diff --git a/VigilCareClinicalAPI/BackgroundServices/KafkaTopicProvisioner.cs b/VigilCareClinicalAPI/BackgroundServices/KafkaTopicProvisioner.cs
new file mode 100644
index 0000000..2c92cd2
--- /dev/null
+++ b/VigilCareClinicalAPI/BackgroundServices/KafkaTopicProvisioner.cs
@@ -0,0 +1,55 @@
+using Confluent.Kafka;
+using Confluent.Kafka.Admin;
+using Microsoft.Extensions.Options;
+
+public class KafkaTopicProvisioner : IHostedService
+{
+    private readonly KafkaOptions _options;
+    private readonly ILogger<KafkaTopicProvisioner> _logger;
+
+    public KafkaTopicProvisioner(IOptions<KafkaOptions> options, ILogger<KafkaTopicProvisioner> logger)
+    {
+        _options = options.Value;
+        _logger = logger;
+    }
+
+    public async Task StartAsync(CancellationToken cancellationToken)
+    {
+        using var admin = new AdminClientBuilder(new AdminClientConfig
+        {
+            BootstrapServers = _options.BootstrapServers
+        }).Build();
+
+        var topicNames = new[]
+        {
+            _options.Topics.ObservationRecorded,
+            _options.Topics.AlertGenerated,
+            _options.Topics.AlertAcknowledged,
+            _options.Topics.EncounterStatusChanged
+        };
+
+        var specs = topicNames.Select(name => new TopicSpecification
+        {
+            Name = name,
+            NumPartitions = _options.NumPartitions,
+            ReplicationFactor = 1
+        }).ToList();
+
+        try
+        {
+            await admin.CreateTopicsAsync(specs);
+            _logger.LogInformation("Kafka topics provisioned: {Topics}", string.Join(", ", topicNames));
+        }
+        catch (CreateTopicsException ex)
+        {
+            var errors = ex.Results.Where(r => r.Error.Code != ErrorCode.TopicAlreadyExists).ToList();
+            if (errors.Count > 0)
+                throw new InvalidOperationException(
+                    $"Failed to create Kafka topics: {string.Join(", ", errors.Select(e => e.Error.Reason))}");
+
+            _logger.LogInformation("Kafka topics already exist — skipping creation");
+        }
+    }
+
+    public Task StopAsync(CancellationToken cancellationToken) => Task.CompletedTask;
+}
\ No newline at end of file
diff --git a/VigilCareClinicalAPI/BackgroundServices/OutboxRelayService.cs b/VigilCareClinicalAPI/BackgroundServices/OutboxRelayService.cs
new file mode 100644
index 0000000..ade903f
--- /dev/null
+++ b/VigilCareClinicalAPI/BackgroundServices/OutboxRelayService.cs
@@ -0,0 +1,146 @@
+using Confluent.Kafka;
+using Microsoft.EntityFrameworkCore;
+using Microsoft.Extensions.Options;
+
+public class OutboxRelayService : BackgroundService
+{
+    private readonly IServiceProvider _services;
+    private readonly KafkaOptions _options;
+    private readonly ILogger<OutboxRelayService> _logger;
+    private IProducer<string, string>? _producer;
+
+    public OutboxRelayService(
+        IServiceProvider services,
+        IOptions<KafkaOptions> options,
+        ILogger<OutboxRelayService> logger)
+    {
+        _services = services;
+        _options = options.Value;
+        _logger = logger;
+    }
+
+    public override Task StartAsync(CancellationToken cancellationToken)
+    {
+        _producer = new ProducerBuilder<string, string>(new ProducerConfig
+        {
+            BootstrapServers = _options.BootstrapServers,
+            Acks = Acks.All,
+            // Idempotent producer: the broker deduplicates in-flight retries using
+            // the producer ID + sequence number. Prevents duplicates from network
+            // timeouts that cause the client to retry a message the broker already accepted.
+            EnableIdempotence = true,
+            MessageSendMaxRetries = 3,
+            RetryBackoffMs = 100
+        }).Build();
+
+        return base.StartAsync(cancellationToken);
+    }
+
+    protected override async Task ExecuteAsync(CancellationToken stoppingToken)
+    {
+        _logger.LogInformation("Outbox relay started. PollInterval={Interval}ms", _options.OutboxPollIntervalMs);
+
+        while (!stoppingToken.IsCancellationRequested)
+        {
+            try
+            {
+                await ProcessBatchAsync(stoppingToken);
+            }
+            catch (Exception ex) when (ex is not OperationCanceledException)
+            {
+                _logger.LogError(ex, "Outbox relay error — will retry on next poll cycle");
+            }
+
+            await Task.Delay(_options.OutboxPollIntervalMs, stoppingToken);
+        }
+    }
+
+    private async Task ProcessBatchAsync(CancellationToken ct)
+    {
+        using var scope = _services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+
+        // FOR UPDATE SKIP LOCKED: if a second relay instance is running concurrently,
+        // it skips rows already locked by this instance. Both instances make progress
+        // without blocking each other. A plain SELECT without locking would cause both
+        // to read the same rows and publish duplicates.
+        await using var tx = await db.Database.BeginTransactionAsync(ct);
+
+        var events = await db.OutboxEvents
+            .FromSqlRaw("""
+                SELECT id, topic, payload, partition_key, created_at, processed_at
+                FROM outbox_events
+                WHERE processed_at IS NULL
+                ORDER BY created_at ASC
+                LIMIT {0}
+                FOR UPDATE SKIP LOCKED
+                """, _options.OutboxBatchSize)
+            .ToListAsync(ct);
+
+        if (events.Count == 0)
+        {
+            await tx.RollbackAsync(ct);
+            return;
+        }
+
+        var published = new List<Guid>();
+        var failed = false;
+
+        foreach (var ev in events)
+        {
+            try
+            {
+                var result = await _producer!.ProduceAsync(
+                    ev.Topic,
+                    new Message<string, string>
+                    {
+                        // The partition key ensures all events for one encounter land on
+                        // the same partition. The sepsis engine depends on this — if two
+                        // observations for the same patient arrive on different partitions,
+                        // a single-partition consumer misses one and SIRS evaluation is wrong.
+                        Key = ev.PartitionKey ?? string.Empty,
+                        Value = ev.Payload
+                    },
+                    ct);
+
+                published.Add(ev.Id);
+
+                _logger.LogDebug(
+                    "Published {Topic} offset={Offset} partition={Partition} key={Key}",
+                    ev.Topic, result.Offset.Value, result.Partition.Value, ev.PartitionKey);
+            }
+            catch (ProduceException<string, string> ex)
+            {
+                _logger.LogWarning(ex,
+                    "Kafka produce failed for outbox event {Id} — leaving unprocessed for next cycle",
+                    ev.Id);
+                failed = true;
+                break;  // stop processing this batch; retry from this row next cycle
+            }
+        }
+
+        if (published.Count > 0)
+        {
+            var now = DateTimeOffset.UtcNow;
+            foreach (var id in published)
+            {
+                var ev = events.First(e => e.Id == id);
+                ev.ProcessedAt = now;
+            }
+            await db.SaveChangesAsync(ct);
+        }
+
+        await tx.CommitAsync(ct);
+
+        if (published.Count > 0)
+            _logger.LogInformation(
+                "Outbox relay published {Count} events. Failed={Failed}",
+                published.Count, failed);
+    }
+
+    public override void Dispose()
+    {
+        _producer?.Dispose();
+        base.Dispose();
+    }
+}
\ No newline at end of file
diff --git a/VigilCareClinicalAPI/Configuration/KafkaOptions.cs b/VigilCareClinicalAPI/Configuration/KafkaOptions.cs
new file mode 100644
index 0000000..53f481c
--- /dev/null
+++ b/VigilCareClinicalAPI/Configuration/KafkaOptions.cs
@@ -0,0 +1,9 @@
+public class KafkaOptions
+{
+    public const string Section = "Kafka";
+    public string BootstrapServers { get; set; } = null!;
+    public KafkaTopicOptions Topics { get; set; } = null!;
+    public int NumPartitions { get; set; } = 6;
+    public int OutboxBatchSize { get; set; } = 100;
+    public int OutboxPollIntervalMs { get; set; } = 500;
+}
diff --git a/VigilCareClinicalAPI/Configuration/KafkaTopicOptions.cs b/VigilCareClinicalAPI/Configuration/KafkaTopicOptions.cs
new file mode 100644
index 0000000..091007f
--- /dev/null
+++ b/VigilCareClinicalAPI/Configuration/KafkaTopicOptions.cs
@@ -0,0 +1,7 @@
+public class KafkaTopicOptions
+{
+    public string ObservationRecorded { get; set; } = "observation.recorded";
+    public string AlertGenerated { get; set; } = "alert.generated";
+    public string AlertAcknowledged { get; set; } = "alert.acknowledged";
+    public string EncounterStatusChanged { get; set; } = "encounter.status.changed";
+}
\ No newline at end of file
diff --git a/VigilCareClinicalAPI/Data/Configurations/OutboxEventConfiguration.cs b/VigilCareClinicalAPI/Data/Configurations/OutboxEventConfiguration.cs
index dc712b5..ac57e6b 100644
--- a/VigilCareClinicalAPI/Data/Configurations/OutboxEventConfiguration.cs
+++ b/VigilCareClinicalAPI/Data/Configurations/OutboxEventConfiguration.cs
@@ -10,6 +10,7 @@ public class OutboxEventConfiguration : IEntityTypeConfiguration<OutboxEvent>
         builder.Property(o => o.Id).HasColumnName("id").HasDefaultValueSql("gen_random_uuid()");
         builder.Property(o => o.Topic).HasColumnName("topic").HasMaxLength(200).IsRequired();
         builder.Property(o => o.Payload).HasColumnName("payload").HasColumnType("jsonb").IsRequired();
+        builder.Property(o => o.PartitionKey).HasColumnName("partition_key").HasMaxLength(36);
         builder.Property(o => o.CreatedAt).HasColumnName("created_at").HasDefaultValueSql("NOW()");
         builder.Property(o => o.ProcessedAt).HasColumnName("processed_at");
 
diff --git a/VigilCareClinicalAPI/Domains/Entities/OutboxEvent.cs b/VigilCareClinicalAPI/Domains/Entities/OutboxEvent.cs
index d4a1588..f9125b8 100644
--- a/VigilCareClinicalAPI/Domains/Entities/OutboxEvent.cs
+++ b/VigilCareClinicalAPI/Domains/Entities/OutboxEvent.cs
@@ -3,6 +3,7 @@ public class OutboxEvent
     public Guid Id { get; set; }
     public string Topic { get; set; } = null!;
     public string Payload { get; set; } = null!;  // JSON string
+    public string? PartitionKey { get; set; }   // encounter_id for all clinical events
     public DateTimeOffset CreatedAt { get; set; }
     public DateTimeOffset? ProcessedAt { get; set; }
 }
\ No newline at end of file
diff --git a/VigilCareClinicalAPI/Migrations/20260616132054_AddOutboxPartitionKey.Designer.cs b/VigilCareClinicalAPI/Migrations/20260616132054_AddOutboxPartitionKey.Designer.cs
new file mode 100644
index 0000000..b6833c1
--- /dev/null
+++ b/VigilCareClinicalAPI/Migrations/20260616132054_AddOutboxPartitionKey.Designer.cs
@@ -0,0 +1,568 @@
+// <auto-generated />
+using System;
+using Microsoft.EntityFrameworkCore;
+using Microsoft.EntityFrameworkCore.Infrastructure;
+using Microsoft.EntityFrameworkCore.Migrations;
+using Microsoft.EntityFrameworkCore.Storage.ValueConversion;
+using Npgsql.EntityFrameworkCore.PostgreSQL.Metadata;
+
+#nullable disable
+
+namespace VigilCareClinicalAPI.Migrations
+{
+    [DbContext(typeof(AppDbContext))]
+    [Migration("20260616132054_AddOutboxPartitionKey")]
+    partial class AddOutboxPartitionKey
+    {
+        /// <inheritdoc />
+        protected override void BuildTargetModel(ModelBuilder modelBuilder)
+        {
+#pragma warning disable 612, 618
+            modelBuilder
+                .HasAnnotation("ProductVersion", "8.0.4")
+                .HasAnnotation("Relational:MaxIdentifierLength", 63);
+
+            NpgsqlModelBuilderExtensions.UseIdentityByDefaultColumns(modelBuilder);
+
+            modelBuilder.Entity("AlertThreshold", b =>
+                {
+                    b.Property<Guid>("Id")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("uuid")
+                        .HasColumnName("id")
+                        .HasDefaultValueSql("gen_random_uuid()");
+
+                    b.Property<DateTimeOffset>("CreatedAt")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("created_at")
+                        .HasDefaultValueSql("NOW()");
+
+                    b.Property<decimal?>("CriticalHigh")
+                        .HasColumnType("decimal(10,3)")
+                        .HasColumnName("critical_high");
+
+                    b.Property<decimal?>("CriticalLow")
+                        .HasColumnType("decimal(10,3)")
+                        .HasColumnName("critical_low");
+
+                    b.Property<string>("DisplayName")
+                        .IsRequired()
+                        .HasMaxLength(200)
+                        .HasColumnType("character varying(200)")
+                        .HasColumnName("display_name");
+
+                    b.Property<string>("ObservationCode")
+                        .IsRequired()
+                        .HasMaxLength(50)
+                        .HasColumnType("character varying(50)")
+                        .HasColumnName("observation_code");
+
+                    b.Property<string>("Unit")
+                        .IsRequired()
+                        .HasMaxLength(20)
+                        .HasColumnType("character varying(20)")
+                        .HasColumnName("unit");
+
+                    b.Property<decimal?>("WarningHigh")
+                        .HasColumnType("decimal(10,3)")
+                        .HasColumnName("warning_high");
+
+                    b.Property<decimal?>("WarningLow")
+                        .HasColumnType("decimal(10,3)")
+                        .HasColumnName("warning_low");
+
+                    b.HasKey("Id");
+
+                    b.HasIndex("ObservationCode")
+                        .IsUnique();
+
+                    b.ToTable("alert_thresholds", (string)null);
+                });
+
+            modelBuilder.Entity("ClinicalAlert", b =>
+                {
+                    b.Property<Guid>("Id")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("uuid")
+                        .HasColumnName("id")
+                        .HasDefaultValueSql("gen_random_uuid()");
+
+                    b.Property<DateTimeOffset?>("AcknowledgedAt")
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("acknowledged_at");
+
+                    b.Property<string>("AcknowledgedBy")
+                        .HasMaxLength(200)
+                        .HasColumnType("character varying(200)")
+                        .HasColumnName("acknowledged_by");
+
+                    b.Property<string>("AlertType")
+                        .IsRequired()
+                        .HasMaxLength(50)
+                        .HasColumnType("character varying(50)")
+                        .HasColumnName("alert_type");
+
+                    b.Property<string>("Details")
+                        .IsRequired()
+                        .HasColumnType("text")
+                        .HasColumnName("details");
+
+                    b.Property<Guid>("EncounterId")
+                        .HasColumnType("uuid")
+                        .HasColumnName("encounter_id");
+
+                    b.Property<Guid?>("ObservationId")
+                        .HasColumnType("uuid")
+                        .HasColumnName("observation_id");
+
+                    b.Property<Guid>("PatientId")
+                        .HasColumnType("uuid")
+                        .HasColumnName("patient_id");
+
+                    b.Property<DateTimeOffset?>("ResolvedAt")
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("resolved_at");
+
+                    b.Property<string>("Severity")
+                        .IsRequired()
+                        .HasMaxLength(20)
+                        .HasColumnType("character varying(20)")
+                        .HasColumnName("severity");
+
+                    b.Property<string>("Status")
+                        .IsRequired()
+                        .ValueGeneratedOnAdd()
+                        .HasMaxLength(20)
+                        .HasColumnType("character varying(20)")
+                        .HasColumnName("status")
+                        .HasDefaultValueSql("'OPEN'");
+
+                    b.Property<DateTimeOffset>("TriggeredAt")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("triggered_at")
+                        .HasDefaultValueSql("NOW()");
+
+                    b.HasKey("Id");
+
+                    b.HasIndex("EncounterId", "TriggeredAt");
+
+                    b.HasIndex("PatientId", "TriggeredAt");
+
+                    b.HasIndex("Severity", "TriggeredAt")
+                        .HasFilter("status = 'OPEN'");
+
+                    b.ToTable("clinical_alerts", null, t =>
+                        {
+                            t.HasCheckConstraint("chk_clinical_alerts_alert_type", "alert_type IN ('SEPSIS_WARNING', 'CRITICAL_HEART_RATE', 'CRITICAL_TEMP_C', 'CRITICAL_POTASSIUM_MEQ_L', 'CRITICAL_SPO2', 'CRITICAL_RESP_RATE', 'CRITICAL_WBC_K_UL')");
+
+                            t.HasCheckConstraint("chk_clinical_alerts_severity", "severity IN ('WARNING', 'CRITICAL')");
+
+                            t.HasCheckConstraint("chk_clinical_alerts_status", "status IN ('OPEN', 'ACKNOWLEDGED', 'RESOLVED', 'ESCALATED')");
+                        });
+                });
+
+            modelBuilder.Entity("Encounter", b =>
+                {
+                    b.Property<Guid>("Id")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("uuid")
+                        .HasColumnName("id")
+                        .HasDefaultValueSql("gen_random_uuid()");
+
+                    b.Property<DateTimeOffset>("AdmittedAt")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("admitted_at")
+                        .HasDefaultValueSql("NOW()");
+
+                    b.Property<string>("AttendingPhysician")
+                        .IsRequired()
+                        .HasMaxLength(200)
+                        .HasColumnType("character varying(200)")
+                        .HasColumnName("attending_physician");
+
+                    b.Property<DateTimeOffset>("CreatedAt")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("created_at")
+                        .HasDefaultValueSql("NOW()");
+
+                    b.Property<string>("Department")
+                        .IsRequired()
+                        .HasMaxLength(100)
+                        .HasColumnType("character varying(100)")
+                        .HasColumnName("department");
+
+                    b.Property<DateTimeOffset?>("DischargedAt")
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("discharged_at");
+
+                    b.Property<string>("EncounterType")
+                        .IsRequired()
+                        .HasMaxLength(20)
+                        .HasColumnType("character varying(20)")
+                        .HasColumnName("encounter_type");
+
+                    b.Property<Guid>("PatientId")
+                        .HasColumnType("uuid")
+                        .HasColumnName("patient_id");
+
+                    b.Property<string>("Status")
+                        .IsRequired()
+                        .ValueGeneratedOnAdd()
+                        .HasMaxLength(20)
+                        .HasColumnType("character varying(20)")
+                        .HasColumnName("status")
+                        .HasDefaultValueSql("'SCHEDULED'");
+
+                    b.HasKey("Id");
+
+                    b.HasIndex("PatientId", "AdmittedAt");
+
+                    b.HasIndex("Status", "AdmittedAt")
+                        .HasFilter("status = 'ACTIVE'");
+
+                    b.ToTable("encounters", null, t =>
+                        {
+                            t.HasCheckConstraint("chk_encounters_encounter_type", "encounter_type IN ('INPATIENT', 'OUTPATIENT', 'EMERGENCY')");
+
+                            t.HasCheckConstraint("chk_encounters_status", "status IN ('SCHEDULED', 'ACTIVE', 'DISCHARGED', 'CANCELLED')");
+                        });
+                });
+
+            modelBuilder.Entity("Observation", b =>
+                {
+                    b.Property<Guid>("Id")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("uuid")
+                        .HasColumnName("id")
+                        .HasDefaultValueSql("gen_random_uuid()");
+
+                    b.Property<DateTimeOffset>("CreatedAt")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("created_at")
+                        .HasDefaultValueSql("NOW()");
+
+                    b.Property<Guid>("EncounterId")
+                        .HasColumnType("uuid")
+                        .HasColumnName("encounter_id");
+
+                    b.Property<string>("IdempotencyKey")
+                        .HasMaxLength(100)
+                        .HasColumnType("character varying(100)")
+                        .HasColumnName("idempotency_key");
+
+                    b.Property<string>("ObservationCode")
+                        .IsRequired()
+                        .HasMaxLength(50)
+                        .HasColumnType("character varying(50)")
+                        .HasColumnName("observation_code");
+
+                    b.Property<DateTimeOffset>("RecordedAt")
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("recorded_at");
+
+                    b.Property<string>("Source")
+                        .IsRequired()
+                        .ValueGeneratedOnAdd()
+                        .HasMaxLength(20)
+                        .HasColumnType("character varying(20)")
+                        .HasColumnName("source")
+                        .HasDefaultValueSql("'MANUAL'");
+
+                    b.Property<string>("Unit")
+                        .IsRequired()
+                        .HasMaxLength(20)
+                        .HasColumnType("character varying(20)")
+                        .HasColumnName("unit");
+
+                    b.Property<decimal>("Value")
+                        .HasColumnType("decimal(10,3)")
+                        .HasColumnName("value");
+
+                    b.HasKey("Id");
+
+                    b.HasIndex("IdempotencyKey")
+                        .IsUnique()
+                        .HasFilter("idempotency_key IS NOT NULL");
+
+                    b.HasIndex("EncounterId", "ObservationCode", "RecordedAt");
+
+                    b.ToTable("observations", null, t =>
+                        {
+                            t.HasCheckConstraint("chk_observations_source", "source IN ('MANUAL', 'DEVICE', 'LAB')");
+                        });
+                });
+
+            modelBuilder.Entity("Order", b =>
+                {
+                    b.Property<Guid>("Id")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("uuid")
+                        .HasColumnName("id")
+                        .HasDefaultValueSql("gen_random_uuid()");
+
+                    b.Property<string>("Description")
+                        .IsRequired()
+                        .HasColumnType("text")
+                        .HasColumnName("description");
+
+                    b.Property<Guid>("EncounterId")
+                        .HasColumnType("uuid")
+                        .HasColumnName("encounter_id");
+
+                    b.Property<string>("OrderType")
+                        .IsRequired()
+                        .HasMaxLength(20)
+                        .HasColumnType("character varying(20)")
+                        .HasColumnName("order_type");
+
+                    b.Property<DateTimeOffset>("OrderedAt")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("ordered_at")
+                        .HasDefaultValueSql("NOW()");
+
+                    b.Property<string>("OrderedBy")
+                        .IsRequired()
+                        .HasMaxLength(200)
+                        .HasColumnType("character varying(200)")
+                        .HasColumnName("ordered_by");
+
+                    b.Property<DateTimeOffset?>("ResultedAt")
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("resulted_at");
+
+                    b.Property<string>("Status")
+                        .IsRequired()
+                        .ValueGeneratedOnAdd()
+                        .HasMaxLength(20)
+                        .HasColumnType("character varying(20)")
+                        .HasDefaultValue("pending")
+                        .HasColumnName("status");
+
+                    b.HasKey("Id");
+
+                    b.HasIndex("EncounterId", "OrderedAt");
+
+                    b.HasIndex("Status", "OrderedAt")
+                        .HasFilter("status IN ('pending', 'in_progress')");
+
+                    b.ToTable("orders", null, t =>
+                        {
+                            t.HasCheckConstraint("chk_orders_order_type", "order_type IN ('LAB', 'IMAGING', 'MEDICATION', 'PROCEDURE')");
+                        });
+                });
+
+            modelBuilder.Entity("OutboxEvent", b =>
+                {
+                    b.Property<Guid>("Id")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("uuid")
+                        .HasColumnName("id")
+                        .HasDefaultValueSql("gen_random_uuid()");
+
+                    b.Property<DateTimeOffset>("CreatedAt")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("created_at")
+                        .HasDefaultValueSql("NOW()");
+
+                    b.Property<string>("PartitionKey")
+                        .HasMaxLength(36)
+                        .HasColumnType("character varying(36)")
+                        .HasColumnName("partition_key");
+
+                    b.Property<string>("Payload")
+                        .IsRequired()
+                        .HasColumnType("jsonb")
+                        .HasColumnName("payload");
+
+                    b.Property<DateTimeOffset?>("ProcessedAt")
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("processed_at");
+
+                    b.Property<string>("Topic")
+                        .IsRequired()
+                        .HasMaxLength(200)
+                        .HasColumnType("character varying(200)")
+                        .HasColumnName("topic");
+
+                    b.HasKey("Id");
+
+                    b.HasIndex("CreatedAt")
+                        .HasFilter("processed_at IS NULL");
+
+                    b.ToTable("outbox_events", (string)null);
+                });
+
+            modelBuilder.Entity("Patient", b =>
+                {
+                    b.Property<Guid>("Id")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("uuid")
+                        .HasColumnName("id")
+                        .HasDefaultValueSql("gen_random_uuid()");
+
+                    b.Property<DateTimeOffset>("CreatedAt")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("created_at")
+                        .HasDefaultValueSql("NOW()");
+
+                    b.Property<DateOnly>("DateOfBirth")
+                        .HasColumnType("date")
+                        .HasColumnName("date_of_birth");
+
+                    b.Property<string>("FirstName")
+                        .IsRequired()
+                        .HasMaxLength(100)
+                        .HasColumnType("character varying(100)")
+                        .HasColumnName("first_name");
+
+                    b.Property<string>("Gender")
+                        .IsRequired()
+                        .HasMaxLength(10)
+                        .HasColumnType("character varying(10)")
+                        .HasColumnName("gender");
+
+                    b.Property<string>("LastName")
+                        .IsRequired()
+                        .HasMaxLength(100)
+                        .HasColumnType("character varying(100)")
+                        .HasColumnName("last_name");
+
+                    b.Property<string>("Mrn")
+                        .IsRequired()
+                        .HasMaxLength(20)
+                        .HasColumnType("character varying(20)")
+                        .HasColumnName("mrn");
+
+                    b.Property<string>("Status")
+                        .IsRequired()
+                        .ValueGeneratedOnAdd()
+                        .HasMaxLength(20)
+                        .HasColumnType("character varying(20)")
+                        .HasDefaultValue("active")
+                        .HasColumnName("status");
+
+                    b.HasKey("Id");
+
+                    b.HasIndex("Mrn")
+                        .IsUnique();
+
+                    b.ToTable("patients", (string)null);
+                });
+
+            modelBuilder.Entity("ReconciliationAlert", b =>
+                {
+                    b.Property<Guid>("Id")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("uuid")
+                        .HasColumnName("id")
+                        .HasDefaultValueSql("gen_random_uuid()");
+
+                    b.Property<string>("CheckType")
+                        .IsRequired()
+                        .HasMaxLength(50)
+                        .HasColumnType("character varying(50)")
+                        .HasColumnName("check_type");
+
+                    b.Property<DateTimeOffset>("CreatedAt")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("created_at")
+                        .HasDefaultValueSql("NOW()");
+
+                    b.Property<string>("Details")
+                        .IsRequired()
+                        .HasColumnType("text")
+                        .HasColumnName("details");
+
+                    b.Property<Guid?>("EncounterId")
+                        .HasColumnType("uuid")
+                        .HasColumnName("encounter_id");
+
+                    b.Property<Guid?>("PatientId")
+                        .HasColumnType("uuid")
+                        .HasColumnName("patient_id");
+
+                    b.Property<DateTimeOffset?>("ResolvedAt")
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("resolved_at");
+
+                    b.HasKey("Id");
+
+                    b.HasIndex("CheckType", "EncounterId")
+                        .HasFilter("resolved_at IS NULL");
+
+                    b.ToTable("reconciliation_alerts", null, t =>
+                        {
+                            t.HasCheckConstraint("chk_reconciliation_alerts_check_type", "check_type IN ('UNACKNOWLEDGED_CRITICAL_ALERT', 'PENDING_ORDER_NO_RESULT', 'ACTIVE_INPATIENT_NO_OBSERVATION')");
+                        });
+                });
+
+            modelBuilder.Entity("ClinicalAlert", b =>
+                {
+                    b.HasOne("Encounter", "Encounter")
+                        .WithMany("Alerts")
+                        .HasForeignKey("EncounterId")
+                        .OnDelete(DeleteBehavior.Restrict)
+                        .IsRequired();
+
+                    b.Navigation("Encounter");
+                });
+
+            modelBuilder.Entity("Encounter", b =>
+                {
+                    b.HasOne("Patient", "Patient")
+                        .WithMany("Encounters")
+                        .HasForeignKey("PatientId")
+                        .OnDelete(DeleteBehavior.Restrict)
+                        .IsRequired();
+
+                    b.Navigation("Patient");
+                });
+
+            modelBuilder.Entity("Observation", b =>
+                {
+                    b.HasOne("Encounter", "Encounter")
+                        .WithMany("Observations")
+                        .HasForeignKey("EncounterId")
+                        .OnDelete(DeleteBehavior.Restrict)
+                        .IsRequired();
+
+                    b.Navigation("Encounter");
+                });
+
+            modelBuilder.Entity("Order", b =>
+                {
+                    b.HasOne("Encounter", "Encounter")
+                        .WithMany("Orders")
+                        .HasForeignKey("EncounterId")
+                        .OnDelete(DeleteBehavior.Restrict)
+                        .IsRequired();
+
+                    b.Navigation("Encounter");
+                });
+
+            modelBuilder.Entity("Encounter", b =>
+                {
+                    b.Navigation("Alerts");
+
+                    b.Navigation("Observations");
+
+                    b.Navigation("Orders");
+                });
+
+            modelBuilder.Entity("Patient", b =>
+                {
+                    b.Navigation("Encounters");
+                });
+#pragma warning restore 612, 618
+        }
+    }
+}
diff --git a/VigilCareClinicalAPI/Migrations/20260616132054_AddOutboxPartitionKey.cs b/VigilCareClinicalAPI/Migrations/20260616132054_AddOutboxPartitionKey.cs
new file mode 100644
index 0000000..1446e4a
--- /dev/null
+++ b/VigilCareClinicalAPI/Migrations/20260616132054_AddOutboxPartitionKey.cs
@@ -0,0 +1,29 @@
+using Microsoft.EntityFrameworkCore.Migrations;
+
+#nullable disable
+
+namespace VigilCareClinicalAPI.Migrations
+{
+    /// <inheritdoc />
+    public partial class AddOutboxPartitionKey : Migration
+    {
+        /// <inheritdoc />
+        protected override void Up(MigrationBuilder migrationBuilder)
+        {
+            migrationBuilder.AddColumn<string>(
+                name: "partition_key",
+                table: "outbox_events",
+                type: "character varying(36)",
+                maxLength: 36,
+                nullable: true);
+        }
+
+        /// <inheritdoc />
+        protected override void Down(MigrationBuilder migrationBuilder)
+        {
+            migrationBuilder.DropColumn(
+                name: "partition_key",
+                table: "outbox_events");
+        }
+    }
+}
diff --git a/VigilCareClinicalAPI/Migrations/AppDbContextModelSnapshot.cs b/VigilCareClinicalAPI/Migrations/AppDbContextModelSnapshot.cs
index 3a48a7a..acf6840 100644
--- a/VigilCareClinicalAPI/Migrations/AppDbContextModelSnapshot.cs
+++ b/VigilCareClinicalAPI/Migrations/AppDbContextModelSnapshot.cs
@@ -368,6 +368,11 @@ namespace VigilCareClinicalAPI.Migrations
                         .HasColumnName("created_at")
                         .HasDefaultValueSql("NOW()");
 
+                    b.Property<string>("PartitionKey")
+                        .HasMaxLength(36)
+                        .HasColumnType("character varying(36)")
+                        .HasColumnName("partition_key");
+
                     b.Property<string>("Payload")
                         .IsRequired()
                         .HasColumnType("jsonb")
diff --git a/VigilCareClinicalAPI/Program.cs b/VigilCareClinicalAPI/Program.cs
index 81c11f1..fb0bc1a 100644
--- a/VigilCareClinicalAPI/Program.cs
+++ b/VigilCareClinicalAPI/Program.cs
@@ -22,6 +22,9 @@ try
     builder.Services.AddSingleton<IConnectionMultiplexer>(sp =>
         ConnectionMultiplexer.Connect(sp.GetRequiredService<IConfiguration>()["Redis:ConnectionString"]!));
 
+    builder.Services.Configure<KafkaOptions>(
+    builder.Configuration.GetSection(KafkaOptions.Section));
+
     builder.Services.AddScoped<IPatientService, PatientService>();
     builder.Services.AddScoped<IEncounterService, EncounterService>();
     builder.Services.AddScoped<IAlertThresholdService, AlertThresholdService>();
@@ -30,6 +33,8 @@ try
     builder.Services.AddScoped<IAlertService, AlertService>();
 
     builder.Services.AddHostedService<ThresholdCacheLoader>();
+    builder.Services.AddHostedService<KafkaTopicProvisioner>();
+    builder.Services.AddHostedService<OutboxRelayService>();
 
     builder.Services.AddControllers()
         .AddJsonOptions(opts =>
diff --git a/VigilCareClinicalAPI/Services/AlertService.cs b/VigilCareClinicalAPI/Services/AlertService.cs
index 2ef3afa..89cf7ad 100644
--- a/VigilCareClinicalAPI/Services/AlertService.cs
+++ b/VigilCareClinicalAPI/Services/AlertService.cs
@@ -96,6 +96,7 @@ public class AlertService : IAlertService
                 acknowledgedAt = alert.AcknowledgedAt,
                 note = req.Note
             }),
+            PartitionKey = alert.EncounterId.ToString(),
             CreatedAt = DateTimeOffset.UtcNow
         });
 
diff --git a/VigilCareClinicalAPI/Services/EncounterService.cs b/VigilCareClinicalAPI/Services/EncounterService.cs
index bbc9fec..83aa37f 100644
--- a/VigilCareClinicalAPI/Services/EncounterService.cs
+++ b/VigilCareClinicalAPI/Services/EncounterService.cs
@@ -1,3 +1,4 @@
+using System.Text.Json;
 using Microsoft.EntityFrameworkCore;
 
 public class EncounterService : IEncounterService
@@ -41,11 +42,29 @@ public class EncounterService : IEncounterService
             throw new ConflictException(
                 $"Transition to '{targetStatus}' is not permitted from the current status.",
                 "ILLEGAL_STATUS_TRANSITION");
-
+        
+        var previousStatus = encounter.Status;
         encounter.Status = targetStatus;
+
         if (targetStatus == EncounterStatus.Discharged)
             encounter.DischargedAt = DateTimeOffset.UtcNow;
 
+        _db.OutboxEvents.Add(new OutboxEvent
+        {
+            Id = Guid.NewGuid(),
+            Topic = "encounter.status.changed",
+            Payload = JsonSerializer.Serialize(new
+            {
+                encounterId,
+                patientId = encounter.PatientId,
+                previousStatus = previousStatus.ToDbString(),
+                newStatus = targetStatus.ToDbString(),
+                changedAt = DateTimeOffset.UtcNow
+            }),
+            PartitionKey = encounterId.ToString(),
+            CreatedAt = DateTimeOffset.UtcNow
+        });
+
         await _db.SaveChangesAsync();
         return new EncounterStatusTransitionResult(encounterId, targetStatus);
     }
diff --git a/VigilCareClinicalAPI/Services/ObservationService.cs b/VigilCareClinicalAPI/Services/ObservationService.cs
index 621d1bf..fc52aa0 100644
--- a/VigilCareClinicalAPI/Services/ObservationService.cs
+++ b/VigilCareClinicalAPI/Services/ObservationService.cs
@@ -116,7 +116,7 @@ public class ObservationService : IObservationService
                     severity = alert.Severity.ToDbString(),
                     triggeredAt = alert.TriggeredAt,
                     partitionKey = encounterId.ToString()
-                }));
+                }, encounterId.ToString()));
             }
 
             // Step 7 — outbox event for the observation (always; Kafka consumer handles warnings)
@@ -131,7 +131,7 @@ public class ObservationService : IObservationService
                 source = req.Source.ToDbString(),
                 recordedAt = req.RecordedAt,
                 partitionKey = encounterId.ToString()
-            }));
+            }, encounterId.ToString()));
 
             // Step 8 — COMMIT
             await _db.SaveChangesAsync();
@@ -202,11 +202,12 @@ public class ObservationService : IObservationService
         return $"{req.ObservationCode} value {req.Value} {req.Unit} is above critical high of {t.CriticalHigh} {req.Unit}.";
     }
 
-    private static OutboxEvent BuildOutboxEvent(string topic, object payload) => new()
+    private static OutboxEvent BuildOutboxEvent(string topic, object payload, string partitionKey) => new()
     {
         Id = Guid.NewGuid(),
         Topic = topic,
         Payload = JsonSerializer.Serialize(payload),
+        PartitionKey = partitionKey,
         CreatedAt = DateTimeOffset.UtcNow
     };
 
diff --git a/VigilCareClinicalAPI/VigilCareClinicalAPI.csproj b/VigilCareClinicalAPI/VigilCareClinicalAPI.csproj
index 803c26c..dd9278d 100644
--- a/VigilCareClinicalAPI/VigilCareClinicalAPI.csproj
+++ b/VigilCareClinicalAPI/VigilCareClinicalAPI.csproj
@@ -9,6 +9,7 @@
   </PropertyGroup>
 
   <ItemGroup>
+    <PackageReference Include="Confluent.Kafka" Version="2.14.0" />
     <PackageReference Include="Microsoft.AspNetCore.OpenApi" Version="8.0.27" />
     <PackageReference Include="Microsoft.EntityFrameworkCore.Tools" Version="8.0.4">
       <IncludeAssets>runtime; build; native; contentfiles; analyzers; buildtransitive</IncludeAssets>
diff --git a/VigilCareClinicalAPI/appsettings.json b/VigilCareClinicalAPI/appsettings.json
index 9d0e9d6..15a3aee 100644
--- a/VigilCareClinicalAPI/appsettings.json
+++ b/VigilCareClinicalAPI/appsettings.json
@@ -35,5 +35,16 @@
       "Microsoft.EntityFrameworkCore.Database.Command": "Information"
     }
   },
-  "AllowedHosts": "*"
+  "AllowedHosts": "*",
+  "Kafka": {
+    "BootstrapServers": "localhost:9092",
+    "Topics": {
+      "ObservationRecorded": "observation.recorded",
+      "AlertGenerated": "alert.generated",
+      "EncounterStatusChanged": "encounter.status.changed"
+    },
+    "NumPartitions": 6,
+    "OutboxBatchSize": 100,
+    "OutboxPollIntervalMs": 500
+  }
 }
diff --git a/docker-compose.yml b/docker-compose.yml
index 666ec17..dbdef46 100644
--- a/docker-compose.yml
+++ b/docker-compose.yml
@@ -19,11 +19,38 @@ services:
     image: datalust/seq:latest
     environment:
       ACCEPT_EULA: "Y"
+      SEQ_FIRSTRUN_ADMINPASSWORD: "admin"
     ports:
       - "5345:80"
     volumes:
       - seq_data:/data
 
+  kafka:
+    image: apache/kafka:3.7.0
+    ports:
+      - "9092:9092"
+    environment:
+      KAFKA_NODE_ID: 1
+      KAFKA_PROCESS_ROLES: broker,controller
+      KAFKA_LISTENERS: PLAINTEXT://0.0.0.0:9092,CONTROLLER://0.0.0.0:9093
+      KAFKA_ADVERTISED_LISTENERS: PLAINTEXT://localhost:9092
+      KAFKA_LISTENER_SECURITY_PROTOCOL_MAP: PLAINTEXT:PLAINTEXT,CONTROLLER:PLAINTEXT
+      KAFKA_CONTROLLER_QUORUM_VOTERS: 1@kafka:9093
+      KAFKA_CONTROLLER_LISTENER_NAMES: CONTROLLER
+      KAFKA_OFFSETS_TOPIC_REPLICATION_FACTOR: 1
+      KAFKA_TRANSACTION_STATE_LOG_REPLICATION_FACTOR: 1
+      KAFKA_TRANSACTION_STATE_LOG_MIN_ISR: 1
+      # Disable auto-creation — topics are provisioned explicitly with the correct
+      # partition count. Auto-creation would silently create a topic with 1 partition
+      # if the relay publishes before the provisioner runs.
+      KAFKA_AUTO_CREATE_TOPICS_ENABLE: "false"
+      # Fixed ID prevents the broker from reinitializing storage on restart.
+      # Generate once with: kafka-storage.sh random-uuid | base64
+      CLUSTER_ID: "MkU3OEVBNTcwNTJENDM2Qk"
+    volumes:
+      - kafka_data:/var/lib/kafka/data
+
 volumes:
   pg_data:
-  seq_data:
\ No newline at end of file
+  seq_data:
+  kafka_data:
\ No newline at end of file
diff --git a/docs/vigilcare-clinical-api-prd.md b/docs/vigilcare-clinical-api-prd.md
index baa2c8a..f53fc46 100644
--- a/docs/vigilcare-clinical-api-prd.md
+++ b/docs/vigilcare-clinical-api-prd.md
@@ -12,6 +12,25 @@ This project maps to `sd-mid-009` (Outbox Pattern), `sd-mid-013` (CQRS), `sd-mid
 
 ---
 
+## Local Development Setup
+
+Start all infrastructure services with:
+
+```bash
+docker compose up -d
+```
+
+| Service | Port | Notes |
+|---|---|---|
+| PostgreSQL | 5436 | Database: `vigilcare`, user: `postgres`, password: `password` |
+| Redis | 6382 | No auth |
+| Seq | 5345 | UI at `http://localhost:5345` — login: `admin` / `admin` |
+| Kafka | 9092 | KRaft mode, no Zookeeper |
+
+**Seq first-run:** `SEQ_FIRSTRUN_ADMINPASSWORD=admin` is set in `docker-compose.yml`. This password is only applied on the very first container start (when `/data` volume is empty). After initialization, the password is stored in the volume and this env var is ignored.
+
+---
+
 ## Goals
 
 - Model the observe-alert-acknowledge lifecycle that sits at the center of any clinical monitoring system
diff --git a/scripts/run-kafka-outbox-tests.sh b/scripts/run-kafka-outbox-tests.sh
new file mode 100755
index 0000000..ac5facc
--- /dev/null
+++ b/scripts/run-kafka-outbox-tests.sh
@@ -0,0 +1,366 @@
+#!/usr/bin/env bash
+
+set -euo pipefail
+
+SCRIPT_DIR="$(cd "$(dirname "${BASH_SOURCE[0]}")" && pwd)"
+COMPOSE_FILE="${COMPOSE_FILE:-${SCRIPT_DIR}/../docker-compose.yml}"
+
+BASE_URL="${BASE_URL:-http://localhost:5270}"
+PGHOST="${PGHOST:-localhost}"
+PGPORT="${PGPORT:-5436}"
+PGDATABASE="${PGDATABASE:-vigilcare}"
+PGUSER="${PGUSER:-postgres}"
+PGPASSWORD="${PGPASSWORD:-password}"
+
+TOPIC_OBSERVATION="${TOPIC_OBSERVATION:-observation.recorded}"
+TOPIC_ENCOUNTER="${TOPIC_ENCOUNTER:-encounter.status.changed}"
+RELAY_WAIT_SECS="${RELAY_WAIT_SECS:-45}"
+KAFKA_READY_WAIT_SECS="${KAFKA_READY_WAIT_SECS:-30}"
+
+RECORDED_AT="$(date -u +"%Y-%m-%dT%H:%M:%SZ")"
+SCRIPT_RUN_ID="$(date -u +"%Y%m%d%H%M%S")"
+
+TMP_FILES=()
+
+cleanup() {
+  local f
+  for f in "${TMP_FILES[@]}"; do
+    rm -f "${f}" "${f}.status" 2>/dev/null || true
+  done
+}
+trap cleanup EXIT
+
+if ! command -v curl >/dev/null 2>&1; then
+  echo "Missing dependency: curl"
+  exit 1
+fi
+
+if ! command -v jq >/dev/null 2>&1; then
+  echo "Missing dependency: jq"
+  exit 1
+fi
+
+if ! command -v docker >/dev/null 2>&1 || [[ ! -f "${COMPOSE_FILE}" ]]; then
+  echo "Missing dependency: docker compose (${COMPOSE_FILE})"
+  exit 1
+fi
+
+compose() {
+  docker compose -f "${COMPOSE_FILE}" "$@"
+}
+
+kafka_exec() {
+  compose exec -T kafka "$@"
+}
+
+psql_cmd() {
+  local sql="$1"
+  if command -v psql >/dev/null 2>&1; then
+    PGPASSWORD="${PGPASSWORD}" psql -h "${PGHOST}" -p "${PGPORT}" -U "${PGUSER}" -d "${PGDATABASE}" -tAc "${sql}"
+  else
+    compose exec -T postgres psql -U "${PGUSER}" -d "${PGDATABASE}" -tAc "${sql}"
+  fi
+}
+
+request() {
+  local method="$1"
+  local url="$2"
+  local body="${3:-}"
+  local tmp_body
+  tmp_body="$(mktemp)"
+  TMP_FILES+=("${tmp_body}")
+  local status
+
+  if [[ -n "${body}" ]]; then
+    status="$(curl -sS -o "${tmp_body}" -w "%{http_code}" -X "${method}" "${url}" \
+      -H "Content-Type: application/json" -d "${body}")"
+  else
+    status="$(curl -sS -o "${tmp_body}" -w "%{http_code}" -X "${method}" "${url}")"
+  fi
+
+  echo "${status}" > "${tmp_body}.status"
+  echo "${tmp_body}"
+}
+
+assert_status() {
+  local expected="$1"
+  local body_file="$2"
+  local status
+  status="$(cat "${body_file}.status")"
+  if [[ "${status}" != "${expected}" ]]; then
+    echo "Expected HTTP ${expected}, got ${status}"
+    echo "Response body:"
+    cat "${body_file}"
+    echo
+    return 1
+  fi
+}
+
+wait_for_kafka() {
+  local elapsed=0
+  while (( elapsed < KAFKA_READY_WAIT_SECS )); do
+    if kafka_exec /opt/kafka/bin/kafka-broker-api-versions.sh --bootstrap-server localhost:9092 >/dev/null 2>&1; then
+      return 0
+    fi
+    sleep 2
+    elapsed=$((elapsed + 2))
+  done
+  echo "Kafka did not become ready within ${KAFKA_READY_WAIT_SECS}s"
+  return 1
+}
+
+wait_for_outbox_processed() {
+  local outbox_id="$1"
+  local elapsed=0
+  while (( elapsed < RELAY_WAIT_SECS )); do
+    local processed
+    processed="$(psql_cmd "SELECT processed_at IS NOT NULL FROM outbox_events WHERE id = '${outbox_id}'")"
+    if [[ "${processed}" == "t" ]]; then
+      return 0
+    fi
+    sleep 1
+    elapsed=$((elapsed + 1))
+  done
+  echo "Outbox row ${outbox_id} was not processed within ${RELAY_WAIT_SECS}s"
+  return 1
+}
+
+wait_for_pending_outbox_count() {
+  local expected="$1"
+  local elapsed=0
+  while (( elapsed < RELAY_WAIT_SECS )); do
+    local pending
+    pending="$(psql_cmd "SELECT COUNT(*) FROM outbox_events WHERE processed_at IS NULL")"
+    if [[ "${pending}" == "${expected}" ]]; then
+      return 0
+    fi
+    sleep 1
+    elapsed=$((elapsed + 1))
+  done
+  echo "Expected ${expected} pending outbox row(s), timed out after ${RELAY_WAIT_SECS}s"
+  return 1
+}
+
+consume_topic() {
+  local topic="$1"
+  local group="$2"
+  local max_messages="$3"
+  local tmp_out
+  tmp_out="$(mktemp)"
+  TMP_FILES+=("${tmp_out}")
+
+  kafka_exec /opt/kafka/bin/kafka-console-consumer.sh \
+    --bootstrap-server localhost:9092 \
+    --topic "${topic}" \
+    --group "${group}" \
+    --from-beginning \
+    --property print.key=true \
+    --property print.partition=true \
+    --timeout-ms 15000 \
+    --max-messages "${max_messages}" > "${tmp_out}" 2>/dev/null || true
+
+  echo "${tmp_out}"
+}
+
+TOTAL_STEPS=11
+
+echo "Running Kafka + outbox verification against ${BASE_URL}"
+echo "Script run id: ${SCRIPT_RUN_ID}"
+
+echo ""
+echo "[0/${TOTAL_STEPS}] Preflight — API, Postgres, and Kafka reachable"
+preflight_status="$(curl -sS -o /dev/null -w "%{http_code}" "${BASE_URL}/api/v1/alert-thresholds" || true)"
+if [[ "${preflight_status}" != "200" ]]; then
+  echo "API not reachable at ${BASE_URL} (HTTP ${preflight_status})."
+  echo "Start the API with: dotnet run --project VigilCareClinicalAPI"
+  exit 1
+fi
+
+if ! psql_cmd "SELECT 1" >/dev/null 2>&1; then
+  echo "Postgres not reachable on ${PGHOST}:${PGPORT}."
+  echo "Start the stack with: docker compose up -d"
+  exit 1
+fi
+
+if ! wait_for_kafka; then
+  exit 1
+fi
+echo "OK: API, Postgres, and Kafka are up"
+
+echo ""
+echo "[1/${TOTAL_STEPS}] Verifying Kafka topics were provisioned"
+topic_list="$(kafka_exec /opt/kafka/bin/kafka-topics.sh --bootstrap-server localhost:9092 --list)"
+for topic in alert.generated alert.acknowledged encounter.status.changed observation.recorded; do
+  if ! grep -qx "${topic}" <<< "${topic_list}"; then
+    echo "Missing Kafka topic: ${topic}"
+    echo "Topics found:"
+    echo "${topic_list}"
+    exit 1
+  fi
+done
+echo "OK: observation.recorded, alert.generated, alert.acknowledged, encounter.status.changed exist"
+
+echo ""
+echo "[2/${TOTAL_STEPS}] Creating patient and two active encounters"
+patient_payload='{"firstName":"Kafka","lastName":"Verifier","dateOfBirth":"1990-06-01","gender":"M"}'
+resp="$(request POST "${BASE_URL}/api/v1/patients" "${patient_payload}")"
+assert_status "201" "${resp}"
+patient_id="$(jq -r '.data.id' "${resp}")"
+
+enc_payload_a='{"encounterType":"Inpatient","department":"ICU","attendingPhysician":"Dr. Kafka"}'
+resp="$(request POST "${BASE_URL}/api/v1/patients/${patient_id}/encounters" "${enc_payload_a}")"
+assert_status "201" "${resp}"
+encounter_a="$(jq -r '.data.id' "${resp}")"
+
+enc_payload_b='{"encounterType":"Outpatient","department":"Clinic","attendingPhysician":"Dr. Kafka"}'
+resp="$(request POST "${BASE_URL}/api/v1/patients/${patient_id}/encounters" "${enc_payload_b}")"
+assert_status "201" "${resp}"
+encounter_b="$(jq -r '.data.id' "${resp}")"
+
+enc_payload_discharge='{"encounterType":"Emergency","department":"ED","attendingPhysician":"Dr. Kafka"}'
+resp="$(request POST "${BASE_URL}/api/v1/patients/${patient_id}/encounters" "${enc_payload_discharge}")"
+assert_status "201" "${resp}"
+encounter_discharge="$(jq -r '.data.id' "${resp}")"
+
+echo "OK: encounters ${encounter_a}, ${encounter_b}, ${encounter_discharge}"
+
+echo ""
+echo "[3/${TOTAL_STEPS}] Ingesting observations for partition-key verification"
+for encounter_id in "${encounter_a}" "${encounter_b}"; do
+  for i in 1 2; do
+    obs_payload="$(jq -nc \
+      --arg recordedAt "${RECORDED_AT}" \
+      --arg key "kafka-script-${SCRIPT_RUN_ID}-${encounter_id}-${i}" \
+      '{observations:[{observationCode:"HEART_RATE",value:80,unit:"bpm",source:"DEVICE",recordedAt:$recordedAt,idempotencyKey:$key}]}')"
+    resp="$(request POST "${BASE_URL}/api/v1/encounters/${encounter_id}/observations" "${obs_payload}")"
+    assert_status "201" "${resp}"
+  done
+done
+echo "OK: four observation.recorded outbox rows written"
+
+echo ""
+echo "[4/${TOTAL_STEPS}] Waiting for relay to publish observation events"
+latest_outbox="$(psql_cmd "SELECT id FROM outbox_events WHERE topic = '${TOPIC_OBSERVATION}' AND partition_key = '${encounter_a}' ORDER BY created_at DESC LIMIT 1")"
+if [[ -z "${latest_outbox}" ]]; then
+  echo "Could not find outbox row for encounter ${encounter_a}"
+  exit 1
+fi
+wait_for_outbox_processed "${latest_outbox}"
+echo "OK: relay marked observation outbox rows processed"
+
+echo ""
+echo "[5/${TOTAL_STEPS}] Verifying partition ordering (same encounter key → same partition)"
+consumer_out="$(consume_topic "${TOPIC_OBSERVATION}" "partition-check-${SCRIPT_RUN_ID}" 50)"
+for encounter_id in "${encounter_a}" "${encounter_b}"; do
+  partitions="$(grep -F "${encounter_id}" "${consumer_out}" | sed -n 's/^Partition:\([0-9]*\).*/\1/p' | sort -u)"
+  partition_count="$(echo "${partitions}" | grep -c . || true)"
+  if [[ "${partition_count}" -lt 1 ]]; then
+    echo "No Kafka messages found for encounter ${encounter_id}"
+    exit 1
+  fi
+  if [[ "${partition_count}" -gt 1 ]]; then
+    echo "Encounter ${encounter_id} landed on multiple partitions: ${partitions}"
+    exit 1
+  fi
+done
+echo "OK: each encounter's messages share a single partition"
+
+echo ""
+echo "[6/${TOTAL_STEPS}] Verifying consumer group independence"
+group_a="es-indexer-${SCRIPT_RUN_ID}"
+group_b="sepsis-engine-${SCRIPT_RUN_ID}"
+out_a="$(consume_topic "${TOPIC_OBSERVATION}" "${group_a}" 20)"
+out_b="$(consume_topic "${TOPIC_OBSERVATION}" "${group_b}" 20)"
+count_a="$(grep -c '^Partition:' "${out_a}" || true)"
+count_b="$(grep -c '^Partition:' "${out_b}" || true)"
+if [[ "${count_a}" -lt 4 || "${count_b}" -lt 4 ]]; then
+  echo "Expected each consumer group to read at least 4 messages, got ${count_a} and ${count_b}"
+  exit 1
+fi
+
+offset_a="$(kafka_exec /opt/kafka/bin/kafka-consumer-groups.sh \
+  --bootstrap-server localhost:9092 \
+  --describe --group "${group_a}" 2>/dev/null | awk '/observation.recorded/ {sum += $4} END {print sum+0}')"
+offset_b="$(kafka_exec /opt/kafka/bin/kafka-consumer-groups.sh \
+  --bootstrap-server localhost:9092 \
+  --describe --group "${group_b}" 2>/dev/null | awk '/observation.recorded/ {sum += $4} END {print sum+0}')"
+if [[ "${offset_a}" -lt 4 || "${offset_b}" -lt 4 ]]; then
+  echo "Consumer groups did not commit expected offsets (es-indexer=${offset_a}, sepsis-engine=${offset_b})"
+  exit 1
+fi
+echo "OK: two consumer groups read independently (offsets es-indexer=${offset_a}, sepsis-engine=${offset_b})"
+
+echo ""
+echo "[7/${TOTAL_STEPS}] Verifying encounter.status.changed outbox write and Kafka publish"
+discharge_payload='{"status":"Discharged"}'
+resp="$(request PATCH "${BASE_URL}/api/v1/encounters/${encounter_discharge}/status" "${discharge_payload}")"
+assert_status "200" "${resp}"
+
+outbox_status="$(psql_cmd "SELECT payload->>'newStatus' FROM outbox_events WHERE topic = '${TOPIC_ENCOUNTER}' AND partition_key = '${encounter_discharge}' ORDER BY created_at DESC LIMIT 1")"
+if [[ "${outbox_status}" != "DISCHARGED" ]]; then
+  echo "Expected encounter.status.changed outbox row with newStatus=DISCHARGED, got '${outbox_status}'"
+  exit 1
+fi
+
+discharge_outbox_id="$(psql_cmd "SELECT id FROM outbox_events WHERE topic = '${TOPIC_ENCOUNTER}' AND partition_key = '${encounter_discharge}' ORDER BY created_at DESC LIMIT 1")"
+wait_for_outbox_processed "${discharge_outbox_id}"
+
+encounter_consumer_out="$(consume_topic "${TOPIC_ENCOUNTER}" "encounter-check-${SCRIPT_RUN_ID}" 5)"
+if ! grep -Fq "${encounter_discharge}" "${encounter_consumer_out}"; then
+  echo "encounter.status.changed message not found on Kafka for ${encounter_discharge}"
+  exit 1
+fi
+echo "OK: discharge produced outbox row and Kafka message"
+
+echo ""
+echo "[8/${TOTAL_STEPS}] Verifying relay survives Kafka restart (no rows lost)"
+compose stop kafka >/dev/null
+
+restart_obs_payload="$(jq -nc \
+  --arg recordedAt "${RECORDED_AT}" \
+  --arg key "kafka-restart-${SCRIPT_RUN_ID}" \
+  '{observations:[{observationCode:"HEART_RATE",value:83,unit:"bpm",source:"DEVICE",recordedAt:$recordedAt,idempotencyKey:$key}]}')"
+resp="$(request POST "${BASE_URL}/api/v1/encounters/${encounter_a}/observations" "${restart_obs_payload}")"
+assert_status "201" "${resp}"
+
+restart_outbox_id="$(psql_cmd "SELECT id FROM outbox_events WHERE topic = '${TOPIC_OBSERVATION}' AND partition_key = '${encounter_a}' ORDER BY created_at DESC LIMIT 1")"
+restart_pending="$(psql_cmd "SELECT processed_at IS NULL FROM outbox_events WHERE id = '${restart_outbox_id}'")"
+if [[ "${restart_pending}" != "t" ]]; then
+  echo "Expected outbox row ${restart_outbox_id} to remain pending while Kafka is down"
+  exit 1
+fi
+echo "OK: outbox row pending while Kafka is stopped"
+
+compose start kafka >/dev/null
+wait_for_kafka
+wait_for_outbox_processed "${restart_outbox_id}"
+echo "OK: relay caught up after Kafka restart"
+
+echo ""
+echo "[9/${TOTAL_STEPS}] Verifying partial index and relay poll plan"
+index_count="$(psql_cmd "SELECT COUNT(*) FROM pg_indexes WHERE tablename = 'outbox_events' AND indexdef LIKE '%processed_at IS NULL%'")"
+if [[ "${index_count}" -lt 1 ]]; then
+  echo "Expected partial index on outbox_events (processed_at IS NULL), found ${index_count}"
+  exit 1
+fi
+
+psql_cmd "ANALYZE outbox_events" >/dev/null
+explain_out="$(psql_cmd "BEGIN; SET LOCAL enable_seqscan = off; EXPLAIN SELECT id, topic, payload, partition_key FROM outbox_events WHERE processed_at IS NULL ORDER BY created_at ASC LIMIT 100 FOR UPDATE SKIP LOCKED; ROLLBACK;")"
+if ! grep -qi 'Index Scan' <<< "${explain_out}"; then
+  echo "Expected Index Scan when seqscan is disabled, got:"
+  echo "${explain_out}"
+  exit 1
+fi
+echo "OK: partial index exists and backs the relay poll query"
+
+echo ""
+echo "[10/${TOTAL_STEPS}] Verifying partition_key is set on clinical outbox rows"
+missing_keys="$(psql_cmd "SELECT COUNT(*) FROM outbox_events WHERE created_at >= NOW() - INTERVAL '10 minutes' AND topic IN ('${TOPIC_OBSERVATION}', '${TOPIC_ENCOUNTER}', 'alert.generated', 'alert.acknowledged') AND (partition_key IS NULL OR partition_key = '')")"
+if [[ "${missing_keys}" != "0" ]]; then
+  echo "Found ${missing_keys} clinical outbox row(s) without partition_key"
+  exit 1
+fi
+echo "OK: all clinical outbox rows have partition_key"
+
+echo ""
+echo "All ${TOTAL_STEPS} Kafka + outbox checks passed."