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 31ee811d9..551487cd7 100755
--- a/openhis-ui-vue3/src/views/doctorstation/components/prescription/prescriptionlist.vue
+++ b/openhis-ui-vue3/src/views/doctorstation/components/prescription/prescriptionlist.vue
@@ -3418,7 +3418,12 @@ async function setValue(row) {
   console.log('[BugFix] setValue - prescriptionList[rowIndex].adviceType_dictText:', prescriptionList.value[rowIndex.value].adviceType_dictText);
   // 🔧 Bug #455: 诊疗医嘱(adviceType=3)的执行科室默认使用患者就诊科室，
   // 不使用positionId(诊疗目录配置的执行科室)，避免配置ID不在机构树中导致显示原始ID
-  if (Number(row.adviceType) != 3) {
+  if (Number(row.adviceType) == 3) {
+    // 覆盖 catalog 传来的 positionId/orgId，使用患者就诊科室
+    prescriptionList.value[rowIndex.value].orgId = props.patientInfo?.orgId;
+    prescriptionList.value[rowIndex.value].positionId = props.patientInfo?.orgId;
+    prescriptionList.value[rowIndex.value].positionName = findOrgNameById(props.patientInfo?.orgId) || props.patientInfo?.orgName || '';
+  } else {
     prescriptionList.value[rowIndex.value].orgId = row.positionId || props.patientInfo?.orgId;
   }
   prescriptionList.value[rowIndex.value].dose = row.dose || row.doseQuantity;
@@ -3652,7 +3657,10 @@ function handleSaveGroup(orderGroupList) {
       unitCode_dictText: item.unitCodeName || '',
       statusEnum: 1,
       // 🔧 修复执行科室逻辑：优先使用 orgId(所属科室)，其次 positionId
-      orgId: item.orderDetailInfos?.orgId || mergedDetail.orgId || item.positionId || item.orderDetailInfos?.positionId || mergedDetail.positionId,
+      // 🔧 Bug #455: 诊疗类(adviceType=3)使用患者就诊科室，不使用目录配置的ID
+      orgId: item.adviceType === 3
+        ? props.patientInfo?.orgId
+        : (item.orderDetailInfos?.orgId || mergedDetail.orgId || item.positionId || item.orderDetailInfos?.positionId || mergedDetail.positionId),
       dbOpType: prescriptionList.value[rowIndex.value].requestId ? '2' : '1',
       conditionId: conditionId.value,
       conditionDefinitionId: conditionDefinitionId.value,