diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationAdviceAppServiceImpl.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationAdviceAppServiceImpl.java
index f5530839..aa2e422c 100644
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationAdviceAppServiceImpl.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationAdviceAppServiceImpl.java
@@ -1075,6 +1075,12 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
         }
 
         for (AdviceSaveDto adviceSaveDto : insertOrUpdateList) {
+            // 🔧 Bug Fix #238: 诊疗项目执行科室非空校验
+            if (adviceSaveDto.getAdviceType() != null && adviceSaveDto.getAdviceType() == 3) {
+                if (adviceSaveDto.getPositionId() == null) {
+                    throw new ServiceException("诊疗项目必须选择执行科室");
+                }
+            }
             serviceRequest = new ServiceRequest();
             serviceRequest.setId(adviceSaveDto.getRequestId()); // 主键id
             serviceRequest.setStatusEnum(is_save ? RequestStatus.DRAFT.getValue() : RequestStatus.ACTIVE.getValue());// 请求状态
diff --git a/openhis-ui-vue3/src/views/doctorstation/components/prescription/prescriptionlist.vue b/openhis-ui-vue3/src/views/doctorstation/components/prescription/prescriptionlist.vue
index 60d2b97a..8b973667 100644
--- a/openhis-ui-vue3/src/views/doctorstation/components/prescription/prescriptionlist.vue
+++ b/openhis-ui-vue3/src/views/doctorstation/components/prescription/prescriptionlist.vue
@@ -2100,6 +2100,13 @@ function handleSave(prescriptionId) {
   // 过滤出真正可以签发的列表 (已保存的)
   saveList = saveList.filter((item) => item.isSaved || item.requestId);
 
+  // 🔧 Bug Fix #238: 批量签发前校验诊疗项目执行科室
+  const invalidItems = saveList.filter(item => item.adviceType === 3 && !item.orgId);
+  if (invalidItems.length > 0) {
+    proxy.$modal.msgWarning(`有 ${invalidItems.length} 个诊疗项目未选择执行科室，请先编辑完善`);
+    return;
+  }
+
   if (saveList.length == 0) {
     if (selectedRows.length > 0) {
       proxy.$modal.msgWarning('选中的医嘱不可签发（可能未保存或已签发）');
@@ -3067,7 +3074,10 @@ function setValue(row) {
         prescriptionList.value[rowIndex.value].categoryEnum = 31; // 会诊的category_enum设置为31
       } else {
         // 诊疗类型（adviceType == 3）
-        prescriptionList.value[rowIndex.value].orgId = JSON.parse(JSON.stringify(row)).positionId;
+        // 🔧 Bug Fix #238: 诊疗项目默认使用患者就诊科室
+        if (!prescriptionList.value[rowIndex.value].orgId) {
+          prescriptionList.value[rowIndex.value].orgId = props.patientInfo.orgId;
+        }
         // 🔧 Bug #218 修复：使用组套中维护的quantity，如果没有则默认1
         prescriptionList.value[rowIndex.value].quantity = row.quantity || 1;
         // 🔧 Bug #144 修复：安全访问 priceList，防止 orderDetailInfos 为空时出错