.000Z",
+        "takenAt": "2026-10-15T08:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:12>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:17>",
+        "userId": "<id:3>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-15T09:00:00.000Z",
+        "takenAt": "2026-10-15T09:20:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0001",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:18>",
+        "userId": "<id:3>",
+        "medicationId": "<id:4>",
+        "scheduledFor": "2026-10-15T10:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": "bulk-key-0001",
+        "createdAt": "<createdAt>",
+        "injectionSite": "ABDOMEN_LEFT",
+        "doseTaken": "0.5 pen",
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:19>",
+        "userId": "<id:3>",
+        "medicationId": "<id:6>",
+        "scheduledFor": "2026-10-15T20:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:20>",
+        "userId": "<id:3>",
+        "medicationId": "<id:6>",
+        "scheduledFor": "2026-10-16T08:00:00.000Z",
+        "takenAt": null,
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      }
+    ],
+    "doseChanges": [],
+    "inventoryItems": [
+      {
+        "id": "<id:12>",
+        "userId": "<id:3>",
+        "medicationId": "<id:6>",
+        "state": "IN_USE",
+        "containerType": "OTHER",
+        "unitsTotal": "30",
+        "unitsRemaining": "28",
+        "firstUseAt": "2026-10-15T08:30:00.000Z",
+        "expiresAt": null,
+        "printedExpiry": null,
+        "purchasedAt": "2026-10-01T06:00:00.000Z",
+        "manufacturer": null,
+        "doseStrength": null,
+        "notes": null,
+        "notesEncrypted": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "inventoryEvents": [],
+    "categories": [],
+    "ingredients": [],
+    "audit": [
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:3>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:3>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 0,
+          "updated": 5,
+          "duplicates": 6,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:3>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 6,
+          "updated": 2,
+          "duplicates": 3,
+          "skipped": 7
+        },
+        "ipAddress": null
+      }
+    ],
+    "idempotency": []
+  },
+  "extra": {
+    "lastSyncedAt": "<now>",
+    "arrivals": [
+      {
+        "type": "MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": "background",
+        "lastNewSampleAt": "<now>",
+        "lastBackgroundAt": "<now>",
+        "lastSeenDuplicateAt": "<now>"
+      }
+    ]
+  }
+}
diff --git a/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.03b-backfill.json.snap b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.03b-backfill.json.snap
new file mode 100644
index 000000000..628b2b978
--- /dev/null
+++ b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.03b-backfill.json.snap
@@ -0,0 +1,648 @@
+{
+  "status": 200,
+  "body": {
+    "data": {
+      "processed": 1,
+      "inserted": 1,
+      "updated": 0,
+      "duplicates": 0,
+      "skipped": [],
+      "entries": [
+        {
+          "index": 0,
+          "status": "inserted",
+          "id": "<id:1>"
+        }
+      ]
+    },
+    "error": null
+  },
+  "events": [
+    {
+      "status": 200,
+      "action": {
+        "name": "medications.intake.bulk.ingest"
+      },
+      "meta": {
+        "write_bucket": "own",
+        "medication_id": "<id:2>",
+        "units": 0,
+        "item_ids": [],
+        "auto_opened": 0,
+        "processed": 1,
+        "inserted": 1,
+        "updated": 0,
+        "duplicates": 0,
+        "skipped": 0,
+        "extra_doses_unscheduled": 0
+      },
+      "warnings": null,
+      "error": null
+    }
+  ],
+  "effects": [
+    {
+      "effect": "queueMedicationIntakeSync",
+      "args": [
+        {
+          "userId": "<id:3>",
+          "originDeviceToken": null
+        }
+      ]
+    },
+    {
+      "effect": "countOutstandingDosesToday",
+      "args": [
+        "<id:3>",
+        "UTC"
+      ]
+    },
+    {
+      "effect": "dispatchMedicationIntakeWebClearBulk",
+      "args": [
+        {
+          "userId": "<id:3>",
+          "slots": [
+            {
+              "medicationId": "<id:2>",
+              "scheduledFor": "2026-10-12T09:00:00.000Z"
+            }
+          ],
+          "badgeCount": 2
+        }
+      ]
+    }
+  ],
+  "stored": {
+    "medications": [
+      {
+        "id": "<id:2>",
+        "userId": "<id:3>",
+        "name": "Apple mirror",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": "APPLE_HEALTH",
+        "externalId": "hk-concept-0001",
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:4>",
+        "userId": "<id:3>",
+        "name": "As-needed pen",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": true,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "INJECTION",
+        "trackInjectionSites": true,
+        "allowedInjectionSites": [
+          "ABDOMEN_LEFT",
+          "ABDOMEN_RIGHT"
+        ],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:5>",
+        "userId": "<id:3>",
+        "name": "Record only",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": false,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:6>",
+        "userId": "<id:3>",
+        "name": "Twice daily",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "schedules": [
+      {
+        "id": "<id:7>",
+        "medicationId": "<id:5>",
+        "windowStart": "07:00",
+        "windowEnd": "08:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "07:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:8>",
+        "medicationId": "<id:6>",
+        "windowStart": "08:00",
+        "windowEnd": "10:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "08:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:9>",
+        "medicationId": "<id:2>",
+        "windowStart": "09:00",
+        "windowEnd": "11:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "09:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:10>",
+        "medicationId": "<id:6>",
+        "windowStart": "20:00",
+        "windowEnd": "22:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "20:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      }
+    ],
+    "revisions": [],
+    "pauseEras": [],
+    "courses": [],
+    "intakes": [
+      {
+        "id": "<id:1>",
+        "userId": "<id:3>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-12T09:00:00.000Z",
+        "takenAt": "2026-10-12T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0004",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:11>",
+        "userId": "<id:3>",
+        "medicationId": "<id:6>",
+        "scheduledFor": "2026-10-13T08:00:00.000Z",
+        "takenAt": "2026-10-13T11:00:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "USER_PIN",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:12>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:13>",
+        "userId": "<id:3>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-13T09:00:00.000Z",
+        "takenAt": "2026-10-13T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0003",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:14>",
+        "userId": "<id:3>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-14T09:00:00.000Z",
+        "takenAt": "2026-10-14T09:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": "hk-dose-0000",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:15>",
+        "userId": "<id:3>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-14T09:30:00.000Z",
+        "takenAt": "2026-10-14T09:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0002",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:16>",
+        "userId": "<id:3>",
+        "medicationId": "<id:6>",
+        "scheduledFor": "2026-10-14T20:00:00.000Z",
+        "takenAt": "2026-10-14T20:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:17>",
+        "userId": "<id:3>",
+        "medicationId": "<id:6>",
+        "scheduledFor": "2026-10-15T08:00:00.000Z",
+        "takenAt": "2026-10-15T08:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:12>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:18>",
+        "userId": "<id:3>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-15T09:00:00.000Z",
+        "takenAt": "2026-10-15T09:20:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0001",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:19>",
+        "userId": "<id:3>",
+        "medicationId": "<id:4>",
+        "scheduledFor": "2026-10-15T10:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": "bulk-key-0001",
+        "createdAt": "<createdAt>",
+        "injectionSite": "ABDOMEN_LEFT",
+        "doseTaken": "0.5 pen",
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:20>",
+        "userId": "<id:3>",
+        "medicationId": "<id:6>",
+        "scheduledFor": "2026-10-15T20:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:21>",
+        "userId": "<id:3>",
+        "medicationId": "<id:6>",
+        "scheduledFor": "2026-10-16T08:00:00.000Z",
+        "takenAt": null,
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      }
+    ],
+    "doseChanges": [],
+    "inventoryItems": [
+      {
+        "id": "<id:12>",
+        "userId": "<id:3>",
+        "medicationId": "<id:6>",
+        "state": "IN_USE",
+        "containerType": "OTHER",
+        "unitsTotal": "30",
+        "unitsRemaining": "28",
+        "firstUseAt": "2026-10-15T08:30:00.000Z",
+        "expiresAt": null,
+        "printedExpiry": null,
+        "purchasedAt": "2026-10-01T06:00:00.000Z",
+        "manufacturer": null,
+        "doseStrength": null,
+        "notes": null,
+        "notesEncrypted": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "inventoryEvents": [],
+    "categories": [],
+    "ingredients": [],
+    "audit": [
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:3>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:3>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:3>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 0,
+          "updated": 5,
+          "duplicates": 6,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:3>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 6,
+          "updated": 2,
+          "duplicates": 3,
+          "skipped": 7
+        },
+        "ipAddress": null
+      }
+    ],
+    "idempotency": []
+  },
+  "extra": {
+    "lastSyncedAt": "<now>",
+    "arrivals": [
+      {
+        "type": "MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": "background",
+        "lastNewSampleAt": "<now>",
+        "lastBackgroundAt": "<now>",
+        "lastSeenDuplicateAt": "<now>"
+      },
+      {
+        "type": "backfill:MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": null,
+        "lastNewSampleAt": null,
+        "lastBackgroundAt": null,
+        "lastSeenDuplicateAt": null
+      }
+    ]
+  }
+}
diff --git a/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.04a-too-large.json.snap b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.04a-too-large.json.snap
new file mode 100644
index 000000000..3b6ab3db5
--- /dev/null
+++ b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.04a-too-large.json.snap
@@ -0,0 +1,595 @@
+{
+  "status": 422,
+  "body": {
+    "data": null,
+    "error": "Batch exceeds the 500-entry limit",
+    "meta": {
+      "errorCode": "medications.intake.bulk.too_large",
+      "requestId": "<requestId>"
+    }
+  },
+  "events": [
+    {
+      "status": 422,
+      "action": null,
+      "meta": {
+        "write_bucket": "own"
+      },
+      "warnings": null,
+      "error": null
+    }
+  ],
+  "effects": [],
+  "stored": {
+    "medications": [
+      {
+        "id": "<id:1>",
+        "userId": "<id:2>",
+        "name": "Apple mirror",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": "APPLE_HEALTH",
+        "externalId": "hk-concept-0001",
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:3>",
+        "userId": "<id:2>",
+        "name": "As-needed pen",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": true,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "INJECTION",
+        "trackInjectionSites": true,
+        "allowedInjectionSites": [
+          "ABDOMEN_LEFT",
+          "ABDOMEN_RIGHT"
+        ],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:4>",
+        "userId": "<id:2>",
+        "name": "Record only",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": false,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:5>",
+        "userId": "<id:2>",
+        "name": "Twice daily",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "schedules": [
+      {
+        "id": "<id:6>",
+        "medicationId": "<id:4>",
+        "windowStart": "07:00",
+        "windowEnd": "08:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "07:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:7>",
+        "medicationId": "<id:5>",
+        "windowStart": "08:00",
+        "windowEnd": "10:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "08:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:8>",
+        "medicationId": "<id:1>",
+        "windowStart": "09:00",
+        "windowEnd": "11:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "09:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:9>",
+        "medicationId": "<id:5>",
+        "windowStart": "20:00",
+        "windowEnd": "22:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "20:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      }
+    ],
+    "revisions": [],
+    "pauseEras": [],
+    "courses": [],
+    "intakes": [
+      {
+        "id": "<id:10>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-12T09:00:00.000Z",
+        "takenAt": "2026-10-12T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0004",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:11>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-13T08:00:00.000Z",
+        "takenAt": "2026-10-13T11:00:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "USER_PIN",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:12>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:13>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-13T09:00:00.000Z",
+        "takenAt": "2026-10-13T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0003",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:14>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-14T09:00:00.000Z",
+        "takenAt": "2026-10-14T09:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": "hk-dose-0000",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:15>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-14T09:30:00.000Z",
+        "takenAt": "2026-10-14T09:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0002",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:16>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-14T20:00:00.000Z",
+        "takenAt": "2026-10-14T20:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:17>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-15T08:00:00.000Z",
+        "takenAt": "2026-10-15T08:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:12>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:18>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-15T09:00:00.000Z",
+        "takenAt": "2026-10-15T09:20:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0001",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:19>",
+        "userId": "<id:2>",
+        "medicationId": "<id:3>",
+        "scheduledFor": "2026-10-15T10:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": "bulk-key-0001",
+        "createdAt": "<createdAt>",
+        "injectionSite": "ABDOMEN_LEFT",
+        "doseTaken": "0.5 pen",
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:20>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-15T20:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:21>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-16T08:00:00.000Z",
+        "takenAt": null,
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      }
+    ],
+    "doseChanges": [],
+    "inventoryItems": [
+      {
+        "id": "<id:12>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "state": "IN_USE",
+        "containerType": "OTHER",
+        "unitsTotal": "30",
+        "unitsRemaining": "28",
+        "firstUseAt": "2026-10-15T08:30:00.000Z",
+        "expiresAt": null,
+        "printedExpiry": null,
+        "purchasedAt": "2026-10-01T06:00:00.000Z",
+        "manufacturer": null,
+        "doseStrength": null,
+        "notes": null,
+        "notesEncrypted": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "inventoryEvents": [],
+    "categories": [],
+    "ingredients": [],
+    "audit": [
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 0,
+          "updated": 5,
+          "duplicates": 6,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 6,
+          "updated": 2,
+          "duplicates": 3,
+          "skipped": 7
+        },
+        "ipAddress": null
+      }
+    ],
+    "idempotency": []
+  },
+  "extra": {
+    "lastSyncedAt": "<now>",
+    "arrivals": [
+      {
+        "type": "MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": "background",
+        "lastNewSampleAt": "<now>",
+        "lastBackgroundAt": "<now>",
+        "lastSeenDuplicateAt": "<now>"
+      },
+      {
+        "type": "backfill:MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": null,
+        "lastNewSampleAt": null,
+        "lastBackgroundAt": null,
+        "lastSeenDuplicateAt": null
+      }
+    ]
+  }
+}
diff --git a/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.04b-invalid.json.snap b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.04b-invalid.json.snap
new file mode 100644
index 000000000..4d2dad010
--- /dev/null
+++ b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.04b-invalid.json.snap
@@ -0,0 +1,630 @@
+{
+  "status": 422,
+  "body": {
+    "data": null,
+    "error": "Validation failed",
+    "details": {
+      "issues": [
+        {
+          "path": "entries.0.medicationId",
+          "code": "too_small",
+          "message": "Too small: expected string to have >=1 characters"
+        },
+        {
+          "path": "entries.0.takenAt",
+          "code": "invalid_format",
+          "message": "Invalid ISO datetime"
+        }
+      ]
+    },
+    "meta": {
+      "errorCode": "medications.intake.bulk.invalid",
+      "requestId": "<requestId>"
+    }
+  },
+  "events": [
+    {
+      "status": 422,
+      "action": {
+        "name": "medications.intake.bulk.validation-failed"
+      },
+      "meta": {
+        "write_bucket": "own",
+        "issue_count": 2
+      },
+      "warnings": null,
+      "error": null
+    }
+  ],
+  "effects": [],
+  "stored": {
+    "medications": [
+      {
+        "id": "<id:1>",
+        "userId": "<id:2>",
+        "name": "Apple mirror",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": "APPLE_HEALTH",
+        "externalId": "hk-concept-0001",
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:3>",
+        "userId": "<id:2>",
+        "name": "As-needed pen",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": true,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "INJECTION",
+        "trackInjectionSites": true,
+        "allowedInjectionSites": [
+          "ABDOMEN_LEFT",
+          "ABDOMEN_RIGHT"
+        ],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:4>",
+        "userId": "<id:2>",
+        "name": "Record only",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": false,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:5>",
+        "userId": "<id:2>",
+        "name": "Twice daily",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "schedules": [
+      {
+        "id": "<id:6>",
+        "medicationId": "<id:4>",
+        "windowStart": "07:00",
+        "windowEnd": "08:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "07:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:7>",
+        "medicationId": "<id:5>",
+        "windowStart": "08:00",
+        "windowEnd": "10:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "08:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:8>",
+        "medicationId": "<id:1>",
+        "windowStart": "09:00",
+        "windowEnd": "11:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "09:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:9>",
+        "medicationId": "<id:5>",
+        "windowStart": "20:00",
+        "windowEnd": "22:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "20:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      }
+    ],
+    "revisions": [],
+    "pauseEras": [],
+    "courses": [],
+    "intakes": [
+      {
+        "id": "<id:10>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-12T09:00:00.000Z",
+        "takenAt": "2026-10-12T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0004",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:11>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-13T08:00:00.000Z",
+        "takenAt": "2026-10-13T11:00:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "USER_PIN",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:12>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:13>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-13T09:00:00.000Z",
+        "takenAt": "2026-10-13T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0003",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:14>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-14T09:00:00.000Z",
+        "takenAt": "2026-10-14T09:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": "hk-dose-0000",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:15>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-14T09:30:00.000Z",
+        "takenAt": "2026-10-14T09:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0002",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:16>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-14T20:00:00.000Z",
+        "takenAt": "2026-10-14T20:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:17>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-15T08:00:00.000Z",
+        "takenAt": "2026-10-15T08:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:12>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:18>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-15T09:00:00.000Z",
+        "takenAt": "2026-10-15T09:20:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0001",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:19>",
+        "userId": "<id:2>",
+        "medicationId": "<id:3>",
+        "scheduledFor": "2026-10-15T10:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": "bulk-key-0001",
+        "createdAt": "<createdAt>",
+        "injectionSite": "ABDOMEN_LEFT",
+        "doseTaken": "0.5 pen",
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:20>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-15T20:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:21>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-16T08:00:00.000Z",
+        "takenAt": null,
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      }
+    ],
+    "doseChanges": [],
+    "inventoryItems": [
+      {
+        "id": "<id:12>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "state": "IN_USE",
+        "containerType": "OTHER",
+        "unitsTotal": "30",
+        "unitsRemaining": "28",
+        "firstUseAt": "2026-10-15T08:30:00.000Z",
+        "expiresAt": null,
+        "printedExpiry": null,
+        "purchasedAt": "2026-10-01T06:00:00.000Z",
+        "manufacturer": null,
+        "doseStrength": null,
+        "notes": null,
+        "notesEncrypted": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "inventoryEvents": [],
+    "categories": [],
+    "ingredients": [],
+    "audit": [
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 0,
+          "updated": 5,
+          "duplicates": 6,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 6,
+          "updated": 2,
+          "duplicates": 3,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.validation-failed",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "issues": [
+            {
+              "path": "entries.0.medicationId",
+              "code": "too_small"
+            },
+            {
+              "path": "entries.0.takenAt",
+              "code": "invalid_format"
+            }
+          ]
+        },
+        "ipAddress": null
+      }
+    ],
+    "idempotency": []
+  },
+  "extra": {
+    "lastSyncedAt": "<now>",
+    "arrivals": [
+      {
+        "type": "MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": "background",
+        "lastNewSampleAt": "<now>",
+        "lastBackgroundAt": "<now>",
+        "lastSeenDuplicateAt": "<now>"
+      },
+      {
+        "type": "backfill:MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": null,
+        "lastNewSampleAt": null,
+        "lastBackgroundAt": null,
+        "lastSeenDuplicateAt": null
+      }
+    ]
+  }
+}
diff --git a/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.04c-apple-not-mirrored.json.snap b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.04c-apple-not-mirrored.json.snap
new file mode 100644
index 000000000..4249b41f7
--- /dev/null
+++ b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.04c-apple-not-mirrored.json.snap
@@ -0,0 +1,613 @@
+{
+  "status": 422,
+  "body": {
+    "data": null,
+    "error": "An APPLE_HEALTH entry may only target a medication mirrored from Apple Health",
+    "meta": {
+      "errorCode": "medications.intake.bulk.apple_health_not_mirrored",
+      "requestId": "<requestId>"
+    }
+  },
+  "events": [
+    {
+      "status": 422,
+      "action": null,
+      "meta": {
+        "write_bucket": "own"
+      },
+      "warnings": null,
+      "error": null
+    }
+  ],
+  "effects": [],
+  "stored": {
+    "medications": [
+      {
+        "id": "<id:1>",
+        "userId": "<id:2>",
+        "name": "Apple mirror",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": "APPLE_HEALTH",
+        "externalId": "hk-concept-0001",
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:3>",
+        "userId": "<id:2>",
+        "name": "As-needed pen",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": true,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "INJECTION",
+        "trackInjectionSites": true,
+        "allowedInjectionSites": [
+          "ABDOMEN_LEFT",
+          "ABDOMEN_RIGHT"
+        ],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:4>",
+        "userId": "<id:2>",
+        "name": "Record only",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": false,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:5>",
+        "userId": "<id:2>",
+        "name": "Twice daily",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "schedules": [
+      {
+        "id": "<id:6>",
+        "medicationId": "<id:4>",
+        "windowStart": "07:00",
+        "windowEnd": "08:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "07:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:7>",
+        "medicationId": "<id:5>",
+        "windowStart": "08:00",
+        "windowEnd": "10:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "08:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:8>",
+        "medicationId": "<id:1>",
+        "windowStart": "09:00",
+        "windowEnd": "11:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "09:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:9>",
+        "medicationId": "<id:5>",
+        "windowStart": "20:00",
+        "windowEnd": "22:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "20:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      }
+    ],
+    "revisions": [],
+    "pauseEras": [],
+    "courses": [],
+    "intakes": [
+      {
+        "id": "<id:10>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-12T09:00:00.000Z",
+        "takenAt": "2026-10-12T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0004",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:11>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-13T08:00:00.000Z",
+        "takenAt": "2026-10-13T11:00:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "USER_PIN",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:12>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:13>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-13T09:00:00.000Z",
+        "takenAt": "2026-10-13T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0003",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:14>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-14T09:00:00.000Z",
+        "takenAt": "2026-10-14T09:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": "hk-dose-0000",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:15>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-14T09:30:00.000Z",
+        "takenAt": "2026-10-14T09:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0002",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:16>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-14T20:00:00.000Z",
+        "takenAt": "2026-10-14T20:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:17>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-15T08:00:00.000Z",
+        "takenAt": "2026-10-15T08:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:12>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:18>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-15T09:00:00.000Z",
+        "takenAt": "2026-10-15T09:20:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0001",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:19>",
+        "userId": "<id:2>",
+        "medicationId": "<id:3>",
+        "scheduledFor": "2026-10-15T10:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": "bulk-key-0001",
+        "createdAt": "<createdAt>",
+        "injectionSite": "ABDOMEN_LEFT",
+        "doseTaken": "0.5 pen",
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:20>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-15T20:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:21>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-16T08:00:00.000Z",
+        "takenAt": null,
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      }
+    ],
+    "doseChanges": [],
+    "inventoryItems": [
+      {
+        "id": "<id:12>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "state": "IN_USE",
+        "containerType": "OTHER",
+        "unitsTotal": "30",
+        "unitsRemaining": "28",
+        "firstUseAt": "2026-10-15T08:30:00.000Z",
+        "expiresAt": null,
+        "printedExpiry": null,
+        "purchasedAt": "2026-10-01T06:00:00.000Z",
+        "manufacturer": null,
+        "doseStrength": null,
+        "notes": null,
+        "notesEncrypted": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "inventoryEvents": [],
+    "categories": [],
+    "ingredients": [],
+    "audit": [
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 0,
+          "updated": 5,
+          "duplicates": 6,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 6,
+          "updated": 2,
+          "duplicates": 3,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.validation-failed",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "issues": [
+            {
+              "path": "entries.0.medicationId",
+              "code": "too_small"
+            },
+            {
+              "path": "entries.0.takenAt",
+              "code": "invalid_format"
+            }
+          ]
+        },
+        "ipAddress": null
+      }
+    ],
+    "idempotency": []
+  },
+  "extra": {
+    "lastSyncedAt": "<now>",
+    "arrivals": [
+      {
+        "type": "MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": "background",
+        "lastNewSampleAt": "<now>",
+        "lastBackgroundAt": "<now>",
+        "lastSeenDuplicateAt": "<now>"
+      },
+      {
+        "type": "backfill:MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": null,
+        "lastNewSampleAt": null,
+        "lastBackgroundAt": null,
+        "lastSeenDuplicateAt": null
+      }
+    ]
+  }
+}
diff --git a/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.05a-native.json.snap b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.05a-native.json.snap
new file mode 100644
index 000000000..6656a318d
--- /dev/null
+++ b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.05a-native.json.snap
@@ -0,0 +1,708 @@
+{
+  "status": 200,
+  "body": {
+    "data": {
+      "processed": 1,
+      "inserted": 1,
+      "updated": 0,
+      "duplicates": 0,
+      "skipped": [],
+      "entries": [
+        {
+          "index": 0,
+          "status": "inserted",
+          "id": "<id:1>"
+        }
+      ]
+    },
+    "error": null
+  },
+  "events": [
+    {
+      "status": 200,
+      "action": {
+        "name": "medications.intake.bulk.ingest"
+      },
+      "meta": {
+        "write_bucket": "own",
+        "medication_id": "<id:2>",
+        "units": 1,
+        "item_ids": [
+          "<id:3>"
+        ],
+        "auto_opened": 0,
+        "processed": 1,
+        "inserted": 1,
+        "updated": 0,
+        "duplicates": 0,
+        "skipped": 0,
+        "extra_doses_unscheduled": 0,
+        "sync_checkpoint_at": "<now>"
+      },
+      "warnings": null,
+      "error": null
+    }
+  ],
+  "effects": [
+    {
+      "effect": "queueMedicationIntakeSync",
+      "args": [
+        {
+          "userId": "<id:4>",
+          "originDeviceToken": null
+        }
+      ]
+    },
+    {
+      "effect": "countOutstandingDosesToday",
+      "args": [
+        "<id:4>",
+        "UTC"
+      ]
+    },
+    {
+      "effect": "dispatchMedicationIntakeWebClearBulk",
+      "args": [
+        {
+          "userId": "<id:4>",
+          "slots": [
+            {
+              "medicationId": "<id:2>",
+              "scheduledFor": "2026-10-12T08:00:00.000Z"
+            }
+          ],
+          "badgeCount": 2
+        }
+      ]
+    }
+  ],
+  "stored": {
+    "medications": [
+      {
+        "id": "<id:5>",
+        "userId": "<id:4>",
+        "name": "Apple mirror",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": "APPLE_HEALTH",
+        "externalId": "hk-concept-0001",
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:6>",
+        "userId": "<id:4>",
+        "name": "As-needed pen",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": true,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "INJECTION",
+        "trackInjectionSites": true,
+        "allowedInjectionSites": [
+          "ABDOMEN_LEFT",
+          "ABDOMEN_RIGHT"
+        ],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:7>",
+        "userId": "<id:4>",
+        "name": "Record only",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": false,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:2>",
+        "userId": "<id:4>",
+        "name": "Twice daily",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "schedules": [
+      {
+        "id": "<id:8>",
+        "medicationId": "<id:7>",
+        "windowStart": "07:00",
+        "windowEnd": "08:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "07:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:9>",
+        "medicationId": "<id:2>",
+        "windowStart": "08:00",
+        "windowEnd": "10:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "08:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:10>",
+        "medicationId": "<id:5>",
+        "windowStart": "09:00",
+        "windowEnd": "11:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "09:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:11>",
+        "medicationId": "<id:2>",
+        "windowStart": "20:00",
+        "windowEnd": "22:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "20:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      }
+    ],
+    "revisions": [],
+    "pauseEras": [],
+    "courses": [],
+    "intakes": [
+      {
+        "id": "<id:1>",
+        "userId": "<id:4>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-12T08:00:00.000Z",
+        "takenAt": "2026-10-12T08:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:3>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:12>",
+        "userId": "<id:4>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-12T09:00:00.000Z",
+        "takenAt": "2026-10-12T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0004",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:13>",
+        "userId": "<id:4>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-13T08:00:00.000Z",
+        "takenAt": "2026-10-13T11:00:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "USER_PIN",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:3>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:14>",
+        "userId": "<id:4>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-13T09:00:00.000Z",
+        "takenAt": "2026-10-13T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0003",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:15>",
+        "userId": "<id:4>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-14T09:00:00.000Z",
+        "takenAt": "2026-10-14T09:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": "hk-dose-0000",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:16>",
+        "userId": "<id:4>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-14T09:30:00.000Z",
+        "takenAt": "2026-10-14T09:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0002",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:17>",
+        "userId": "<id:4>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-14T20:00:00.000Z",
+        "takenAt": "2026-10-14T20:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:18>",
+        "userId": "<id:4>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-15T08:00:00.000Z",
+        "takenAt": "2026-10-15T08:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:3>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:19>",
+        "userId": "<id:4>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-15T09:00:00.000Z",
+        "takenAt": "2026-10-15T09:20:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0001",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:20>",
+        "userId": "<id:4>",
+        "medicationId": "<id:6>",
+        "scheduledFor": "2026-10-15T10:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": "bulk-key-0001",
+        "createdAt": "<createdAt>",
+        "injectionSite": "ABDOMEN_LEFT",
+        "doseTaken": "0.5 pen",
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:21>",
+        "userId": "<id:4>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-15T20:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:22>",
+        "userId": "<id:4>",
+        "medicationId": "<id:2>",
+        "scheduledFor": "2026-10-16T08:00:00.000Z",
+        "takenAt": null,
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      }
+    ],
+    "doseChanges": [],
+    "inventoryItems": [
+      {
+        "id": "<id:3>",
+        "userId": "<id:4>",
+        "medicationId": "<id:2>",
+        "state": "IN_USE",
+        "containerType": "OTHER",
+        "unitsTotal": "30",
+        "unitsRemaining": "27",
+        "firstUseAt": "2026-10-15T08:30:00.000Z",
+        "expiresAt": null,
+        "printedExpiry": null,
+        "purchasedAt": "2026-10-01T06:00:00.000Z",
+        "manufacturer": null,
+        "doseStrength": null,
+        "notes": null,
+        "notesEncrypted": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "inventoryEvents": [],
+    "categories": [],
+    "ingredients": [],
+    "audit": [
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:4>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:4>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:4>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:4>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 0,
+          "updated": 5,
+          "duplicates": 6,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:4>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 6,
+          "updated": 2,
+          "duplicates": 3,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.validation-failed",
+        "userId": "<id:4>",
+        "actorUserId": null,
+        "details": {
+          "issues": [
+            {
+              "path": "entries.0.medicationId",
+              "code": "too_small"
+            },
+            {
+              "path": "entries.0.takenAt",
+              "code": "invalid_format"
+            }
+          ]
+        },
+        "ipAddress": null
+      }
+    ],
+    "idempotency": []
+  },
+  "extra": {
+    "lastSyncedAt": "<now>",
+    "arrivals": [
+      {
+        "type": "MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": "background",
+        "lastNewSampleAt": "<now>",
+        "lastBackgroundAt": "<now>",
+        "lastSeenDuplicateAt": "<now>"
+      },
+      {
+        "type": "backfill:MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": null,
+        "lastNewSampleAt": null,
+        "lastBackgroundAt": null,
+        "lastSeenDuplicateAt": null
+      }
+    ]
+  }
+}
diff --git a/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.05b-narrow-token.json.snap b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.05b-narrow-token.json.snap
new file mode 100644
index 000000000..216e2e279
--- /dev/null
+++ b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.05b-narrow-token.json.snap
@@ -0,0 +1,663 @@
+{
+  "status": 403,
+  "body": {
+    "data": null,
+    "error": "Insufficient permissions",
+    "meta": {
+      "errorCode": "auth.scope.insufficient",
+      "requestId": "<requestId>"
+    }
+  },
+  "events": [
+    {
+      "status": 403,
+      "action": null,
+      "meta": null,
+      "warnings": null,
+      "error": {
+        "type": "HttpError",
+        "message": "Insufficient permissions"
+      }
+    }
+  ],
+  "effects": [],
+  "stored": {
+    "medications": [
+      {
+        "id": "<id:1>",
+        "userId": "<id:2>",
+        "name": "Apple mirror",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": "APPLE_HEALTH",
+        "externalId": "hk-concept-0001",
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:3>",
+        "userId": "<id:2>",
+        "name": "As-needed pen",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": true,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "INJECTION",
+        "trackInjectionSites": true,
+        "allowedInjectionSites": [
+          "ABDOMEN_LEFT",
+          "ABDOMEN_RIGHT"
+        ],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:4>",
+        "userId": "<id:2>",
+        "name": "Record only",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": false,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:5>",
+        "userId": "<id:2>",
+        "name": "Twice daily",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "schedules": [
+      {
+        "id": "<id:6>",
+        "medicationId": "<id:4>",
+        "windowStart": "07:00",
+        "windowEnd": "08:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "07:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:7>",
+        "medicationId": "<id:5>",
+        "windowStart": "08:00",
+        "windowEnd": "10:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "08:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:8>",
+        "medicationId": "<id:1>",
+        "windowStart": "09:00",
+        "windowEnd": "11:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "09:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:9>",
+        "medicationId": "<id:5>",
+        "windowStart": "20:00",
+        "windowEnd": "22:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "20:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      }
+    ],
+    "revisions": [],
+    "pauseEras": [],
+    "courses": [],
+    "intakes": [
+      {
+        "id": "<id:10>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-12T08:00:00.000Z",
+        "takenAt": "2026-10-12T08:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:11>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:12>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-12T09:00:00.000Z",
+        "takenAt": "2026-10-12T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0004",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:13>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-13T08:00:00.000Z",
+        "takenAt": "2026-10-13T11:00:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "USER_PIN",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:11>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:14>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-13T09:00:00.000Z",
+        "takenAt": "2026-10-13T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0003",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:15>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-14T09:00:00.000Z",
+        "takenAt": "2026-10-14T09:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": "hk-dose-0000",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:16>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-14T09:30:00.000Z",
+        "takenAt": "2026-10-14T09:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0002",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:17>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-14T20:00:00.000Z",
+        "takenAt": "2026-10-14T20:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:18>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-15T08:00:00.000Z",
+        "takenAt": "2026-10-15T08:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:11>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:19>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-15T09:00:00.000Z",
+        "takenAt": "2026-10-15T09:20:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0001",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:20>",
+        "userId": "<id:2>",
+        "medicationId": "<id:3>",
+        "scheduledFor": "2026-10-15T10:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": "bulk-key-0001",
+        "createdAt": "<createdAt>",
+        "injectionSite": "ABDOMEN_LEFT",
+        "doseTaken": "0.5 pen",
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:21>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-15T20:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:22>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-16T08:00:00.000Z",
+        "takenAt": null,
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      }
+    ],
+    "doseChanges": [],
+    "inventoryItems": [
+      {
+        "id": "<id:11>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "state": "IN_USE",
+        "containerType": "OTHER",
+        "unitsTotal": "30",
+        "unitsRemaining": "27",
+        "firstUseAt": "2026-10-15T08:30:00.000Z",
+        "expiresAt": null,
+        "printedExpiry": null,
+        "purchasedAt": "2026-10-01T06:00:00.000Z",
+        "manufacturer": null,
+        "doseStrength": null,
+        "notes": null,
+        "notesEncrypted": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "inventoryEvents": [],
+    "categories": [],
+    "ingredients": [],
+    "audit": [
+      {
+        "action": "auth.bearer.failure",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "reason": "undeclared_scope",
+          "tokenId": "<id:23>"
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 0,
+          "updated": 5,
+          "duplicates": 6,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 6,
+          "updated": 2,
+          "duplicates": 3,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.validation-failed",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "issues": [
+            {
+              "path": "entries.0.medicationId",
+              "code": "too_small"
+            },
+            {
+              "path": "entries.0.takenAt",
+              "code": "invalid_format"
+            }
+          ]
+        },
+        "ipAddress": null
+      }
+    ],
+    "idempotency": []
+  },
+  "extra": {
+    "lastSyncedAt": "<now>",
+    "arrivals": [
+      {
+        "type": "MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": "background",
+        "lastNewSampleAt": "<now>",
+        "lastBackgroundAt": "<now>",
+        "lastSeenDuplicateAt": "<now>"
+      },
+      {
+        "type": "backfill:MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": null,
+        "lastNewSampleAt": null,
+        "lastBackgroundAt": null,
+        "lastSeenDuplicateAt": null
+      }
+    ]
+  }
+}
diff --git a/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.05c-delegate.json.snap b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.05c-delegate.json.snap
new file mode 100644
index 000000000..ef83ea41b
--- /dev/null
+++ b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.05c-delegate.json.snap
@@ -0,0 +1,665 @@
+{
+  "status": 403,
+  "body": {
+    "data": null,
+    "error": "This endpoint cannot be used while acting on another account",
+    "meta": {
+      "errorCode": "sharing.not_permitted",
+      "requestId": "<requestId>"
+    }
+  },
+  "events": [
+    {
+      "status": 403,
+      "action": null,
+      "meta": {
+        "sharing_refusal": "undeclared_mode"
+      },
+      "warnings": null,
+      "error": {
+        "type": "SharingNotPermittedError",
+        "message": "This endpoint cannot be used while acting on another account"
+      }
+    }
+  ],
+  "effects": [],
+  "stored": {
+    "medications": [
+      {
+        "id": "<id:1>",
+        "userId": "<id:2>",
+        "name": "Apple mirror",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": "APPLE_HEALTH",
+        "externalId": "hk-concept-0001",
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:3>",
+        "userId": "<id:2>",
+        "name": "As-needed pen",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": true,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "INJECTION",
+        "trackInjectionSites": true,
+        "allowedInjectionSites": [
+          "ABDOMEN_LEFT",
+          "ABDOMEN_RIGHT"
+        ],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:4>",
+        "userId": "<id:2>",
+        "name": "Record only",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": false,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:5>",
+        "userId": "<id:2>",
+        "name": "Twice daily",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "schedules": [
+      {
+        "id": "<id:6>",
+        "medicationId": "<id:4>",
+        "windowStart": "07:00",
+        "windowEnd": "08:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "07:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:7>",
+        "medicationId": "<id:5>",
+        "windowStart": "08:00",
+        "windowEnd": "10:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "08:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:8>",
+        "medicationId": "<id:1>",
+        "windowStart": "09:00",
+        "windowEnd": "11:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "09:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:9>",
+        "medicationId": "<id:5>",
+        "windowStart": "20:00",
+        "windowEnd": "22:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "20:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      }
+    ],
+    "revisions": [],
+    "pauseEras": [],
+    "courses": [],
+    "intakes": [
+      {
+        "id": "<id:10>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-12T08:00:00.000Z",
+        "takenAt": "2026-10-12T08:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:11>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:12>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-12T09:00:00.000Z",
+        "takenAt": "2026-10-12T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0004",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:13>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-13T08:00:00.000Z",
+        "takenAt": "2026-10-13T11:00:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "USER_PIN",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:11>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:14>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-13T09:00:00.000Z",
+        "takenAt": "2026-10-13T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0003",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:15>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-14T09:00:00.000Z",
+        "takenAt": "2026-10-14T09:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": "hk-dose-0000",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:16>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-14T09:30:00.000Z",
+        "takenAt": "2026-10-14T09:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0002",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:17>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-14T20:00:00.000Z",
+        "takenAt": "2026-10-14T20:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:18>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-15T08:00:00.000Z",
+        "takenAt": "2026-10-15T08:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:11>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:19>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-15T09:00:00.000Z",
+        "takenAt": "2026-10-15T09:20:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0001",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:20>",
+        "userId": "<id:2>",
+        "medicationId": "<id:3>",
+        "scheduledFor": "2026-10-15T10:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": "bulk-key-0001",
+        "createdAt": "<createdAt>",
+        "injectionSite": "ABDOMEN_LEFT",
+        "doseTaken": "0.5 pen",
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:21>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-15T20:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:22>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-16T08:00:00.000Z",
+        "takenAt": null,
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      }
+    ],
+    "doseChanges": [],
+    "inventoryItems": [
+      {
+        "id": "<id:11>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "state": "IN_USE",
+        "containerType": "OTHER",
+        "unitsTotal": "30",
+        "unitsRemaining": "27",
+        "firstUseAt": "2026-10-15T08:30:00.000Z",
+        "expiresAt": null,
+        "printedExpiry": null,
+        "purchasedAt": "2026-10-01T06:00:00.000Z",
+        "manufacturer": null,
+        "doseStrength": null,
+        "notes": null,
+        "notesEncrypted": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "inventoryEvents": [],
+    "categories": [],
+    "ingredients": [],
+    "audit": [
+      {
+        "action": "auth.bearer.failure",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "reason": "undeclared_scope",
+          "tokenId": "<id:23>"
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 0,
+          "updated": 5,
+          "duplicates": 6,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 6,
+          "updated": 2,
+          "duplicates": 3,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.validation-failed",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "issues": [
+            {
+              "path": "entries.0.medicationId",
+              "code": "too_small"
+            },
+            {
+              "path": "entries.0.takenAt",
+              "code": "invalid_format"
+            }
+          ]
+        },
+        "ipAddress": null
+      }
+    ],
+    "idempotency": []
+  },
+  "extra": {
+    "lastSyncedAt": "<now>",
+    "arrivals": [
+      {
+        "type": "MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": "background",
+        "lastNewSampleAt": "<now>",
+        "lastBackgroundAt": "<now>",
+        "lastSeenDuplicateAt": "<now>"
+      },
+      {
+        "type": "backfill:MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": null,
+        "lastNewSampleAt": null,
+        "lastBackgroundAt": null,
+        "lastSeenDuplicateAt": null
+      }
+    ]
+  }
+}
diff --git a/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.05d-anonymous.json.snap b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.05d-anonymous.json.snap
new file mode 100644
index 000000000..8fff49289
--- /dev/null
+++ b/tests/integration/routes/parity/__snapshots__/medication-intake-bulk.05d-anonymous.json.snap
@@ -0,0 +1,663 @@
+{
+  "status": 401,
+  "body": {
+    "data": null,
+    "error": "Not authenticated",
+    "meta": {
+      "errorCode": "auth.missing",
+      "requestId": "<requestId>"
+    }
+  },
+  "events": [
+    {
+      "status": 401,
+      "action": null,
+      "meta": null,
+      "warnings": null,
+      "error": {
+        "type": "HttpError",
+        "message": "Not authenticated"
+      }
+    }
+  ],
+  "effects": [],
+  "stored": {
+    "medications": [
+      {
+        "id": "<id:1>",
+        "userId": "<id:2>",
+        "name": "Apple mirror",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": "APPLE_HEALTH",
+        "externalId": "hk-concept-0001",
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:3>",
+        "userId": "<id:2>",
+        "name": "As-needed pen",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": true,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "INJECTION",
+        "trackInjectionSites": true,
+        "allowedInjectionSites": [
+          "ABDOMEN_LEFT",
+          "ABDOMEN_RIGHT"
+        ],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:4>",
+        "userId": "<id:2>",
+        "name": "Record only",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": null,
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": false,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      },
+      {
+        "id": "<id:5>",
+        "userId": "<id:2>",
+        "name": "Twice daily",
+        "dose": "10mg",
+        "treatmentClass": "GENERIC",
+        "dosesPerUnit": null,
+        "unitsPerDose": "1",
+        "active": true,
+        "notificationsEnabled": true,
+        "pausedAt": null,
+        "snoozedUntil": null,
+        "startsOn": "2026-10-01T00:00:00.000Z",
+        "endsOn": null,
+        "oneShot": false,
+        "asNeeded": false,
+        "trackIntake": true,
+        "autoMarkTaken": false,
+        "autoMarkTakenSince": null,
+        "deliveryForm": "ORAL",
+        "trackInjectionSites": false,
+        "allowedInjectionSites": [],
+        "liveActivityEnabled": false,
+        "criticalAlarmEnabled": false,
+        "atcCode": null,
+        "rxNormCode": null,
+        "lowStockNotifiedAt": null,
+        "lowStockNotifiedThresholdDays": null,
+        "reorderLeadDays": null,
+        "externalSource": null,
+        "externalId": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "schedules": [
+      {
+        "id": "<id:6>",
+        "medicationId": "<id:4>",
+        "windowStart": "07:00",
+        "windowEnd": "08:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "07:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:7>",
+        "medicationId": "<id:5>",
+        "windowStart": "08:00",
+        "windowEnd": "10:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "08:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:8>",
+        "medicationId": "<id:1>",
+        "windowStart": "09:00",
+        "windowEnd": "11:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "09:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      },
+      {
+        "id": "<id:9>",
+        "medicationId": "<id:5>",
+        "windowStart": "20:00",
+        "windowEnd": "22:00",
+        "label": null,
+        "dose": null,
+        "unitsPerDose": null,
+        "daysOfWeek": null,
+        "timesOfDay": [
+          "20:00"
+        ],
+        "reminderGraceMinutes": null,
+        "rrule": "FREQ=DAILY",
+        "rollingIntervalDays": null,
+        "scheduleType": "SCHEDULED",
+        "cyclicOnWeeks": null,
+        "cyclicOffWeeks": null,
+        "doseWindows": null
+      }
+    ],
+    "revisions": [],
+    "pauseEras": [],
+    "courses": [],
+    "intakes": [
+      {
+        "id": "<id:10>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-12T08:00:00.000Z",
+        "takenAt": "2026-10-12T08:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:11>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:12>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-12T09:00:00.000Z",
+        "takenAt": "2026-10-12T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0004",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:13>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-13T08:00:00.000Z",
+        "takenAt": "2026-10-13T11:00:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "USER_PIN",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:11>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:14>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-13T09:00:00.000Z",
+        "takenAt": "2026-10-13T09:10:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0003",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:15>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-14T09:00:00.000Z",
+        "takenAt": "2026-10-14T09:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": "hk-dose-0000",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:16>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-14T09:30:00.000Z",
+        "takenAt": "2026-10-14T09:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0002",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:17>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-14T20:00:00.000Z",
+        "takenAt": "2026-10-14T20:05:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:18>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-15T08:00:00.000Z",
+        "takenAt": "2026-10-15T08:30:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "REMINDER",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [
+          {
+            "units": 1,
+            "itemId": "<id:11>"
+          }
+        ],
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:19>",
+        "userId": "<id:2>",
+        "medicationId": "<id:1>",
+        "scheduledFor": "2026-10-15T09:00:00.000Z",
+        "takenAt": "2026-10-15T09:20:00.000Z",
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "APPLE_HEALTH",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": [],
+        "externalId": "hk-dose-0001",
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:20>",
+        "userId": "<id:2>",
+        "medicationId": "<id:3>",
+        "scheduledFor": "2026-10-15T10:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": "bulk-key-0001",
+        "createdAt": "<createdAt>",
+        "injectionSite": "ABDOMEN_LEFT",
+        "doseTaken": "0.5 pen",
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:21>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-15T20:00:00.000Z",
+        "takenAt": null,
+        "skipped": true,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      },
+      {
+        "id": "<id:22>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "scheduledFor": "2026-10-16T08:00:00.000Z",
+        "takenAt": null,
+        "skipped": false,
+        "autoMissed": false,
+        "autoRecorded": false,
+        "attributionSource": "AUTO",
+        "source": "API",
+        "idempotencyKey": null,
+        "createdAt": "<createdAt>",
+        "injectionSite": null,
+        "doseTaken": null,
+        "inventoryConsumption": null,
+        "externalId": null,
+        "updatedAt": "<updatedAt>",
+        "syncVersion": "<syncVersion>",
+        "deletedAt": null
+      }
+    ],
+    "doseChanges": [],
+    "inventoryItems": [
+      {
+        "id": "<id:11>",
+        "userId": "<id:2>",
+        "medicationId": "<id:5>",
+        "state": "IN_USE",
+        "containerType": "OTHER",
+        "unitsTotal": "30",
+        "unitsRemaining": "27",
+        "firstUseAt": "2026-10-15T08:30:00.000Z",
+        "expiresAt": null,
+        "printedExpiry": null,
+        "purchasedAt": "2026-10-01T06:00:00.000Z",
+        "manufacturer": null,
+        "doseStrength": null,
+        "notes": null,
+        "notesEncrypted": null,
+        "createdAt": "<createdAt>",
+        "updatedAt": "<updatedAt>"
+      }
+    ],
+    "inventoryEvents": [],
+    "categories": [],
+    "ingredients": [],
+    "audit": [
+      {
+        "action": "auth.bearer.failure",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "reason": "undeclared_scope",
+          "tokenId": "<id:23>"
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 1,
+          "inserted": 1,
+          "updated": 0,
+          "duplicates": 0,
+          "skipped": 0
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 0,
+          "updated": 5,
+          "duplicates": 6,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.ingest",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "processed": 18,
+          "inserted": 6,
+          "updated": 2,
+          "duplicates": 3,
+          "skipped": 7
+        },
+        "ipAddress": null
+      },
+      {
+        "action": "medications.intake.bulk.validation-failed",
+        "userId": "<id:2>",
+        "actorUserId": null,
+        "details": {
+          "issues": [
+            {
+              "path": "entries.0.medicationId",
+              "code": "too_small"
+            },
+            {
+              "path": "entries.0.takenAt",
+              "code": "invalid_format"
+            }
+          ]
+        },
+        "ipAddress": null
+      }
+    ],
+    "idempotency": []
+  },
+  "extra": {
+    "lastSyncedAt": "<now>",
+    "arrivals": [
+      {
+        "type": "MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": "background",
+        "lastNewSampleAt": "<now>",
+        "lastBackgroundAt": "<now>",
+        "lastSeenDuplicateAt": "<now>"
+      },
+      {
+        "type": "backfill:MEDICATION_DOSE",
+        "lastReceivedAt": "<now>",
+        "lastTrigger": null,
+        "lastNewSampleAt": null,
+        "lastBackgroundAt": null,
+        "lastSeenDuplicateAt": null
+      }
+    ]
+  }
+}
diff --git a/tests/integration/routes/parity/medication-intake-bulk.parity.test.ts b/tests/integration/routes/parity/medication-intake-bulk.parity.test.ts
new file mode 100644
index 000000000..ec3fc649b
--- /dev/null
+++ b/tests/integration/routes/parity/medication-intake-bulk.parity.test.ts
@@ -0,0 +1,450 @@
+/**
+ * Parity for `POST /api/medications/intake/bulk` while the batch ingest moves
+ * into `src/lib/medications/`.
+ *
+ * One record walks through the cases the route tells apart, in order, each
+ * request seeing what the earlier ones stored. A first mixed batch carries
+ * one entry per per-entry outcome: an unknown medication, a record-only one,
+ * an unstable idempotency key and an unstable external id, a take inside its
+ * band, a pinned take and both pin refusals, a skip on a named slot, a
+ * pending echo onto a recorded dose and one onto a fresh slot, a standalone
+ * take with a site, a dose override and a key, its replay, a disallowed
+ * site, an Apple dose and its repeat inside the batch, an Apple dose whose
+ * slot another dose holds, and a skip that converges onto the standalone
+ * dose. Then the same batch again, a background and a backfill sync, the
+ * refusals (too large, a body the schema refuses, an Apple entry on a native
+ * medication), a native client, a narrow token, a delegate and nobody.
+ *
+ * After each request the snapshot holds the response, the wide event, the
+ * recorded tails, every medication row of the accounts, and the sync
+ * checkpoint and Apple Health arrival rows the batch writes. The clock is
+ * pinned (`Date` only), so the snapshot is the same on every day it runs.
+ */
+import { afterAll, beforeAll, describe, it, vi } from "vitest";
+
+import { POST } from "@/app/api/medications/intake/bulk/route";
+
+import { anonymous, type RouteAuth } from "../../../kit/call-route";
+import {
+  makeMedication,
+  makeSession,
+  makeToken,
+  makeUser,
+} from "../../../kit/factories";
+import { getPrismaClient, truncateAllTables } from "../../setup";
+import { delegateOf, parityStep } from "./medication-state";
+
+vi.mock("@/lib/logging/transports", async (importOriginal) => {
+  const actual =
+    await importOriginal<typeof import("@/lib/logging/transports")>();
+  const { wideEventRecorder: recorder } = await import("../../../kit/parity");
+  return {
+    ...actual,
+    emitIfSampled: (event: (typeof recorder.events)[number]) => {
+      recorder.events.push(event);
+    },
+  };
+});
+
+// The tails the route starts without awaiting them (the cross-device push,
+// the web-push dose clear with its badge count), recorded instead of run
+// (see `effectRecorder`).
+vi.mock(
+  "@/lib/notifications/medication-intake-sync",
+  async (importOriginal) => {
+    const actual =
+      await importOriginal<
+        typeof import("@/lib/notifications/medication-intake-sync")
+      >();
+    const { effectRecorder } = await import("../../../kit/parity");
+    return {
+      ...actual,
+      queueMedicationIntakeSync: (...args: unknown[]) => {
+        effectRecorder.record("queueMedicationIntakeSync", args);
+      },
+    };
+  },
+);
+vi.mock("@/lib/notifications/web-push-clear", async (importOriginal) => {
+  const actual =
+    await importOriginal<typeof import("@/lib/notifications/web-push-clear")>();
+  const { effectRecorder } = await import("../../../kit/parity");
+  return {
+    ...actual,
+    dispatchMedicationIntakeWebClearBulk: async (...args: unknown[]) => {
+      effectRecorder.record("dispatchMedicationIntakeWebClearBulk", args);
+    },
+  };
+});
+vi.mock("@/lib/medications/outstanding-doses", async (importOriginal) => {
+  const actual =
+    await importOriginal<
+      typeof import("@/lib/medications/outstanding-doses")
+    >();
+  const { effectRecorder } = await import("../../../kit/parity");
+  return {
+    ...actual,
+    countOutstandingDosesToday: async (...args: unknown[]) => {
+      effectRecorder.record("countOutstandingDosesToday", args);
+      return 2;
+    },
+  };
+});
+
+const prisma = getPrismaClient();
+const NOW = new Date("2026-10-15T12:00:00.000Z");
+const ROUTE = "/api/medications/intake/bulk";
+const INVALID_ACTION = "medications.intake.bulk.validation-failed";
+
+let ownerId: string;
+let userIds: string[];
+let owner: RouteAuth;
+let ownerBearer: RouteAuth;
+let narrowBearer: RouteAuth;
+let writer: { auth: RouteAuth; headers: Record<string, string> };
+const med: Record<string, string> = {};
+
+type Caller = { auth?: RouteAuth; headers?: Record<string, string> };
+
+/** The sync checkpoint and the Apple Health arrival rows of the owner. */
+async function syncState() {
+  const [user, arrivals] = await Promise.all([
+    prisma.user.findUniqueOrThrow({
+      where: { id: ownerId },
+      select: { lastSyncedAt: true },
+    }),
+    prisma.healthKitTypeSync.findMany({
+      where: { userId: ownerId },
+      orderBy: { type: "asc" },
+      select: {
+        type: true,
+        lastReceivedAt: true,
+        lastTrigger: true,
+        lastNewSampleAt: true,
+        lastBackgroundAt: true,
+        lastSeenDuplicateAt: true,
+      },
+    }),
+  ]);
+  return { lastSyncedAt: user.lastSyncedAt, arrivals };
+}
+
+/**
+ * An audit row a refusal writes without awaiting it: the schema refusal's
+ * own, and the narrow token's `auth.bearer.failure`.
+ */
+async function auditRows(action: string, count: number): Promise<void> {
+  // Polled on the real timer: the pinned clock stamps the rows read back,
+  // and nothing here may move it.
+  for (let attempt = 0; attempt < 250; attempt += 1) {
+    const rows = await prisma.auditLog.count({ where: { action } });
+    if (rows >= count) return;
+    await new Promise((resolve) => setTimeout(resolve, 20));
+  }
+  throw new Error(`fewer than ${count} ${action} rows landed`);
+}
+
+async function post(
+  name: string,
+  body: unknown,
+  options: Caller & { settle?: () => Promise<void> } = {},
+) {
+  await parityStep({
+    name: `medication-intake-bulk.${name}`,
+    handler: POST,
+    options: {
+      method: "POST",
+      route: ROUTE,
+      body,
+      auth: options.auth ?? owner,
+      headers: options.headers,
+    },
+    userIds,
+    now: NOW,
+    settle: options.settle,
+    extra: syncState,
+  });
+}
+
+async function intake(
+  medicationId: string,
+  data: {
+    scheduledFor: string;
+    takenAt?: string;
+    source?: "REMINDER" | "APPLE_HEALTH";
+    externalId?: string;
+  },
+) {
+  await prisma.medicationIntakeEvent.create({
+    data: {
+      userId: ownerId,
+      medicationId,
+      scheduledFor: new Date(data.scheduledFor),
+      takenAt: data.takenAt ? new Date(data.takenAt) : null,
+      source: data.source ?? "REMINDER",
+      externalId: data.externalId ?? null,
+      createdAt: new Date("2026-10-01T06:00:00.000Z"),
+    },
+  });
+}
+
+const daily = (time: string, windowEnd: string) => ({
+  windowStart: time,
+  windowEnd,
+  timesOfDay: [time],
+  rrule: "FREQ=DAILY",
+});
+
+/** One entry per per-entry outcome the loop tells apart. */
+function mixedBatch() {
+  return {
+    syncTrigger: "foreground",
+    entries: [
+      { medicationId: med.foreign, takenAt: "2026-10-15T08:10:00.000Z" },
+      { medicationId: med.recordOnly, takenAt: "2026-10-15T07:10:00.000Z" },
+      {
+        medicationId: med.daily,
+        takenAt: "2026-10-15T08:20:00.000Z",
+        idempotencyKey: "<HKDoseEvent: 0x600003a1c0c0>",
+      },
+      { medicationId: med.daily, takenAt: "2026-10-15T08:30:00.000Z" },
+      {
+        medicationId: med.daily,
+        takenAt: "2026-10-13T11:00:00.000Z",
+        forceSlotInstant: "2026-10-13T08:00:00.000Z",
+      },
+      {
+        medicationId: med.daily,
+        takenAt: "2026-10-13T16:00:00.000Z",
+        forceSlotInstant: "2026-10-13T15:00:00.000Z",
+      },
+      {
+        medicationId: med.daily,
+        takenAt: "2026-10-14T23:00:00.000Z",
+        forceSlotInstant: "2026-10-14T20:00:00.000Z",
+      },
+      {
+        medicationId: med.daily,
+        skipped: true,
+        scheduledFor: "2026-10-15T20:00:00.000Z",
+      },
+      { medicationId: med.daily, scheduledFor: "2026-10-14T20:00:00.000Z" },
+      { medicationId: med.daily, scheduledFor: "2026-10-16T08:00:00.000Z" },
+      {
+        medicationId: med.pen,
+        takenAt: "2026-10-15T10:00:00.000Z",
+        injectionSite: "ABDOMEN_LEFT",
+        doseTaken: "0.5 pen",
+        idempotencyKey: "bulk-key-0001",
+      },
+      {
+        medicationId: med.pen,
+        takenAt: "2026-10-15T10:00:00.000Z",
+        idempotencyKey: "bulk-key-0001",
+      },
+      {
+        medicationId: med.pen,
+        takenAt: "2026-10-15T10:30:00.000Z",
+        injectionSite: "ABDOMEN_RIGHT",
+      },
+      {
+        medicationId: med.apple,
+        takenAt: "2026-10-15T09:20:00.000Z",
+        source: "APPLE_HEALTH",
+        externalId: "hk-dose-0001",
+      },
+      {
+        medicationId: med.apple,
+        takenAt: "2026-10-15T09:20:00.000Z",
+        source: "APPLE_HEALTH",
+        externalId: "hk-dose-0001",
+      },
+      {
+        medicationId: med.apple,
+        takenAt: "2026-10-14T09:30:00.000Z",
+        source: "APPLE_HEALTH",
+        externalId: "hk-dose-0002",
+      },
+      {
+        medicationId: med.apple,
+        takenAt: "2026-10-14T10:00:00.000Z",
+        source: "APPLE_HEALTH",
+        externalId: "<HKMedicationDoseEvent: 0x600003b2d0d0>",
+      },
+      {
+        medicationId: med.pen,
+        skipped: true,
+        scheduledFor: "2026-10-15T10:00:00.000Z",
+      },
+    ],
+  };
+}
+
+beforeAll(async () => {
+  vi.useFakeTimers({ toFake: ["Date"], now: NOW });
+  await truncateAllTables(prisma);
+  const user = await makeUser({
+    timezone: "UTC",
+    globalExcludedInjectionSites: ["ABDOMEN_RIGHT"],
+  });
+  ownerId = user.id;
+  owner = await makeSession(user);
+  ownerBearer = await makeToken(user, { name: "kit-phone" });
+  narrowBearer = await makeToken(user, {
+    name: "kit-ingest",
+    permissions: ["medication:ingest"],
+  });
+  const created = new Date("2026-10-01T06:00:00.000Z");
+
+  const dailyMed = await makeMedication(
+    user,
+    {
+      name: "Twice daily",
+      startsOn: new Date("2026-10-01"),
+      createdAt: created,
+      snoozedUntil: new Date("2026-10-15T12:30:00.000Z"),
+    },
+    [daily("08:00", "10:00"), daily("20:00", "22:00")],
+  );
+  med.daily = dailyMed.id;
+  await prisma.medicationInventoryItem.create({
+    data: {
+      userId: ownerId,
+      medicationId: dailyMed.id,
+      unitsTotal: 30,
+      unitsRemaining: 30,
+      purchasedAt: created,
+    },
+  });
+  await intake(dailyMed.id, { scheduledFor: "2026-10-15T08:00:00.000Z" });
+  await intake(dailyMed.id, {
+    scheduledFor: "2026-10-14T20:00:00.000Z",
+    takenAt: "2026-10-14T20:05:00.000Z",
+  });
+
+  med.pen = (
+    await makeMedication(
+      user,
+      {
+        name: "As-needed pen",
+        createdAt: created,
+        asNeeded: true,
+        deliveryForm: "INJECTION",
+        trackInjectionSites: true,
+        allowedInjectionSites: ["ABDOMEN_LEFT", "ABDOMEN_RIGHT"],
+      },
+      [],
+    )
+  ).id;
+
+  const apple = await makeMedication(
+    user,
+    {
+      name: "Apple mirror",
+      startsOn: new Date("2026-10-01"),
+      createdAt: created,
+      externalSource: "APPLE_HEALTH",
+      externalId: "hk-concept-0001",
+    },
+    [daily("09:00", "11:00")],
+  );
+  med.apple = apple.id;
+  await intake(apple.id, {
+    scheduledFor: "2026-10-14T09:00:00.000Z",
+    takenAt: "2026-10-14T09:05:00.000Z",
+    source: "APPLE_HEALTH",
+    externalId: "hk-dose-0000",
+  });
+
+  med.recordOnly = (
+    await makeMedication(
+      user,
+      { name: "Record only", createdAt: created, trackIntake: false },
+      [daily("07:00", "08:00")],
+    )
+  ).id;
+
+  const stranger = await makeUser({ timezone: "UTC" });
+  med.foreign = (await makeMedication(stranger, { name: "Not yours" })).id;
+
+  const w = await delegateOf(prisma, user, "WRITE");
+  writer = { auth: w.auth, headers: w.headers };
+  userIds = [ownerId, w.delegate.id];
+});
+
+afterAll(() => {
+  vi.useRealTimers();
+});
+
+describe("POST /api/medications/intake/bulk parity", () => {
+  it("01 a mixed first batch", async () => {
+    await post("01-mixed", mixedBatch());
+  });
+
+  it("02 the same batch again", async () => {
+    await post("02-mixed-again", mixedBatch());
+  });
+
+  it("03 a background sync and a backfill", async () => {
+    await post("03a-background", {
+      syncTrigger: "background",
+      entries: [
+        {
+          medicationId: med.apple,
+          takenAt: "2026-10-13T09:10:00.000Z",
+          source: "APPLE_HEALTH",
+          externalId: "hk-dose-0003",
+        },
+      ],
+    });
+    await post("03b-backfill", {
+      syncTrigger: "backfill",
+      entries: [
+        {
+          medicationId: med.apple,
+          takenAt: "2026-10-12T09:10:00.000Z",
+          source: "APPLE_HEALTH",
+          externalId: "hk-dose-0004",
+        },
+      ],
+    });
+  });
+
+  it("04 the batch refusals", async () => {
+    await post("04a-too-large", {
+      entries: Array.from({ length: 501 }, () => ({
+        medicationId: med.daily,
+      })),
+    });
+    await post(
+      "04b-invalid",
+      { entries: [{ medicationId: "", takenAt: "never" }] },
+      { settle: () => auditRows(INVALID_ACTION, 1) },
+    );
+    await post("04c-apple-not-mirrored", {
+      entries: [
+        {
+          medicationId: med.daily,
+          takenAt: "2026-10-12T08:10:00.000Z",
+          source: "APPLE_HEALTH",
+          externalId: "hk-dose-0005",
+        },
+      ],
+    });
+  });
+
+  it("05 a native client, a narrow token, a delegate and nobody", async () => {
+    const batch = {
+      entries: [
+        { medicationId: med.daily, takenAt: "2026-10-12T08:10:00.000Z" },
+      ],
+    };
+    await post("05a-native", batch, { auth: ownerBearer });
+    await post("05b-narrow-token", batch, {
+      auth: narrowBearer,
+      settle: () => auditRows("auth.bearer.failure", 1),
+    });
+    await post("05c-delegate", batch, writer);
+    await post("05d-anonymous", batch, { auth: anonymous });
+  });
+});