diff --git a/pkg/clinical/application/dto/input.go b/pkg/clinical/application/dto/input.go
index 128b96b4..9bcb0eec 100644
--- a/pkg/clinical/application/dto/input.go
+++ b/pkg/clinical/application/dto/input.go
@@ -132,9 +132,10 @@ type SectionInput struct {
 
 // ConsentInput models the consent input
 type ConsentInput struct {
-	Status    ConsentStatusEnum        `json:"status"`
-	Provision ConsentProvisionTypeEnum `json:"provision,omitempty"`
-	PatientID string                   `json:"patientID,omitempty"`
+	Status     ConsentStatusEnum        `json:"status"`
+	Provision  ConsentProvisionTypeEnum `json:"provision,omitempty"`
+	PatientID  string                   `json:"patientID,omitempty"`
+	DenyReason string                   `json:"denyReason,omitempty"`
 }
 
 // QuestionnaireResponse models input for questionnaire response resource in fhir
diff --git a/pkg/clinical/domain/consent.go b/pkg/clinical/domain/consent.go
index a4fe4ddc..e842541d 100644
--- a/pkg/clinical/domain/consent.go
+++ b/pkg/clinical/domain/consent.go
@@ -4,7 +4,7 @@ import (
 	"github.com/savannahghi/clinical/pkg/clinical/application/dto"
 )
 
-// Consent models a fhir consent resource
+// Consent models a fhir consent resource.
 type FHIRConsent struct {
 	ID         *string                `json:"id,omitempty"`
 	Status     *dto.ConsentStatusEnum `json:"status"`
@@ -14,6 +14,7 @@ type FHIRConsent struct {
 	Provision  *FHIRConsentProvision  `json:"provision,omitempty"`
 	Patient    *FHIRReference         `json:"patient,omitempty"`
 	Meta       *FHIRMetaInput         `json:"meta,omitempty"`
+	Extension  []Extension            `json:"extension,omitempty"`
 }
 
 // ConsentProvision models a fhir consent provision
diff --git a/pkg/clinical/presentation/graph/generated/generated.go b/pkg/clinical/presentation/graph/generated/generated.go
index 3fb9955a..efeb1285 100644
--- a/pkg/clinical/presentation/graph/generated/generated.go
+++ b/pkg/clinical/presentation/graph/generated/generated.go
@@ -4384,6 +4384,7 @@ input ConsentInput{
   status: ConsentStatusEnum!
   provision: ConsentProvisionTypeEnum!
   patientID: String!
+  denyReason: String
 }
 
 input ReferenceInput {
@@ -28750,7 +28751,7 @@ func (ec *executionContext) unmarshalInputConsentInput(ctx context.Context, obj
 		asMap[k] = v
 	}
 
-	fieldsInOrder := [...]string{"status", "provision", "patientID"}
+	fieldsInOrder := [...]string{"status", "provision", "patientID", "denyReason"}
 	for _, k := range fieldsInOrder {
 		v, ok := asMap[k]
 		if !ok {
@@ -28784,6 +28785,15 @@ func (ec *executionContext) unmarshalInputConsentInput(ctx context.Context, obj
 				return it, err
 			}
 			it.PatientID = data
+		case "denyReason":
+			var err error
+
+			ctx := graphql.WithPathContext(ctx, graphql.NewPathWithField("denyReason"))
+			data, err := ec.unmarshalOString2string(ctx, v)
+			if err != nil {
+				return it, err
+			}
+			it.DenyReason = data
 		}
 	}
 
diff --git a/pkg/clinical/presentation/graph/inputs.graphql b/pkg/clinical/presentation/graph/inputs.graphql
index fc4e6cc1..6e93eacc 100644
--- a/pkg/clinical/presentation/graph/inputs.graphql
+++ b/pkg/clinical/presentation/graph/inputs.graphql
@@ -109,6 +109,7 @@ input ConsentInput{
   status: ConsentStatusEnum!
   provision: ConsentProvisionTypeEnum!
   patientID: String!
+  denyReason: String
 }
 
 input ReferenceInput {
diff --git a/pkg/clinical/usecases/clinical/consent.go b/pkg/clinical/usecases/clinical/consent.go
index 9abd8c11..83a7ddc7 100644
--- a/pkg/clinical/usecases/clinical/consent.go
+++ b/pkg/clinical/usecases/clinical/consent.go
@@ -23,7 +23,7 @@ func (u *UseCasesClinicalImpl) RecordConsent(ctx context.Context, input dto.Cons
 	}
 
 	scope := &domain.FHIRCodeableConcept{
-		Text: "privacy",
+		Text: "patient-privacy",
 	}
 
 	var system scalarutils.URI = "http://terminology.hl7.org/CodeSystem/consentcategorycodes"
@@ -65,6 +65,14 @@ func (u *UseCasesClinicalImpl) RecordConsent(ctx context.Context, input dto.Cons
 		Meta:       &consentMeta,
 	}
 
+	if input.Provision == dto.ConsentProvisionTypeDeny {
+		extension := &domain.Extension{
+			URL:         "http://hl7.org/fhir/StructureDefinition/event-statusReason",
+			ValueString: input.DenyReason,
+		}
+		consent.Extension = []domain.Extension{*extension}
+	}
+
 	resp, err := u.infrastructure.FHIR.CreateFHIRConsent(ctx, consent)
 	if err != nil {
 		return nil, err
diff --git a/pkg/clinical/usecases/clinical/consent_test.go b/pkg/clinical/usecases/clinical/consent_test.go
index 02c53c63..ab1033fb 100644
--- a/pkg/clinical/usecases/clinical/consent_test.go
+++ b/pkg/clinical/usecases/clinical/consent_test.go
@@ -37,9 +37,10 @@ func TestUseCasesClinicalImpl_RecordConsent(t *testing.T) {
 			args: args{
 				ctx: context.Background(),
 				input: dto.ConsentInput{
-					PatientID: ID,
-					Provision: dto.ConsentProvisionTypeEnum(provisionType),
-					Status:    dto.ConsentStatusEnum(status),
+					PatientID:  ID,
+					Provision:  dto.ConsentProvisionTypeEnum(provisionType),
+					Status:     dto.ConsentStatusEnum(status),
+					DenyReason: "",
 				},
 			},
 			wantErr: false,
@@ -49,8 +50,9 @@ func TestUseCasesClinicalImpl_RecordConsent(t *testing.T) {
 			args: args{
 				ctx: context.Background(),
 				input: dto.ConsentInput{
-					PatientID: ID,
-					Status:    dto.ConsentStatusEnum(status),
+					PatientID:  ID,
+					Status:     dto.ConsentStatusEnum(status),
+					DenyReason: "",
 				},
 			},
 			wantErr: true,
@@ -60,8 +62,9 @@ func TestUseCasesClinicalImpl_RecordConsent(t *testing.T) {
 			args: args{
 				ctx: context.Background(),
 				input: dto.ConsentInput{
-					PatientID: "",
-					Status:    dto.ConsentStatusEnum(status),
+					PatientID:  "",
+					Status:     dto.ConsentStatusEnum(status),
+					DenyReason: "",
 				},
 			},
 			wantErr: true,
@@ -71,8 +74,9 @@ func TestUseCasesClinicalImpl_RecordConsent(t *testing.T) {
 			args: args{
 				ctx: nil,
 				input: dto.ConsentInput{
-					PatientID: "",
-					Status:    dto.ConsentStatusEnum(status),
+					PatientID:  "",
+					Status:     dto.ConsentStatusEnum(status),
+					DenyReason: "",
 				},
 			},
 			wantErr: true,