diff --git a/openhis-ui-vue3/src/views/charge/outpatientregistration/index.vue b/openhis-ui-vue3/src/views/charge/outpatientregistration/index.vue
index c6c74a1c..a3b132d2 100644
--- a/openhis-ui-vue3/src/views/charge/outpatientregistration/index.vue
+++ b/openhis-ui-vue3/src/views/charge/outpatientregistration/index.vue
@@ -239,6 +239,7 @@
                     highlight-current
                     default-expand-all
                     @node-click="handleNodeClick"
+                    @clear="handleOrgClear"
                     clearable
                   />
                 </el-form-item>
@@ -250,7 +251,7 @@
                     placeholder="挂号类型"
                     clearable
                     style="width: 240px"
-                    @change="setchargeItem"
+                    @change="handleServiceTypeChange"
                     ref="serviceTypeRef"
                   >
                     <el-option
@@ -754,7 +755,8 @@ const patientInfoList = ref(undefined);
 // 费用性质
 const contractList = ref(undefined);
 // const locationOptions = ref(undefined); // 地点树选项
-const doctorList = ref(undefined); // 医生选项
+const doctorList = ref(undefined); // 医生选项（过滤后的）
+const allDoctorList = ref(undefined); // 所有医生选项（用于过滤）
 const healthcareList = ref(undefined); // 挂号项目选项
 const orgOptions = ref(undefined); // 科室选项
 const readCardLoading = ref(false);
@@ -1073,6 +1075,29 @@ function setchargeItem() {
     healthcareData.length > 0 ? healthcareData[0].price + healthcareData[0].activityPrice : '';
   form.value.definitionId = healthcareData.length > 0 ? healthcareData[0].definitionId : '';
 }
+
+/** 处理挂号类型变化 */
+function handleServiceTypeChange() {
+  // 先设置费用项信息
+  setchargeItem();
+  // 然后根据就诊科室和挂号类型过滤医生
+  filterDoctorsByHealthcare();
+}
+
+/** 处理科室清空 */
+function handleOrgClear() {
+  // 清空科室时，清空相关数据
+  form.value.orgId = undefined;
+  form.value.organizationId = undefined;
+  healthcareList.value = [];
+  form.value.serviceTypeId = undefined;
+  form.value.practitionerId = undefined;
+  form.value.doctorName = '';
+  // 如果有医生列表，显示所有医生
+  if (allDoctorList.value) {
+    doctorList.value = allDoctorList.value;
+  }
+}
 /**  查询患者信息 */
 function getList() {
   loading.value = true;
@@ -1132,6 +1157,7 @@ function handleNodeClick(data) {
   // handleQuery();
   console.log('handleNodeClick', 'data', data);
   form.value.organ = data.id;
+  // 先获取医生和服务项目，然后在回调中过滤
   getPractitioner(data);
   getHealthcare(data);
 }
@@ -1144,7 +1170,15 @@ function getPractitioner(data) {
   console.log('getPractitioner', 'param', param);
   getPractitionerMetadata(param).then((response) => {
     console.log('getPractitioner', 'response', response.data);
-    doctorList.value = response.data.records;
+    // 保存所有医生列表用于后续过滤
+    allDoctorList.value = response.data.records;
+    // 如果已选择挂号类型，则根据科室和挂号类型过滤医生
+    if (form.value.serviceTypeId) {
+      filterDoctorsByHealthcare();
+    } else {
+      // 如果未选择挂号类型，显示所有医生
+      doctorList.value = allDoctorList.value;
+    }
   });
 }
 
@@ -1159,6 +1193,104 @@ function getHealthcare(data) {
   getHealthcareMetadata(param).then((response) => {
     healthcareList.value = response.data.records;
     console.log('getHealthcareMetadata', 'response', response.data);
+    // 使用 nextTick 确保数据更新后再过滤
+    nextTick(() => {
+      // 如果已选择挂号类型，则根据科室和挂号类型过滤医生
+      if (form.value.serviceTypeId && allDoctorList.value) {
+        filterDoctorsByHealthcare();
+      }
+    });
+  });
+}
+
+/** 根据就诊科室和挂号类型过滤医生列表 */
+function filterDoctorsByHealthcare() {
+  // 如果没有医生列表，直接返回
+  if (!allDoctorList.value) {
+    return;
+  }
+
+  // 如果未选择科室或挂号类型，显示所有医生
+  if (!form.value.orgId || !form.value.serviceTypeId || !healthcareList.value) {
+    doctorList.value = allDoctorList.value;
+    // 如果当前选中的医生不在列表中，清空选择
+    if (form.value.practitionerId && !doctorList.value.some((d) => d.id === form.value.practitionerId)) {
+      form.value.practitionerId = undefined;
+      form.value.doctorName = '';
+    }
+    return;
+  }
+
+  // 获取选中的挂号类型信息
+  const selectedHealthcare = healthcareList.value.find(
+    (healthcare) => healthcare.id === form.value.serviceTypeId
+  );
+
+  if (!selectedHealthcare) {
+    // 如果找不到选中的挂号类型，显示所有医生
+    doctorList.value = allDoctorList.value;
+    return;
+  }
+
+  // 从healthcareList中筛选出匹配科室和服务类型的记录
+  // 注意：healthcare.offeredOrgId 是提供部门ID，需要与 form.value.orgId 匹配
+  // selectedHealthcare.typeCode 是服务类型
+  // 统一转换为字符串进行比较，避免类型不匹配问题
+  const orgIdStr = String(form.value.orgId);
+  const selectedTypeCode = selectedHealthcare.typeCode; // 使用 typeCode（代码值），不是 typeCode_dictText（字典文本）
+  
+  const matchedHealthcares = healthcareList.value.filter((healthcare) => {
+    // 匹配科室（offeredOrgId）和服务类型（typeCode）
+    // 统一转换为字符串进行比较
+    const healthcareOrgIdStr = healthcare.offeredOrgId != null ? String(healthcare.offeredOrgId) : null;
+    const healthcareTypeCode = healthcare.typeCode; // 使用 typeCode（代码值）
+    
+    return (
+      healthcareOrgIdStr === orgIdStr &&
+      healthcareTypeCode === selectedTypeCode &&
+      healthcare.practitionerId != null // 必须有出诊医生
+    );
+  });
+
+  // 提取所有匹配记录的出诊医生ID，并去重
+  const practitionerIds = [...new Set(matchedHealthcares.map((h) => h.practitionerId).filter((id) => id != null))];
+
+  // 从所有医生列表中筛选出匹配的医生
+  if (practitionerIds.length > 0) {
+    doctorList.value = allDoctorList.value.filter((doctor) => practitionerIds.includes(doctor.id));
+  } else {
+    // 如果没有匹配的医生，清空医生列表
+    doctorList.value = [];
+  }
+
+  // 如果当前选中的医生不在过滤后的列表中，清空选择
+  if (form.value.practitionerId && !doctorList.value.some((d) => d.id === form.value.practitionerId)) {
+    form.value.practitionerId = undefined;
+    form.value.doctorName = '';
+  }
+
+  console.log('filterDoctorsByHealthcare', {
+    orgId: form.value.orgId,
+    orgIdStr: orgIdStr,
+    serviceTypeId: form.value.serviceTypeId,
+    selectedTypeCode: selectedTypeCode,
+    selectedHealthcare: selectedHealthcare,
+    healthcareListSample: healthcareList.value.slice(0, 3).map(h => ({
+      id: h.id,
+      offeredOrgId: h.offeredOrgId,
+      typeCode: h.typeCode,
+      typeCode_dictText: h.typeCode_dictText,
+      practitionerId: h.practitionerId
+    })),
+    matchedHealthcares: matchedHealthcares.length,
+    matchedHealthcaresDetail: matchedHealthcares.map(h => ({
+      id: h.id,
+      offeredOrgId: h.offeredOrgId,
+      typeCode: h.typeCode,
+      practitionerId: h.practitionerId
+    })),
+    practitionerIds: practitionerIds,
+    filteredDoctors: doctorList.value.length,
   });
 }