diff --git a/crates/erp-health/src/handler/alert_handler.rs b/crates/erp-health/src/handler/alert_handler.rs
index 73a8864..56fe5af 100644
--- a/crates/erp-health/src/handler/alert_handler.rs
+++ b/crates/erp-health/src/handler/alert_handler.rs
@@ -10,6 +10,7 @@ use erp_core::rbac::require_permission;
 use erp_core::types::{ApiResponse, PaginatedResponse, TenantContext};
 
 use crate::dto::alert_dto::AcknowledgeAlertRequest;
+use crate::handler::consent_check::check_consent_active;
 use crate::service::alert_service;
 use crate::state::HealthState;
 
@@ -32,6 +33,9 @@ where
     S: Clone + Send + Sync + 'static,
 {
     require_permission(&ctx, "health.alerts.list")?;
+    if let Some(pid) = query.patient_id {
+        check_consent_active(&state.db, ctx.tenant_id, pid, &ctx).await?;
+    }
     let page = query.page.unwrap_or(1);
     let page_size = query.page_size.unwrap_or(20).min(100);
 
diff --git a/crates/erp-health/src/handler/consent_check.rs b/crates/erp-health/src/handler/consent_check.rs
new file mode 100644
index 0000000..963188c
--- /dev/null
+++ b/crates/erp-health/src/handler/consent_check.rs
@@ -0,0 +1,40 @@
+use erp_core::error::AppError;
+use erp_core::types::TenantContext;
+use sea_orm::{ColumnTrait, EntityTrait, QueryFilter};
+
+use crate::entity::consent::{Column, Entity as ConsentEntity};
+use uuid::Uuid;
+
+/// 医护角色跳过 consent 检查
+const BYPASS_ROLES: &[&str] = &["admin", "doctor", "nurse", "health_manager"];
+
+/// 检查患者是否有有效的知情同意记录（status = granted）
+/// 在 handler 层调用，对患者数据的读取进行 consent 门控
+pub async fn check_consent_active(
+    db: &sea_orm::DatabaseConnection,
+    tenant_id: Uuid,
+    patient_id: Uuid,
+    ctx: &TenantContext,
+) -> Result<(), AppError> {
+    // 医护和管理角色不需要 consent 检查
+    if ctx.roles.iter().any(|r| BYPASS_ROLES.contains(&r.as_str())) {
+        return Ok(());
+    }
+
+    let has_active = ConsentEntity::find()
+        .filter(Column::TenantId.eq(tenant_id))
+        .filter(Column::PatientId.eq(patient_id))
+        .filter(Column::Status.eq("granted"))
+        .filter(Column::DeletedAt.is_null())
+        .one(db)
+        .await
+        .map_err(|e| AppError::Internal(e.to_string()))?;
+
+    if has_active.is_none() {
+        return Err(AppError::Forbidden(
+            "患者未签署知情同意书，无法访问数据".to_string(),
+        ));
+    }
+
+    Ok(())
+}
diff --git a/crates/erp-health/src/handler/daily_monitoring_handler.rs b/crates/erp-health/src/handler/daily_monitoring_handler.rs
index efe697c..7535926 100644
--- a/crates/erp-health/src/handler/daily_monitoring_handler.rs
+++ b/crates/erp-health/src/handler/daily_monitoring_handler.rs
@@ -11,6 +11,7 @@ use erp_core::types::{ApiResponse, PaginatedResponse, TenantContext};
 
 use crate::dto::DeleteWithVersion;
 use crate::dto::daily_monitoring_dto::*;
+use crate::handler::consent_check::check_consent_active;
 use crate::service::daily_monitoring_service;
 use crate::state::HealthState;
 
@@ -38,6 +39,7 @@ where
     S: Clone + Send + Sync + 'static,
 {
     require_permission(&ctx, "health.daily-monitoring.list")?;
+    check_consent_active(&state.db, ctx.tenant_id, patient_id, &ctx).await?;
     let page = params.page.unwrap_or(1);
     let page_size = params.page_size.unwrap_or(20).min(100);
     let result = daily_monitoring_service::list_daily_monitoring(
diff --git a/crates/erp-health/src/handler/device_reading_handler.rs b/crates/erp-health/src/handler/device_reading_handler.rs
index c9019fa..84e3dcb 100644
--- a/crates/erp-health/src/handler/device_reading_handler.rs
+++ b/crates/erp-health/src/handler/device_reading_handler.rs
@@ -9,6 +9,7 @@ use erp_core::error::AppError;
 use erp_core::rbac::require_permission;
 use erp_core::types::{ApiResponse, TenantContext};
 
+use crate::handler::consent_check::check_consent_active;
 use crate::service::device_reading_service;
 use crate::state::HealthState;
 
@@ -75,6 +76,7 @@ where
     S: Clone + Send + Sync + 'static,
 {
     require_permission(&ctx, "health.device-readings.list")?;
+    check_consent_active(&state.db, ctx.tenant_id, path.patient_id, &ctx).await?;
     let page = query.page.unwrap_or(1);
     let page_size = query.page_size.unwrap_or(20).min(100);
     let result = device_reading_service::query_device_readings(
@@ -108,6 +110,7 @@ where
     S: Clone + Send + Sync + 'static,
 {
     require_permission(&ctx, "health.device-readings.list")?;
+    check_consent_active(&state.db, ctx.tenant_id, path.patient_id, &ctx).await?;
     let page = query.page.unwrap_or(1);
     let page_size = query.page_size.unwrap_or(20).min(100);
     let days = query.days.unwrap_or(7);
diff --git a/crates/erp-health/src/handler/health_data_handler.rs b/crates/erp-health/src/handler/health_data_handler.rs
index b1616b7..325b324 100644
--- a/crates/erp-health/src/handler/health_data_handler.rs
+++ b/crates/erp-health/src/handler/health_data_handler.rs
@@ -12,6 +12,7 @@ use validator::Validate;
 
 use crate::dto::DeleteWithVersion;
 use crate::dto::health_data_dto::*;
+use crate::handler::consent_check::check_consent_active;
 use crate::service::health_data_service;
 use crate::service::trend_service;
 use crate::state::HealthState;
@@ -59,6 +60,7 @@ where
     S: Clone + Send + Sync + 'static,
 {
     require_permission(&ctx, "health.health-data.list")?;
+    check_consent_active(&state.db, ctx.tenant_id, patient_id, &ctx).await?;
     let page = params.page.unwrap_or(1);
     let page_size = params.page_size.unwrap_or(20).min(100);
     let result =
@@ -158,6 +160,7 @@ where
     S: Clone + Send + Sync + 'static,
 {
     require_permission(&ctx, "health.health-data.list")?;
+    check_consent_active(&state.db, ctx.tenant_id, patient_id, &ctx).await?;
     let page = params.page.unwrap_or(1);
     let page_size = params.page_size.unwrap_or(20).min(100);
     let result =
@@ -285,6 +288,7 @@ where
     S: Clone + Send + Sync + 'static,
 {
     require_permission(&ctx, "health.health-data.list")?;
+    check_consent_active(&state.db, ctx.tenant_id, patient_id, &ctx).await?;
     let page = params.page.unwrap_or(1);
     let page_size = params.page_size.unwrap_or(20).min(100);
     let result = health_data_service::list_health_records(
@@ -389,6 +393,7 @@ where
     S: Clone + Send + Sync + 'static,
 {
     require_permission(&ctx, "health.health-data.list")?;
+    check_consent_active(&state.db, ctx.tenant_id, patient_id, &ctx).await?;
     let page = params.page.unwrap_or(1);
     let page_size = params.page_size.unwrap_or(20).min(100);
     let result =
@@ -430,6 +435,7 @@ where
     S: Clone + Send + Sync + 'static,
 {
     require_permission(&ctx, "health.health-data.list")?;
+    check_consent_active(&state.db, ctx.tenant_id, patient_id, &ctx).await?;
     let result = trend_service::get_indicator_timeseries(
         &state,
         ctx.tenant_id,
diff --git a/crates/erp-health/src/handler/mod.rs b/crates/erp-health/src/handler/mod.rs
index 45eb4f0..a760c5e 100644
--- a/crates/erp-health/src/handler/mod.rs
+++ b/crates/erp-health/src/handler/mod.rs
@@ -8,6 +8,7 @@ pub mod article_tag_handler;
 pub mod banner_handler;
 pub mod ble_gateway_handler;
 pub mod care_plan_handler;
+pub mod consent_check;
 pub mod consent_handler;
 pub mod consultation_handler;
 pub mod critical_alert_handler;
diff --git a/crates/erp-health/src/handler/vital_signs_daily_handler.rs b/crates/erp-health/src/handler/vital_signs_daily_handler.rs
index 7e10b3e..f86d4da 100644
--- a/crates/erp-health/src/handler/vital_signs_daily_handler.rs
+++ b/crates/erp-health/src/handler/vital_signs_daily_handler.rs
@@ -8,6 +8,7 @@ use erp_core::error::AppError;
 use erp_core::rbac::require_permission;
 use erp_core::types::{ApiResponse, TenantContext};
 
+use crate::handler::consent_check::check_consent_active;
 use crate::service::vital_signs_daily_service;
 use crate::state::HealthState;
 
@@ -37,6 +38,10 @@ where
 {
     require_permission(&ctx, "health.device-readings.list")?;
 
+    if let Some(pid) = query.patient_id {
+        check_consent_active(&state.db, ctx.tenant_id, pid, &ctx).await?;
+    }
+
     let start = query.start_date.parse::<chrono::NaiveDate>().map_err(|_| {
         AppError::Validation("Invalid start_date format, expected YYYY-MM-DD".into())
     })?;