diff --git a/app/models/event_procedure.rb b/app/models/event_procedure.rb
index c2a56bb..8697d9b 100644
--- a/app/models/event_procedure.rb
+++ b/app/models/event_procedure.rb
@@ -32,10 +32,18 @@ class EventProcedure < ApplicationRecord
   validates :urgency, inclusion: [true, false], if: -> { health_insurance? }
   validates :payment, presence: true
 
+  validate :match_user_with_patient_user
   validate :custom_and_urgency_cannot_be_true
 
   private
 
+  def match_user_with_patient_user
+    return if patient.nil? || user.nil?
+    return if patient.user_id == user_id
+
+    errors.add(:base, "The patient must be associated with the same procedure user")
+  end
+
   def custom_and_urgency_cannot_be_true
     return unless procedure&.custom && urgency
 
diff --git a/spec/factories/event_procedures.rb b/spec/factories/event_procedures.rb
index 95556f9..e6b3943 100644
--- a/spec/factories/event_procedures.rb
+++ b/spec/factories/event_procedures.rb
@@ -5,9 +5,8 @@
     cbhpm
     health_insurance
     hospital
-    patient
-    procedure
     user
+    procedure
 
     patient_service_number { "202312150001" }
     date { "2023-12-15 16:02:00" }
@@ -22,24 +21,20 @@
 
     transient do
       health_insurance_attributes { nil }
-    end
-
-    transient do
       patient_attributes { nil }
-    end
-
-    transient do
       procedure_attributes { nil }
     end
 
     after(:build) do |event_procedure, evaluator|
-      event_procedure.patient = build(:patient, evaluator.patient_attributes) if evaluator.patient_attributes
+      event_procedure.user ||= build(:user)
+      event_procedure.patient ||= build(
+        :patient,
+        (evaluator.patient_attributes || {}).merge(user: event_procedure.user)
+      )
       event_procedure.procedure = build(:procedure, evaluator.procedure_attributes) if evaluator.procedure_attributes
+
       if evaluator.health_insurance_attributes
-        event_procedure.health_insurance = build(
-          :health_insurance,
-          evaluator.health_insurance_attributes
-        )
+        event_procedure.health_insurance = build(:health_insurance, evaluator.health_insurance_attributes)
       end
     end
   end
diff --git a/spec/models/event_procedure_spec.rb b/spec/models/event_procedure_spec.rb
index 4a62056..7e54948 100644
--- a/spec/models/event_procedure_spec.rb
+++ b/spec/models/event_procedure_spec.rb
@@ -4,9 +4,11 @@
 
 RSpec.describe EventProcedure do
   describe "acts_as_paranoid" do
-    it "soft deletes the record" do
-      event_procedure = create(:event_procedure)
+    let(:user) { create(:user) }
+    let(:patient) { create(:patient, user: user) }
+    let(:event_procedure) { create(:event_procedure, user: user, patient: patient) }
 
+    it "soft deletes the record" do
       event_procedure.destroy
 
       expect(event_procedure.deleted_at).to be_present
@@ -14,24 +16,18 @@
     end
 
     it "does not include the record in the default scope" do
-      event_procedure = create(:event_procedure)
-
       event_procedure.destroy
 
       expect(described_class.all).not_to include(event_procedure)
     end
 
     it "includes the record in the default scope when with_deleted is called" do
-      event_procedure = create(:event_procedure)
-
       event_procedure.destroy
 
       expect(described_class.with_deleted).to include(event_procedure)
     end
 
     it "restores a soft deleted record" do
-      event_procedure = create(:event_procedure)
-
       event_procedure.destroy
       event_procedure.recover!
 
@@ -75,6 +71,29 @@
         expect(event).to be_valid
       end
     end
+
+    context 'when patient belongs to a different user' do
+      it 'is invalid when patient and event_procedure have different users' do
+        user = create(:user)
+        other_user = create(:user)
+        patient = create(:patient, user: other_user)
+  
+        event_procedure = build(:event_procedure, user: user, patient: patient)
+  
+        expect(event_procedure).not_to be_valid
+        expect(event_procedure.errors[:base]).to include("The patient must be associated with the same procedure user")
+      end
+    end
+  
+    context 'when patient belongs to the same user' do
+      it 'is valid when patient and event_procedure have the same user' do
+        user = create(:user)
+        patient = create(:patient, user: user)
+        event_procedure = build(:event_procedure, user: user, patient: patient)
+  
+        expect(event_procedure).to be_valid
+      end
+    end
   end
 
   describe ".enumerations" do
@@ -96,9 +115,16 @@
   end
 
   describe "nested attributes for patient" do
+    let(:user) { create(:user) }
+
     context "when patient_attributes are provided" do
       it "creates patient" do
-        event_procedure = build(:event_procedure, patient_attributes: { id: nil, name: "John Doe" })
+        event_procedure = build(
+          :event_procedure,
+          user: user,
+          patient: nil,
+          patient_attributes: { name: "John Doe", user_id: user.id }
+        )
 
         expect { event_procedure.save }.to change(Patient, :count).by(1)
         expect(event_procedure.patient).to be_persisted
@@ -108,7 +134,11 @@
 
     context "when patient_attributes are not provided" do
       it "does not create patient" do
-        event_procedure = build(:event_procedure, patient_attributes: { id: nil, name: nil })
+        event_procedure = build(
+          :event_procedure,
+          patient: nil,
+          patient_attributes: { name: nil, user_id: nil }
+        )
 
         expect(event_procedure.save).to be_falsey
         expect(event_procedure.errors[:"patient.name"]).to include("can't be blank")
@@ -120,6 +150,7 @@
     context "when procedure_attributes are provided" do
       it "creates procedure" do
         user = create(:user)
+        patient = create(:patient, user: user)
         procedure_attributes = {
           id: nil,
           name: "procedure name",
@@ -129,7 +160,10 @@
           custom: true,
           user_id: user.id
         }
-        event_procedure = build(:event_procedure, procedure_attributes: procedure_attributes)
+        event_procedure = build(
+          :event_procedure, user: user, patient: patient,
+          procedure_attributes: procedure_attributes
+        )
 
         expect { event_procedure.save }.to change(Procedure, :count).by(1)
         expect(event_procedure.procedure).to be_persisted
@@ -163,13 +197,17 @@
     context "when health_insurance_attributes are provided" do
       it "creates health_insurance" do
         user = create(:user)
+        patient = create(:patient, user: user)
         health_insurance_attributes = {
           id: nil,
           name: "health_insurance name",
           custom: true,
           user_id: user.id
         }
-        event_procedure = build(:event_procedure, health_insurance_attributes: health_insurance_attributes)
+        event_procedure = build(
+          :event_procedure, user: user, patient: patient,
+          health_insurance_attributes: health_insurance_attributes
+        )
 
         expect { event_procedure.save }.to change(HealthInsurance, :count).by(1)
         expect(event_procedure.health_insurance).to be_persisted
diff --git a/spec/models/patient_spec.rb b/spec/models/patient_spec.rb
index 8dbbb5b..86b4db9 100644
--- a/spec/models/patient_spec.rb
+++ b/spec/models/patient_spec.rb
@@ -15,16 +15,17 @@
   describe "deletable?" do
     subject { patient.deletable? }
 
-    let(:patient) { create(:patient, event_procedures:) }
+    let(:user) { create(:user) }
+    let(:patient) { create(:patient, user: user) }
 
     context "when patient has no event_procedures" do
-      let(:event_procedures) { [] }
-
       it { is_expected.to be_truthy }
     end
 
     context "when patient has event_procedures" do
-      let(:event_procedures) { create_list(:event_procedure, 1) }
+      before do
+        create(:event_procedure, patient: patient, user: user)
+      end
 
       it { is_expected.to be_falsy }
     end
diff --git a/spec/operations/event_procedures/build_total_amount_cents_spec.rb b/spec/operations/event_procedures/build_total_amount_cents_spec.rb
index 1956d10..b6a457e 100644
--- a/spec/operations/event_procedures/build_total_amount_cents_spec.rb
+++ b/spec/operations/event_procedures/build_total_amount_cents_spec.rb
@@ -5,12 +5,13 @@
 RSpec.describe EventProcedures::BuildTotalAmountCents, type: :operation do
   describe ".result" do
     it "returns a success" do
+      user = create(:user)
       cbhpm = create(:cbhpm)
       procedure = create(:procedure)
       create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
       create(:port_value, cbhpm: cbhpm, anesthetic_port: "1A", amount_cents: 1000)
-      event_procedure = create(:event_procedure, procedure: procedure, cbhpm: cbhpm)
-
+      patient = create(:patient, user: user)
+      event_procedure = create(:event_procedure, user: user, procedure: procedure, cbhpm: cbhpm, patient: patient)
       expect(described_class.result(event_procedure: event_procedure)).to be_success
     end
 
diff --git a/spec/operations/event_procedures/create_spec.rb b/spec/operations/event_procedures/create_spec.rb
index 573bf96..7f494b5 100644
--- a/spec/operations/event_procedures/create_spec.rb
+++ b/spec/operations/event_procedures/create_spec.rb
@@ -3,10 +3,12 @@
 require "rails_helper"
 
 RSpec.describe EventProcedures::Create, type: :operation do
+  let(:user) { create(:user) }
+  let(:patient) { create(:patient, user: user) }
+
   describe ".result" do
     context "when params are valid" do
       it "is successful" do
-        user = create(:user)
         cbhpm = create(:cbhpm)
         procedure = create(:procedure)
         create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
@@ -19,7 +21,7 @@
           urgency: false,
           room_type: EventProcedures::RoomTypes::WARD,
           payment: EventProcedures::Payments::HEALTH_INSURANCE,
-          patient_attributes: { id: create(:patient).id },
+          patient_attributes: { id: patient.id, user_id: user.id },
           procedure_attributes: { id: procedure.id },
           health_insurance_attributes: { id: create(:health_insurance).id }
         }
@@ -30,7 +32,6 @@
       end
 
       it "creates a new event_procedure" do
-        user = create(:user)
         cbhpm = create(:cbhpm)
         procedure = create(:procedure)
         create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
@@ -43,7 +44,7 @@
           urgency: true,
           room_type: EventProcedures::RoomTypes::WARD,
           payment: EventProcedures::Payments::HEALTH_INSURANCE,
-          patient_attributes: { id: create(:patient).id },
+          patient_attributes: { id: patient.id, user_id: user.id },
           procedure_attributes: { id: procedure.id },
           health_insurance_attributes: { id: create(:health_insurance).id }
         }
@@ -68,7 +69,6 @@
 
       context "when create a new patient" do
         it "creates and does not duplicate the creation" do
-          user = create(:user)
           cbhpm = create(:cbhpm)
           procedure = create(:procedure)
           create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
@@ -94,7 +94,6 @@
       context "when create a new procedure" do
         context "when procedure attributes are valid" do
           it "does not duplicate the creation" do
-            user = create(:user)
             cbhpm = create(:cbhpm)
             procedure = create(:procedure)
             create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
@@ -117,7 +116,7 @@
               urgency: false,
               room_type: EventProcedures::RoomTypes::WARD,
               payment: EventProcedures::Payments::HEALTH_INSURANCE,
-              patient_attributes: { id: create(:patient).id },
+              patient_attributes: { id: patient.id, user_id: user.id },
               procedure_attributes: procedure_attributes,
               health_insurance_attributes: { id: create(:health_insurance).id }
             }
@@ -163,7 +162,6 @@
       context "when create a new health_insurance" do
         context "when health_insurance attributes are valid" do
           it "does not duplicate the creation" do
-            user = create(:user)
             cbhpm = create(:cbhpm)
             procedure = create(:procedure)
             create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
@@ -182,7 +180,7 @@
               urgency: nil,
               room_type: nil,
               payment: EventProcedures::Payments::OTHERS,
-              patient_attributes: { id: create(:patient).id },
+              patient_attributes: { id: patient.id, user_id: user.id },
               procedure_attributes: { id: procedure.id },
               health_insurance_attributes: health_insurance_attributes
             }
@@ -249,9 +247,7 @@
       end
 
       it "returns errors" do
-        user = create(:user)
         procedure = create(:procedure)
-        patient = create(:patient)
         health_insurance = create(:health_insurance)
         attributes = {
           patient_attributes: { id: patient.id },
diff --git a/spec/operations/event_procedures/list_spec.rb b/spec/operations/event_procedures/list_spec.rb
index bf6e911..819c21b 100644
--- a/spec/operations/event_procedures/list_spec.rb
+++ b/spec/operations/event_procedures/list_spec.rb
@@ -24,7 +24,7 @@
     it "includes the associations" do # rubocop:disable RSpec/MultipleExpectations
       user = create(:user)
       procedure = create(:procedure, name: "Tireoidectomia")
-      patient = create(:patient, name: "John Doe")
+      patient = create(:patient, name: "John Doe", user: user)
       hospital = create(:hospital, name: "General Hospital")
       health_insurance = create(:health_insurance, name: "Insurance Corp")
       create_list(
diff --git a/spec/operations/event_procedures/total_amount_cents_spec.rb b/spec/operations/event_procedures/total_amount_cents_spec.rb
index 2125cf6..d5ba170 100644
--- a/spec/operations/event_procedures/total_amount_cents_spec.rb
+++ b/spec/operations/event_procedures/total_amount_cents_spec.rb
@@ -6,7 +6,8 @@
   describe ".result" do
     it "is successful" do
       user = create(:user)
-      event_procedure = create(:event_procedure, user_id: user.id)
+      patient = create(:patient, user: user)
+      event_procedure = create(:event_procedure, user_id: user.id, patient: patient)
       expect(described_class.result(event_procedures: [event_procedure])).to be_success
     end
 
diff --git a/spec/operations/event_procedures/update_spec.rb b/spec/operations/event_procedures/update_spec.rb
index 343da3a..4f7f0b1 100644
--- a/spec/operations/event_procedures/update_spec.rb
+++ b/spec/operations/event_procedures/update_spec.rb
@@ -22,17 +22,21 @@
 
       context "when patient_attributes are provided" do
         it "update event_procedure association patient" do
-          old_patient = create(:patient, name: "Old Patient")
-          new_patient = create(:patient, name: "New Patient name")
+          user = create(:user)
+          old_patient = create(:patient, name: "Old Patient", user: user)
+          new_patient = create(:patient, name: "New Patient name", user: user)
           cbhpm = create(:cbhpm)
           procedure = create(:procedure)
           create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
           create(:port_value, cbhpm: cbhpm, anesthetic_port: "1A", amount_cents: 1000)
-          event_procedure = create(:event_procedure, procedure: procedure, cbhpm: cbhpm, patient: old_patient)
+          event_procedure = create(
+            :event_procedure, procedure: procedure, cbhpm: cbhpm, patient: old_patient,
+            user: user
+          )
           attributes = {
             urgency: true,
             room_type: EventProcedures::RoomTypes::WARD,
-            patient_attributes: { id: new_patient.id, name: nil }
+            patient_attributes: { id: new_patient.id, name: nil, user: user }
           }
           result = described_class.result(id: event_procedure.id.to_s, attributes: attributes)
 
@@ -41,13 +45,13 @@
         end
 
         it "creates a new patient and does not duplicate the creation" do
-          patient = create(:patient, name: "Old Patient")
           user = create(:user)
+          patient = create(:patient, name: "Old Patient", user: user)
           cbhpm = create(:cbhpm)
           procedure = create(:procedure)
           create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
           create(:port_value, cbhpm: cbhpm, anesthetic_port: "1A", amount_cents: 1000)
-          event_procedure = create(:event_procedure, procedure: procedure, cbhpm: cbhpm, patient: patient)
+          event_procedure = create(:event_procedure, procedure: procedure, cbhpm: cbhpm, patient: patient, user: user)
           attributes = {
             urgency: true,
             room_type: EventProcedures::RoomTypes::WARD,
diff --git a/spec/pdfs/event_procedures_report_pdf_spec.rb b/spec/pdfs/event_procedures_report_pdf_spec.rb
index 70ec872..b5e2273 100644
--- a/spec/pdfs/event_procedures_report_pdf_spec.rb
+++ b/spec/pdfs/event_procedures_report_pdf_spec.rb
@@ -5,8 +5,9 @@
 RSpec.describe EventProceduresReportPdf, type: :pdf do
   it "generates a report with the correct content" do
     user = create(:user)
+    patient = create(:patient, user: user)
     pdf = Prawn::Document.new
-    event_procedures = create_list(:event_procedure, 3, user_id: user.id)
+    event_procedures = create_list(:event_procedure, 3, user_id: user.id, patient: patient)
     amount = EventProcedures::TotalAmountCents.call(event_procedures: event_procedures)
 
     described_class.new(
diff --git a/spec/pdfs/footer_pdf_spec.rb b/spec/pdfs/footer_pdf_spec.rb
index 4cf844a..7656db5 100644
--- a/spec/pdfs/footer_pdf_spec.rb
+++ b/spec/pdfs/footer_pdf_spec.rb
@@ -5,7 +5,8 @@
 RSpec.describe FooterPdf, type: :pdf do
   it "generates a footer with the correct content" do
     user = create(:user)
-    event_procedures = create_list(:event_procedure, 3, user_id: user.id)
+    patient = create(:patient, user: user)
+    event_procedures = create_list(:event_procedure, 3, user_id: user.id, patient: patient)
     total_amount_cents = EventProcedures::TotalAmountCents.call(
       event_procedures: event_procedures
     )
diff --git a/spec/requests/api/v1/event_procedures_request_spec.rb b/spec/requests/api/v1/event_procedures_request_spec.rb
index 713d286..4907ce9 100644
--- a/spec/requests/api/v1/event_procedures_request_spec.rb
+++ b/spec/requests/api/v1/event_procedures_request_spec.rb
@@ -133,8 +133,9 @@
             procedure = create(:procedure)
             create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
             create(:port_value, cbhpm: cbhpm, anesthetic_port: "1A", amount_cents: 1000)
-            patient = create(:patient)
+            patient = create(:patient, user: user)
             params = {
+              user_id: user.id,
               hospital_id: create(:hospital).id,
               cbhpm_id: cbhpm.id,
               patient_service_number: "1234567890",
@@ -153,7 +154,7 @@
           end
 
           it "returns event_procedure" do
-            patient = create(:patient)
+            patient = create(:patient, user: user)
             procedure = create(:procedure, amount_cents: 20_000, description: "nice description")
             cbhpm = create(:cbhpm)
             create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
@@ -258,7 +259,7 @@
 
         context "when procedure does not exist" do
           it "returns created" do
-            patient = create(:patient)
+            patient = create(:patient, user: user)
             health_insurance = create(:health_insurance)
             cbhpm = create(:cbhpm)
             create(:port_value, cbhpm: cbhpm, anesthetic_port: "1A", amount_cents: 1000)
@@ -285,7 +286,7 @@
 
         context "when health_insurance does not exist" do
           it "returns created" do
-            patient = create(:patient)
+            patient = create(:patient, user: user)
             procedure = create(:procedure)
             cbhpm = create(:cbhpm)
             create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
@@ -326,7 +327,7 @@
           end
 
           it "returns error message" do
-            patient = create(:patient)
+            patient = create(:patient, user: user)
             procedure = create(:procedure)
             health_insurance = create(:health_insurance)
             params = {
@@ -388,7 +389,7 @@
           cbhpm = create(:cbhpm)
           create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
           create(:port_value, cbhpm: cbhpm, anesthetic_port: "1A", amount_cents: 1000)
-          patient = create(:patient)
+          patient = create(:patient, user: user)
           event_procedure = create(
             :event_procedure,
             health_insurance_id: health_insurance.id,
@@ -420,7 +421,7 @@
         it "updates event_procedure" do
           health_insurance = create(:health_insurance)
           procedure = create(:procedure, name: "Angioplastia transluminal")
-          patient = create(:patient)
+          patient = create(:patient, user: user)
           cbhpm = create(:cbhpm)
           create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, port: "12C", anesthetic_port: "6")
           create(:port_value, cbhpm: cbhpm, port: "12C", anesthetic_port: "6", amount_cents: 60_500)
@@ -448,14 +449,15 @@
 
       context "with valid attributes and the record not belongs to the user" do
         it "returns unauthorized" do
+          other_user = create(:user)
+          patient = create(:patient, user: other_user)
           health_insurance = create(:health_insurance)
           procedure = create(:procedure)
           cbhpm = create(:cbhpm)
           create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
           create(:port_value, cbhpm: cbhpm, anesthetic_port: "1A", amount_cents: 1000)
-          patient = create(:patient)
           event_procedure = create(
-            :event_procedure,
+            :event_procedure, user: other_user,
             health_insurance_id: health_insurance.id,
             procedure_id: procedure.id,
             patient_id: patient.id,
@@ -489,7 +491,7 @@
           cbhpm = create(:cbhpm)
           create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
           create(:port_value, cbhpm: cbhpm, anesthetic_port: "1A", amount_cents: 1000)
-          patient = create(:patient)
+          patient = create(:patient, user: user)
           event_procedure = create(
             :event_procedure,
             health_insurance_id: health_insurance.id,
@@ -510,7 +512,7 @@
           cbhpm = create(:cbhpm)
           create(:cbhpm_procedure, procedure: procedure, cbhpm: cbhpm, anesthetic_port: "1A")
           create(:port_value, cbhpm: cbhpm, anesthetic_port: "1A", amount_cents: 1000)
-          patient = create(:patient)
+          patient = create(:patient, user: user)
           event_procedure = create(
             :event_procedure,
             health_insurance_id: health_insurance.id,
diff --git a/spec/requests/api/v1/patients_request_spec.rb b/spec/requests/api/v1/patients_request_spec.rb
index 22ddd51..89f10c3 100644
--- a/spec/requests/api/v1/patients_request_spec.rb
+++ b/spec/requests/api/v1/patients_request_spec.rb
@@ -160,7 +160,7 @@
   end
 
   describe "DELETE api/v1/patients/:id" do
-    let!(:patient) { create(:patient, user: user) }
+    let(:patient) { create(:patient, user: user) }
     let(:path) { "/api/v1/patients/#{patient.id}" }
     let(:http_method) { :delete }
     let(:params) { {} }
@@ -175,7 +175,7 @@
 
       context "when patient cannot be destroyed" do
         it "returns unprocessable_content" do
-          create(:event_procedure, patient:)
+          create(:event_procedure, patient: patient, user: user)
 
           delete path, headers: headers
 
@@ -183,7 +183,7 @@
         end
 
         it "returns errors" do
-          create(:event_procedure, patient:)
+          create(:event_procedure, patient: patient, user: user)
 
           delete path, headers: headers