diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/charge/patientcardrenewal/PatientCardRenewalServiceImpl.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/charge/patientcardrenewal/PatientCardRenewalServiceImpl.java
index 35a4bd76..c9f73e11 100644
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/charge/patientcardrenewal/PatientCardRenewalServiceImpl.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/charge/patientcardrenewal/PatientCardRenewalServiceImpl.java
@@ -12,6 +12,8 @@ import com.baomidou.mybatisplus.core.conditions.query.LambdaQueryWrapper;
 
 import lombok.extern.slf4j.Slf4j;
 
+import java.util.List;
+
 /**
  * 患者换卡服务实现类
  * 
@@ -43,8 +45,8 @@ public class PatientCardRenewalServiceImpl implements PatientCardRenewalService
         // 2. 检查新卡号是否已被使用
         LambdaQueryWrapper<PatientIdentifier> queryWrapper = new LambdaQueryWrapper<>();
         queryWrapper.eq(PatientIdentifier::getIdentifierNo, request.getNewCardNo());
-        PatientIdentifier existingIdentifier = patientIdentifierService.getOne(queryWrapper);
-        if (existingIdentifier != null) {
+        List<PatientIdentifier> existingIdentifiers = patientIdentifierService.list(queryWrapper);
+        if (existingIdentifiers != null && !existingIdentifiers.isEmpty()) {
             throw new IllegalArgumentException("新卡号已被其他患者使用，请更换新卡号");
         }
         
diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/chargemanage/appservice/impl/OutpatientRegistrationAppServiceImpl.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/chargemanage/appservice/impl/OutpatientRegistrationAppServiceImpl.java
index 4579fd36..b3cfec5f 100644
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/chargemanage/appservice/impl/OutpatientRegistrationAppServiceImpl.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/chargemanage/appservice/impl/OutpatientRegistrationAppServiceImpl.java
@@ -98,10 +98,20 @@ public class OutpatientRegistrationAppServiceImpl implements IOutpatientRegistra
         queryWrapper.orderByDesc("update_time");
         // 通过证件号匹配 patient
         if (StringUtils.isNotEmpty(searchKey)) {
-            PatientIdentifier patientIdentifier = patientIdentifierService
-                .getOne(new LambdaQueryWrapper<PatientIdentifier>().eq(PatientIdentifier::getIdentifierNo, searchKey));
-            if (patientIdentifier != null) {
-                queryWrapper.or(q -> q.eq("id", patientIdentifier.getPatientId()));
+            List<PatientIdentifier> patientIdentifiers = patientIdentifierService
+                .list(new LambdaQueryWrapper<PatientIdentifier>().eq(PatientIdentifier::getIdentifierNo, searchKey));
+            if (patientIdentifiers != null && !patientIdentifiers.isEmpty()) {
+                // 如果有多个匹配结果，将它们全部添加到查询条件中
+                if (patientIdentifiers.size() == 1) {
+                    // 单个结果时直接添加条件
+                    queryWrapper.or(q -> q.eq("id", patientIdentifiers.get(0).getPatientId()));
+                } else {
+                    // 多个结果时使用in条件
+                    List<Long> patientIds = patientIdentifiers.stream()
+                        .map(PatientIdentifier::getPatientId)
+                        .collect(Collectors.toList());
+                    queryWrapper.or(q -> q.in("id", patientIds));
+                }
             }
         }
         // 患者信息
@@ -120,10 +130,11 @@ public class OutpatientRegistrationAppServiceImpl implements IOutpatientRegistra
             e.setFirstEnum_enumText(patientIdList.contains(e.getId()) ? EncounterType.FOLLOW_UP.getInfo()
                 : EncounterType.INITIAL.getInfo());
             // 患者标识
-            PatientIdentifier patientIdentifier = patientIdentifierService
-                    .getOne(new LambdaQueryWrapper<PatientIdentifier>().eq(PatientIdentifier::getPatientId, e.getId()));
-            if (patientIdentifier != null) {
-                e.setIdentifierNo(patientIdentifier.getIdentifierNo());
+            List<PatientIdentifier> patientIdentifiers = patientIdentifierService
+                    .list(new LambdaQueryWrapper<PatientIdentifier>().eq(PatientIdentifier::getPatientId, e.getId()));
+            if (patientIdentifiers != null && !patientIdentifiers.isEmpty()) {
+                // 取第一个标识号，如果需要可以根据业务需求选择其他逻辑
+                e.setIdentifierNo(patientIdentifiers.get(0).getIdentifierNo());
             }
 
         });