diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/controller/DoctorStationAdviceController.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/controller/DoctorStationAdviceController.java
index 2e64d725f..44b57540a 100755
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/controller/DoctorStationAdviceController.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/controller/DoctorStationAdviceController.java
@@ -77,8 +77,10 @@ public class DoctorStationAdviceController {
      */
     @PostMapping(value = "/save-advice")
     @RepeatSubmit(interval = 5000, message = "请勿重复提交医嘱，请稍候再试")
-    public R<?> saveAdvice(@RequestBody AdviceSaveParam adviceSaveParam) {
-        return iDoctorStationAdviceAppService.saveAdvice(adviceSaveParam, AdviceOpType.SAVE_ADVICE.getCode());
+    public R<?> saveAdvice(@RequestBody AdviceSaveParam adviceSaveParam,
+                           @RequestParam(required = false, defaultValue = "1") String adviceOpType) {
+        // 🔧 Bug #445 修复：使用前端传入的 adviceOpType 参数（1=保存草稿，2=签发），而非硬编码
+        return iDoctorStationAdviceAppService.saveAdvice(adviceSaveParam, adviceOpType);
     }
 
     /**
diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inhospitalnursestation/appservice/impl/AdviceProcessAppServiceImpl.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inhospitalnursestation/appservice/impl/AdviceProcessAppServiceImpl.java
index 5688384cb..a86c601a5 100755
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inhospitalnursestation/appservice/impl/AdviceProcessAppServiceImpl.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inhospitalnursestation/appservice/impl/AdviceProcessAppServiceImpl.java
@@ -178,11 +178,24 @@ public class AdviceProcessAppServiceImpl implements IAdviceProcessAppService {
         inpatientAdviceParam.setEncounterIds(null);
         Integer exeStatus = inpatientAdviceParam.getExeStatus();
         inpatientAdviceParam.setExeStatus(null);
-        // requestStatus由前端tab传入，通过QueryWrapper自动添加到SQL外层WHERE过滤
+        // 提取requestStatus手动处理，支持COMPLETED(3)和CHECK_VERIFIED(10)同时查询
+        Integer requestStatus = inpatientAdviceParam.getRequestStatus();
+        inpatientAdviceParam.setRequestStatus(null);
         // 构建查询条件
         QueryWrapper<InpatientAdviceParam> queryWrapper
                 = HisQueryUtils.buildQueryWrapper(inpatientAdviceParam, null, null, null);
 
+        // 手动拼接requestStatus条件：COMPLETED(3)时同时包含CHECK_VERIFIED(10)
+        // UNION查询外层列名为request_status（T1.status_enum AS request_status），不是status_enum
+        if (requestStatus != null) {
+            if (RequestStatus.COMPLETED.getValue().equals(requestStatus)) {
+                queryWrapper.in("request_status",
+                        RequestStatus.COMPLETED.getValue(), RequestStatus.CHECK_VERIFIED.getValue());
+            } else {
+                queryWrapper.eq("request_status", requestStatus);
+            }
+        }
+
         // 手动拼接住院患者id条件
         if (encounterIds != null && !encounterIds.isEmpty()) {
             List<Long> encounterIdList
@@ -315,19 +328,29 @@ public class AdviceProcessAppServiceImpl implements IAdviceProcessAppService {
         Long practitionerId = SecurityUtils.getLoginUser().getPractitionerId();
         Date checkDate = new Date();
         if (!serviceRequestList.isEmpty()) {
-            // 更新服务请求状态已完成
-            serviceRequestService.updateCompleteRequestStatus(
-                    serviceRequestList.stream().map(PerformInfoDto::getRequestId).toList(), practitionerId, checkDate);
-            List<ServiceRequest> serviceRequests = serviceRequestService
-                    .listByIds(serviceRequestList.stream().map(PerformInfoDto::getRequestId).collect(Collectors.toList()));
-            for (ServiceRequest serviceRequest : serviceRequests) {
-                // 判断医嘱类型
+            List<Long> serviceReqIds = serviceRequestList.stream().map(PerformInfoDto::getRequestId).toList();
+            // 先查询服务请求，按 categoryEnum 分流：检查类(23)走 CHECK_VERIFIED，其余走 COMPLETED
+            List<ServiceRequest> allServiceRequests = serviceRequestService.listByIds(serviceReqIds);
+            List<Long> checkReqIds = allServiceRequests.stream()
+                    .filter(sr -> ActivityDefCategory.TEST.getValue().equals(sr.getCategoryEnum()))
+                    .map(ServiceRequest::getId).toList();
+            List<Long> otherReqIds = allServiceRequests.stream()
+                    .filter(sr -> !ActivityDefCategory.TEST.getValue().equals(sr.getCategoryEnum()))
+                    .map(ServiceRequest::getId).toList();
+            // 检查类 → 已校对（CHECK_VERIFIED=10）
+            if (!checkReqIds.isEmpty()) {
+                serviceRequestService.updateCheckVerifiedStatus(checkReqIds, practitionerId, checkDate);
+            }
+            // 其他类 → 已完成（COMPLETED=3）
+            if (!otherReqIds.isEmpty()) {
+                serviceRequestService.updateCompleteRequestStatus(otherReqIds, practitionerId, checkDate);
+            }
+            // 处理转科/出院等特殊医嘱
+            for (ServiceRequest serviceRequest : allServiceRequests) {
                 if (ActivityDefCategory.TRANSFER.getValue().equals(serviceRequest.getCategoryEnum())) {
-                    // 更新患者状态 待转科
                     encounterService.updateEncounterStatus(serviceRequest.getEncounterId(),
                             EncounterZyStatus.PENDING_TRANSFER.getValue());
                 } else if (ActivityDefCategory.DISCHARGE.getValue().equals(serviceRequest.getCategoryEnum())) {
-                    // 更新患者状态 待出院
                     encounterService.updateEncounterStatus(serviceRequest.getEncounterId(),
                             EncounterZyStatus.AWAITING_DISCHARGE.getValue());
                 }
@@ -442,6 +465,15 @@ public class AdviceProcessAppServiceImpl implements IAdviceProcessAppService {
             List<ServiceRequestUseExe> actUseExeList = this.assemblyActivity(activityList);
             // 处理诊疗执行
             this.exeActivity(actUseExeList, exeDate);
+            // 检查类医嘱执行后，状态改为"待接收"（PENDING_RECEIVE=11）
+            List<Long> actReqIds = activityList.stream().map(AdviceExecuteDetailParam::getRequestId).toList();
+            List<ServiceRequest> executedReqs = serviceRequestService.listByIds(actReqIds);
+            List<Long> checkReqIds = executedReqs.stream()
+                    .filter(sr -> ActivityDefCategory.TEST.getValue().equals(sr.getCategoryEnum()))
+                    .map(ServiceRequest::getId).toList();
+            if (!checkReqIds.isEmpty()) {
+                serviceRequestService.updatePendingReceiveStatus(checkReqIds);
+            }
         }
 
         return R.ok(null, MessageUtils.createMessage(PromptMsgConstant.Common.M00004, new Object[]{"医嘱执行"}));
diff --git a/openhis-server-new/openhis-application/src/main/resources/mapper/regdoctorstation/RequestFormManageAppMapper.xml b/openhis-server-new/openhis-application/src/main/resources/mapper/regdoctorstation/RequestFormManageAppMapper.xml
index 69983e4e9..db9118d76 100755
--- a/openhis-server-new/openhis-application/src/main/resources/mapper/regdoctorstation/RequestFormManageAppMapper.xml
+++ b/openhis-server-new/openhis-application/src/main/resources/mapper/regdoctorstation/RequestFormManageAppMapper.xml
@@ -47,10 +47,19 @@
                        ) THEN 5
                        WHEN EXISTS (
                            SELECT 1 FROM wor_service_request ws
-                           INNER JOIN lab_specimen ls ON ls.service_id = ws.id
                            WHERE ws.prescription_no = drf.prescription_no AND ws.delete_flag = '0'
-                             AND ls.collection_status_enum >= 1
+                             AND ws.status_enum = 12
                        ) THEN 4
+                       WHEN EXISTS (
+                           SELECT 1 FROM wor_service_request ws
+                           WHERE ws.prescription_no = drf.prescription_no AND ws.delete_flag = '0'
+                             AND ws.status_enum = 11
+                       ) THEN 3
+                       WHEN EXISTS (
+                           SELECT 1 FROM wor_service_request ws
+                           WHERE ws.prescription_no = drf.prescription_no AND ws.delete_flag = '0'
+                             AND ws.status_enum = 10
+                       ) THEN 2
                        WHEN EXISTS (
                            SELECT 1 FROM wor_service_request ws
                            WHERE ws.prescription_no = drf.prescription_no AND ws.delete_flag = '0'
diff --git a/openhis-server-new/openhis-common/src/main/java/com/openhis/common/enums/RequestStatus.java b/openhis-server-new/openhis-common/src/main/java/com/openhis/common/enums/RequestStatus.java
index 501082d13..b310095ab 100755
--- a/openhis-server-new/openhis-common/src/main/java/com/openhis/common/enums/RequestStatus.java
+++ b/openhis-server-new/openhis-common/src/main/java/com/openhis/common/enums/RequestStatus.java
@@ -57,7 +57,22 @@ public enum RequestStatus implements HisEnumInterface {
     /**
      * 未知
      */
-    UNKNOWN(9, "unknown", "未知");
+    UNKNOWN(9, "unknown", "未知"),
+
+    /**
+     * 已校对（检查申请：护士校对通过）
+     */
+    CHECK_VERIFIED(10, "check_verified", "已校对"),
+
+    /**
+     * 待接收（检查申请：等待医技科室接单）
+     */
+    PENDING_RECEIVE(11, "pending_receive", "待接收"),
+
+    /**
+     * 已接收（检查申请：医技科室已接单）
+     */
+    CHECK_RECEIVED(12, "check_received", "已接收");
 
     @EnumValue
     private final Integer value;
diff --git a/openhis-server-new/openhis-domain/src/main/java/com/openhis/workflow/service/IServiceRequestService.java b/openhis-server-new/openhis-domain/src/main/java/com/openhis/workflow/service/IServiceRequestService.java
index 30156f6e8..da91aef4e 100755
--- a/openhis-server-new/openhis-domain/src/main/java/com/openhis/workflow/service/IServiceRequestService.java
+++ b/openhis-server-new/openhis-domain/src/main/java/com/openhis/workflow/service/IServiceRequestService.java
@@ -39,6 +39,22 @@ public interface IServiceRequestService extends IService<ServiceRequest> {
      */
     void updateCompleteRequestStatus(List<Long> serReqIdList, Long practitionerId, Date checkDate);
 
+    /**
+     * 更新检查申请状态：已校对（护士校对检查申请后状态为CHECK_VERIFIED，而非COMPLETED）
+     *
+     * @param serReqIdList 服务请求id列表
+     * @param practitionerId 校对人
+     * @param checkDate 校对时间
+     */
+    void updateCheckVerifiedStatus(List<Long> serReqIdList, Long practitionerId, Date checkDate);
+
+    /**
+     * 更新检查申请状态：待接收（护士执行检查申请后状态为PENDING_RECEIVE）
+     *
+     * @param serReqIdList 服务请求id列表
+     */
+    void updatePendingReceiveStatus(List<Long> serReqIdList);
+
     /**
      * 获取执行过的诊疗数据
      *
diff --git a/openhis-server-new/openhis-domain/src/main/java/com/openhis/workflow/service/impl/ServiceRequestServiceImpl.java b/openhis-server-new/openhis-domain/src/main/java/com/openhis/workflow/service/impl/ServiceRequestServiceImpl.java
index 9f34065f8..be6db03fa 100755
--- a/openhis-server-new/openhis-domain/src/main/java/com/openhis/workflow/service/impl/ServiceRequestServiceImpl.java
+++ b/openhis-server-new/openhis-domain/src/main/java/com/openhis/workflow/service/impl/ServiceRequestServiceImpl.java
@@ -66,6 +66,31 @@ public class ServiceRequestServiceImpl extends ServiceImpl<ServiceRequestMapper,
                         .eq(ServiceRequest::getDeleteFlag, DelFlag.NO.getCode()));
     }
 
+    /**
+     * 更新检查申请状态：已校对（护士校对检查申请后状态为CHECK_VERIFIED，而非COMPLETED）
+     *
+     * @param serReqIdList 服务请求id列表
+     */
+    @Override
+    public void updateCheckVerifiedStatus(List<Long> serReqIdList, Long practitionerId, Date checkDate) {
+        baseMapper.update(new ServiceRequest().setStatusEnum(RequestStatus.CHECK_VERIFIED.getValue())
+                .setPerformerCheckId(SecurityUtils.getLoginUser().getPractitionerId()).setCheckTime(DateUtils.getNowDate()),
+                new LambdaUpdateWrapper<ServiceRequest>().in(ServiceRequest::getId, serReqIdList)
+                        .eq(ServiceRequest::getDeleteFlag, DelFlag.NO.getCode()));
+    }
+
+    /**
+     * 更新检查申请状态：待接收（护士执行检查申请后状态为PENDING_RECEIVE）
+     *
+     * @param serReqIdList 服务请求id列表
+     */
+    @Override
+    public void updatePendingReceiveStatus(List<Long> serReqIdList) {
+        baseMapper.update(new ServiceRequest().setStatusEnum(RequestStatus.PENDING_RECEIVE.getValue()),
+                new LambdaUpdateWrapper<ServiceRequest>().in(ServiceRequest::getId, serReqIdList)
+                        .eq(ServiceRequest::getDeleteFlag, DelFlag.NO.getCode()));
+    }
+
     /**
      * 获取执行过的诊疗数据
      *
diff --git a/openhis-ui-vue3/src/utils/medicalConstants.js b/openhis-ui-vue3/src/utils/medicalConstants.js
index fb57629d9..7b3dd923c 100755
--- a/openhis-ui-vue3/src/utils/medicalConstants.js
+++ b/openhis-ui-vue3/src/utils/medicalConstants.js
@@ -34,6 +34,12 @@ export const RequestStatus = {
   ENDED: 7,
   /** 未知 */
   UNKNOWN: 9,
+  /** 已校对（检查申请：护士校对通过） */
+  CHECK_VERIFIED: 10,
+  /** 待接收（检查申请：等待医技科室接单） */
+  PENDING_RECEIVE: 11,
+  /** 已接收（检查申请：医技科室已接单） */
+  CHECK_RECEIVED: 12,
 };
 
 /**
@@ -48,6 +54,9 @@ export const RequestStatusDescriptions = {
   6: '停嘱',
   7: '不执行',
   9: '未知',
+  10: '已校对',
+  11: '待接收',
+  12: '已接收',
 };
 
 /**
diff --git a/openhis-ui-vue3/src/views/clinicmanagement/bargain/component/api.js b/openhis-ui-vue3/src/views/clinicmanagement/bargain/component/api.js
index 0dbf88de0..52c814ff4 100755
--- a/openhis-ui-vue3/src/views/clinicmanagement/bargain/component/api.js
+++ b/openhis-ui-vue3/src/views/clinicmanagement/bargain/component/api.js
@@ -25,9 +25,9 @@ export function getAdviceBaseInfo(queryParams) {
 /**
  * 保存处方(单条)
  * @param {Object} data - 处方数据
- * @param {String} adviceOpType - 医嘱操作类型：'0'=保存草稿，'1'=签发医嘱
+ * @param {String} adviceOpType - 医嘱操作类型：'1'=保存草稿(SAVE_ADVICE)，'2'=签发(SIGN_ADVICE)
  */
-export function savePrescription(data, adviceOpType = '0') {
+export function savePrescription(data, adviceOpType = '1') {
   return request({
     url: '/doctor-station/advice/save-advice',
     method: 'post',
diff --git a/openhis-ui-vue3/src/views/clinicmanagement/bargain/component/prescriptionlist.vue b/openhis-ui-vue3/src/views/clinicmanagement/bargain/component/prescriptionlist.vue
index 96847cb5b..92a29678a 100755
--- a/openhis-ui-vue3/src/views/clinicmanagement/bargain/component/prescriptionlist.vue
+++ b/openhis-ui-vue3/src/views/clinicmanagement/bargain/component/prescriptionlist.vue
@@ -1174,7 +1174,9 @@ function handleSaveSign(row, index) {
       cleanRow.sourceBillNo = props.patientInfo.sourceBillNo;
     }
     // 🔧 门诊计费场景：保存为草稿，让药品出现在临时医嘱弹窗"已引用计费药品（待生成医嘱）"中
-    const adviceOpType = props.patientInfo.sourceBillNo ? '0' : '1'
+    // 🔧 修复：后端 AdviceOpType 枚举：'1'=SAVE_ADVICE(草稿), '2'=SIGN_ADVICE(签发)
+    // 之前传 '0' 后端不识别，导致直接创建了已签发(statusEnum=2)的记录
+    const adviceOpType = props.patientInfo.sourceBillNo ? '1' : '1'
     savePrescription({ adviceSaveList: [cleanRow] }, adviceOpType).then((res) => {
       if (res.code === 200) {
         proxy.$modal.msgSuccess('保存成功');
diff --git a/openhis-ui-vue3/src/views/inpatientDoctor/home/components/order/applicationForm/medicalExaminations.vue b/openhis-ui-vue3/src/views/inpatientDoctor/home/components/order/applicationForm/medicalExaminations.vue
index c2c8cf072..edc5bdb5a 100755
--- a/openhis-ui-vue3/src/views/inpatientDoctor/home/components/order/applicationForm/medicalExaminations.vue
+++ b/openhis-ui-vue3/src/views/inpatientDoctor/home/components/order/applicationForm/medicalExaminations.vue
@@ -539,7 +539,7 @@ const submit = () => {
     requestFormId: requestFormId,
     name: selectedNames,
     descJson: JSON.stringify(submitForm),
-    categoryEnum: '22',
+    categoryEnum: '23',
   }).then((res) => {
     if (res.code === 200) {
       ElMessage.success(res.msg || (props.isEditMode ? '修改成功' : '保存成功'));
diff --git a/openhis-ui-vue3/src/views/inpatientDoctor/home/components/order/index.vue b/openhis-ui-vue3/src/views/inpatientDoctor/home/components/order/index.vue
index ab1a6a1d1..8e13d9518 100755
--- a/openhis-ui-vue3/src/views/inpatientDoctor/home/components/order/index.vue
+++ b/openhis-ui-vue3/src/views/inpatientDoctor/home/components/order/index.vue
@@ -230,6 +230,8 @@
               待保存
             </el-tag>
             <el-tag v-else-if="scope.row.statusEnum == 1" type="primary">待签发</el-tag>
+            <el-tag v-else-if="scope.row.statusEnum == 10" type="primary">已校对</el-tag>
+            <el-tag v-else-if="scope.row.statusEnum == 11" type="primary">待接收</el-tag>
             <el-tag v-else-if="scope.row.statusEnum == 3" type="success">已完成</el-tag>
             <el-tag v-else-if="scope.row.statusEnum == 6" type="error">停止</el-tag>
             <el-tag v-else type="info">{{ scope.row.chargeStatus_enumText }}</el-tag>
diff --git a/openhis-ui-vue3/src/views/surgicalschedule/index.vue b/openhis-ui-vue3/src/views/surgicalschedule/index.vue
index de0706b21..a6a744c2c 100755
--- a/openhis-ui-vue3/src/views/surgicalschedule/index.vue
+++ b/openhis-ui-vue3/src/views/surgicalschedule/index.vue
@@ -1519,13 +1519,14 @@ function handleMedicalAdvice(row) {
   }
 
   // 🔧 每次打开临时医嘱都重新拉取最新数据，确保计费弹窗签发后数据自动更新
-  // 先清空旧数据
+  // 🔧 修复 Bug #446: 先保存旧数据再清空，避免竟态条件
+  const prevAdvices = [...temporaryAdvices.value]
   temporaryBillingMedicines.value = []
   temporaryAdvices.value = []
   // 🔧 修复 Bug #446: 如果是同一 encounter 且已有提交的医嘱（有 requestId），保留签名状态
-  const hasSubmittedAdvices = temporaryAdvices.value.length > 0 &&
-    temporaryAdvices.value[0]?.originalMedicine?.encounterId === row.visitId &&
-    temporaryAdvices.value.some(a => a.originalMedicine?.requestId);
+  const hasSubmittedAdvices = prevAdvices.length > 0 &&
+    prevAdvices[0]?.originalMedicine?.encounterId === row.visitId &&
+    prevAdvices.some(a => a.originalMedicine?.requestId);
   temporarySigned.value = hasSubmittedAdvices; // 修复：根据已有数据状态设置，而非盲目重置
   temporaryMedicalLoading.value = true // 🔧 新增：开始加载
 
@@ -1585,7 +1586,13 @@ function handleMedicalAdvice(row) {
             adviceType: item.adviceType || contentData.adviceType || item.advice_type || null,
             chargeItemId: item.chargeItemId || contentData.chargeItemId || item.charge_item_id || null,
             definitionId: item.definitionId || contentData.definitionId || item.definition_id || null,
-            definitionDetailId: item.definitionDetailId || contentData.definitionDetailId || item.definition_detail_id || null
+            definitionDetailId: item.definitionDetailId || contentData.definitionDetailId || item.definition_detail_id || null,
+            // 🔧 修复：传递 requestId，临时医嘱签署时需要用于更新已有记录而非新建
+            requestId: item.requestId || null,
+            // 🔧 保留原始 contentJson，临时医嘱签发时需要展开所有字段传给后端
+            contentJson: item.contentJson || item.content_json || null,
+            // 🔧 标记是否已签发，用于临时医嘱弹窗控制按钮状态
+            _signed: item.statusEnum === 2
           };
         } catch (e) {
           // 如果解析失败，使用顶层数据 - 兼容 snake_case 和 camelCase 以及后端不同字段名
@@ -1606,7 +1613,13 @@ function handleMedicalAdvice(row) {
             adviceType: item.adviceType || item.advice_type || null,
             chargeItemId: item.chargeItemId || item.charge_item_id || null,
             definitionId: item.definitionId || item.definition_id || null,
-            definitionDetailId: item.definitionDetailId || item.definition_detail_id || null
+            definitionDetailId: item.definitionDetailId || item.definition_detail_id || null,
+            // 🔧 修复：传递 requestId，临时医嘱签署时需要用于更新已有记录而非新建
+            requestId: item.requestId || null,
+            // 🔧 保留原始 contentJson，临时医嘱签发时需要展开所有字段传给后端
+            contentJson: item.contentJson || item.content_json || null,
+            // 🔧 标记是否已签发，用于临时医嘱弹窗控制按钮状态
+            _signed: item.statusEnum === 2
           };
         }
       });
@@ -1694,73 +1707,134 @@ function closeTemporaryMedical() {
 // 处理临时医嘱提交
 // 🔧 修复：提交成功后，更新 temporaryAdvices 中的 requestId，以便下次提交时执行更新操作
 function handleTemporaryMedicalSubmit(data) {
-  // 🔧 修复：使用用户修改后的数据，而不是重新加载数据
-  // 这样可以确保用户修改的内容（如剂量）在保存后仍然正确显示
-  if (data.temporaryAdvices && data.temporaryAdvices.length > 0) {
-    // 🔧 关键修复：更新 temporaryAdvices 中的数据，保留用户的修改
-    // 但是需要从后端返回的数据中获取 requestId，以便下次提交时执行更新操作
-    // 如果后端返回了医嘱ID（requestId），我们需要更新到 temporaryAdvices 中
-    temporaryAdvices.value = data.temporaryAdvices.map((advice, index) => {
-      const originalMedicine = advice.originalMedicine || {}
-      
-      // 🔧 关键修复：从后端返回的数据中获取 requestId（如果有）
-      // 后端返回的医嘱ID可能需要通过某个字段获取，这里暂时假设后端会返回
-      // 如果后端返回的 response 中包含医嘱ID，需要更新到 originalMedicine 中
-      // 这里暂时保留原逻辑，等待用户提供后端返回的具体数据结构
-      
-      return {
-        ...advice,
-        // 确保 originalMedicine 包含所有必要字段
-        originalMedicine: {
-          ...originalMedicine,
-          // 保留用户的修改
-          contentJson: originalMedicine.contentJson || JSON.stringify({
-            dose: advice.dosage,
-            methodCode: advice.usage,
-            rateCode: advice.frequency,
-            quantity: advice.quantity,
-            totalPrice: advice.totalPrice
+  // 🔧 Bug #445 修复：提交成功后重新拉取数据，确保"待生成"列表正确更新
+  if (data.patientInfo && data.patientInfo.visitId) {
+    const row = { visitId: data.patientInfo.visitId, operCode: data.patientInfo.operCode }
+    temporarySigned.value = true
+    ElMessage.success('临时医嘱已生成（已签发）')
+
+    // 重新拉取最新数据，后端已将 statusEnum 从 1(草稿) 更新为 2(已签发)
+    getPrescriptionList(row.visitId, 6, row.operCode).then((res) => {
+      if (res.code === 200 && res.data) {
+        const seenIds = new Set()
+        const filteredItems = res.data.filter(item => {
+          if (item.encounterId !== row.visitId) return false
+          const at = Number(item.adviceType ?? item.advice_type)
+          if (at !== 1 && at !== 2) return false
+          const medicineName = item.adviceName || item.advice_name
+          if (!medicineName || medicineName.trim() === '') return false
+          const excludedKeywords = ['术', '超声', '多普勒', '检查', '检验', '彩超', 'X线', 'CT', 'MRI', '扫描', '造影']
+          if (excludedKeywords.some(kw => medicineName.includes(kw))) return false
+          const itemId = item.requestId || item.id
+          if (itemId && seenIds.has(itemId)) return false
+          if (itemId) seenIds.add(itemId)
+          return true
+        })
+
+        const draftItems = filteredItems.filter(item => item.statusEnum === 1)
+        const activeItems = filteredItems.filter(item => item.statusEnum === 2)
+
+        // 更新待生成列表：只保留未生成的项目
+        temporaryBillingMedicines.value = draftItems.map(item => {
+          try {
+            const jsonContent = item.contentJson || item.content_json
+            const contentData = jsonContent ? JSON.parse(jsonContent) : {}
+            return {
+              medicineName: contentData.adviceName || contentData.advice_name || item.adviceName || item.advice_name || item.chargeName || item.charge_name || contentData.itemName || contentData.item_name || '未知药品',
+              specification: contentData.volume || contentData.specification || item.volume || item.specification || '',
+              quantity: contentData.quantity || item.quantity || 0,
+              batchNumber: contentData.lotNumber || contentData.lot_number || item.lotNumber || item.lot_number || '',
+              unitPrice: contentData.unitPrice || contentData.unit_price || item.unitPrice || item.unit_price || 0,
+              subtotal: contentData.totalPrice || contentData.total_price || item.totalPrice || item.total_price ||
+                       (contentData.unitPrice || contentData.unit_price || item.unitPrice || item.unit_price || 0) *
+                       (contentData.quantity || item.quantity || 0),
+              insuranceType: (contentData.insuranceType || contentData.insurance_type) === 1 ? '医保' : (item.insuranceType === 1 || item.insurance_type === 1) ? '医保' : '自费',
+              adviceDefinitionId: item.adviceDefinitionId || contentData.adviceDefinitionId || item.advice_definition_id || null,
+              adviceTableName: item.adviceTableName || contentData.adviceTableName || item.advice_table_name || null,
+              adviceType: item.adviceType || contentData.adviceType || item.advice_type || null,
+              chargeItemId: item.chargeItemId || contentData.chargeItemId || item.charge_item_id || null,
+              definitionId: item.definitionId || contentData.definitionId || item.definition_id || null,
+              definitionDetailId: item.definitionDetailId || contentData.definitionDetailId || item.definition_detail_id || null,
+              // 🔧 修复：传递 requestId
+              requestId: item.requestId || null,
+              // 🔧 保留原始 contentJson，临时医嘱签发时需要展开所有字段传给后端
+              contentJson: item.contentJson || item.content_json || null,
+              // 🔧 标记是否已签发，用于临时医嘱弹窗控制按钮状态
+              _signed: item.statusEnum === 2
+            }
+          } catch (e) {
+            return {
+              medicineName: item.adviceName || item.advice_name || item.chargeName || '',
+              specification: item.specification || item.volume || '',
+              quantity: item.quantity || item.quantity_value || item.quantityValue || 0,
+              batchNumber: item.lotNumber || item.lot_number || '',
+              unitPrice: item.unitPrice || item.unit_price || 0,
+              subtotal: item.totalPrice || item.total_price || 0,
+              insuranceType: (item.insuranceType || item.insurance_type) === 1 ? '医保' : '自费',
+              adviceDefinitionId: item.adviceDefinitionId || item.advice_definition_id || null,
+              adviceTableName: item.adviceTableName || item.advice_table_name || null,
+              adviceType: item.adviceType || item.advice_type || null,
+              chargeItemId: item.chargeItemId || item.charge_item_id || null,
+              definitionId: item.definitionId || item.definition_id || null,
+              definitionDetailId: item.definitionDetailId || item.definition_detail_id || null,
+              // 🔧 修复：传递 requestId
+              requestId: item.requestId || null,
+              // 🔧 保留原始 contentJson，临时医嘱签发时需要展开所有字段传给后端
+              contentJson: item.contentJson || item.content_json || null,
+              // 🔧 标记是否已签发，用于临时医嘱弹窗控制按钮状态
+              _signed: item.statusEnum === 2
+            }
+          }
+        })
+
+        // 更新已生成列表
+        temporaryAdvices.value = activeItems.map((item, index) => {
+          try {
+            const jsonContent = item.contentJson || item.content_json
+            const contentData = jsonContent ? JSON.parse(jsonContent) : {}
+            const medicineName = contentData.adviceName || contentData.advice_name || item.adviceName || item.advice_name || ''
+            const spec = contentData.volume || contentData.specification || item.volume || item.specification || ''
+            const specMatch = spec.match(/(\d+)(\D+)/)
+            const specValue = specMatch ? parseInt(specMatch[1]) : 1
+            const specUnit = specMatch ? specMatch[2] : 'ml'
+            const dosage = specValue * (contentData.quantity || item.quantity || 1)
+            let usageCode = contentData.methodCode || 'iv'
+            return {
+              id: index + 1, adviceName: medicineName, dosage, unit: specUnit,
+              usage: usageCode, frequency: '临时',
+              executeTime: new Date().toLocaleString('zh-CN'),
+              originalMedicine: { ...item, medicineName, specification: spec, quantity: contentData.quantity || item.quantity || 1, encounterId: row.visitId }
+            }
+          } catch (e) {
+            return {
+              id: index + 1, adviceName: item.adviceName || '', dosage: 1, unit: 'ml',
+              usage: 'iv', frequency: '临时', executeTime: new Date().toLocaleString('zh-CN'),
+              originalMedicine: { ...item, medicineName: item.adviceName || '', specification: item.volume || '', quantity: item.quantity || 1, encounterId: row.visitId }
+            }
+          }
+        })
+      }
+    }).catch(() => {
+      // 拉取失败时使用本地过滤作为兜底
+      if (data.temporaryAdvices && data.temporaryAdvices.length > 0) {
+        const submittedKeys = new Set(
+          data.temporaryAdvices.map(a => {
+            const om = a.originalMedicine || {}
+            return `${om.medicineName || a.adviceName || ''}|||${om.specification || ''}|||${om.quantity || 0}`
+          }).filter(k => k !== '|||0')
+        )
+        if (submittedKeys.size > 0) {
+          temporaryBillingMedicines.value = (temporaryBillingMedicines.value || []).filter(m => {
+            return !submittedKeys.has(`${m.medicineName || ''}|||${m.specification || ''}|||${m.quantity || 0}`)
           })
         }
+        temporaryAdvices.value = data.temporaryAdvices
       }
     })
-    
-    // 🔧 修复 Bug #445: 使用稳定的字段组合匹配已提交项目，而不是依赖可能为空的 requestId/chargeItemId
-    // 构建已提交项目的匹配键集合（药品名称 + 规格 + 数量）
-    const submittedKeys = new Set(
-      (data.temporaryAdvices || [])
-        .map(a => {
-          const om = a.originalMedicine || {}
-          const name = om.medicineName || om.adviceName || om.advice_name || a.adviceName || ''
-          const spec = om.specification || om.volume || ''
-          const qty = om.quantity || 0
-          return `${name}|||${spec}|||${qty}`
-        })
-        .filter(k => k !== '|||0') // 过滤掉空项
-    )
-
-    if (submittedKeys.size > 0) {
-      temporaryBillingMedicines.value = (temporaryBillingMedicines.value || []).filter(m => {
-        const key = `${m.medicineName || ''}|||${m.specification || ''}|||${m.quantity || 0}`
-        return !submittedKeys.has(key)
-      })
-    } else {
-      // 如果没有任何匹配键，清空待生成列表（所有项目都已提交）
-      temporaryBillingMedicines.value = []
-    }
-
   } else {
-    // 如果没有传递数据，则清空
     temporaryAdvices.value = []
     temporaryBillingMedicines.value = []
   }
-
-  // 🔧 设置签名状态，保持按钮名称一致
-  temporarySigned.value = true
-
-  // 显示成功提示，不关闭弹窗，让用户可以查看已签发的医嘱状态
-  ElMessage.success('临时医嘱已生成（已签发），可继续查看或修改')
-
 }
 function handleTemporaryMedicalCancel() {
   // 🔧 修复：用户点击取消时才清空数据，因为用户可能要放弃修改
@@ -1911,7 +1985,13 @@ function handleQuoteBilling() {
               orgId: contentData.orgId || item.orgId || contentData.positionId || item.positionId || userStore.orgId,
               positionId: contentData.positionId || item.positionId || userStore.orgId,
               definitionId: contentData.definitionId || item.definitionId,
-              definitionDetailId: contentData.definitionDetailId || item.definitionDetailId
+              definitionDetailId: contentData.definitionDetailId || item.definitionDetailId,
+              // 🔧 修复：传递 requestId
+              requestId: item.requestId || null,
+              // 🔧 保留原始 contentJson，临时医嘱签发时需要展开所有字段传给后端
+              contentJson: item.contentJson || item.content_json || null,
+              // 🔧 标记是否已签发，用于临时医嘱弹窗控制按钮状态
+              _signed: item.statusEnum === 2
             }
           } catch (e) {
             return {
@@ -1927,7 +2007,13 @@ function handleQuoteBilling() {
               orgId: item.orgId || item.positionId || userStore.orgId,
               positionId: item.positionId || userStore.orgId,
               definitionId: item.definitionId,
-              definitionDetailId: item.definitionDetailId
+              definitionDetailId: item.definitionDetailId,
+              // 🔧 修复：传递 requestId
+              requestId: item.requestId || null,
+              // 🔧 保留原始 contentJson，临时医嘱签发时需要展开所有字段传给后端
+              contentJson: item.contentJson || item.content_json || null,
+              // 🔧 标记是否已签发，用于临时医嘱弹窗控制按钮状态
+              _signed: item.statusEnum === 2
             }
           }
         })
diff --git a/openhis-ui-vue3/src/views/surgicalschedule/temporaryMedical.vue b/openhis-ui-vue3/src/views/surgicalschedule/temporaryMedical.vue
index 99c9cc0db..f0314e159 100755
--- a/openhis-ui-vue3/src/views/surgicalschedule/temporaryMedical.vue
+++ b/openhis-ui-vue3/src/views/surgicalschedule/temporaryMedical.vue
@@ -317,10 +317,11 @@ const getMethodCodeDict = computed(() => {
   return dict
 })
 
-// 🔧 修复 Bug #446: 检查计费药品是否已全部提交（有 requestId），用于区分"首次签名"和"已提交重开"
+// 🔧 检查是否已全部签发（statusEnum=2），用于控制"一键签名"按钮是否禁用
+// 注意：不能依赖 requestId，因为草稿记录也有 requestId
 const allItemsSubmitted = computed(() => {
   const meds = props.billingMedicines || []
-  return meds.length > 0 && meds.every(m => m.requestId)
+  return meds.length > 0 && meds.every(m => m._signed)
 })
 
 // 展开/收起控制
@@ -425,32 +426,20 @@ const displayAdvices = ref([])
 
 // 初始化 displayAdvices
 const initDisplayAdvices = () => {
-  // 只要有用户修改过的数据，就优先使用用户修改后的数据
-  // 避免自动转换覆盖用户的修改
+  // 区域二只显示已生成（已签发）的数据，没有时保持为空，不自动转换区域一的草稿
   if (props.temporaryAdvices && props.temporaryAdvices.length > 0) {
-    // 🔧 修复：将旧编码映射到新编码
     displayAdvices.value = props.temporaryAdvices.map(mapUsageCode)
   } else {
-    // 否则自动转换第一区域的已引用计费药品
-    displayAdvices.value = convertedAdvices.value
+    displayAdvices.value = []
   }
 }
 
 // 初始化
 initDisplayAdvices()
 
-// 组件挂载时，如果没有传入临时医嘱数据，将自动转换后的数据同步到父组件
-// 确保修改可以被父组件保存，下次打开仍然能看到
 onMounted(() => {
-
-  
-  // 初始化 displayAdvices
   initDisplayAdvices()
-  
-  if ((!props.temporaryAdvices || props.temporaryAdvices.length === 0) && convertedAdvices.value.length > 0) {
-    console.log('=== onMounted 触发 emit ===')
-    emit('update:temporary-advices', convertedAdvices.value)
-  }
+  // 🔧 修复：不再自动把区域一草稿转为区域二数据
 })
 
 // 🔧 新增：监听 temporary-advices prop 的变化，同步更新 displayAdvices
@@ -465,23 +454,9 @@ watch(() => props.temporaryAdvices, (newVal, oldVal) => {
   }
 }, { deep: true, immediate: true })
 
-// 监听第一区域的计费药品变化，如果第一区域更新了，并且用户还没修改过第二区域数据，自动更新第二区域
+// 🔧 修复：不再自动把区域一草稿转为区域二数据，区域二只显示已签发的记录
 watch(() => props.billingMedicines, (newVal) => {
-  console.log('=== watch billingMedicines 被调用 ===')
-  console.log('=== newVal ===', newVal)
-  console.log('=== props.temporaryAdvices ===', props.temporaryAdvices)
-  console.log('=== props.temporaryAdvices.length ===', props.temporaryAdvices?.length)
-  
-  // 🔧 修复：只有当 temporary-advices 为空时才自动更新，避免覆盖用户的修改
-  if (!props.temporaryAdvices || props.temporaryAdvices.length === 0) {
-    if (newVal.length > 0) {
-      console.log('=== watch 触发 emit ===')
-      displayAdvices.value = convertedAdvices.value
-      emit('update:temporary-advices', convertedAdvices.value)
-    }
-  } else {
-    console.log('=== watch 不触发 emit，因为 props.temporaryAdvices 已有数据 ===')
-  }
+  // 空 watcher，仅保留结构避免破坏其他逻辑
 }, { deep: true })
 
 // 🔧 新增：监听字典加载，确保字典加载后编辑弹窗能正确显示
@@ -697,7 +672,9 @@ const handleSubmit = async () => {
   }
 
   // 检查是否有医嘱数据
-  if (displayAdvices.value.length === 0) {
+  // 🔧 修复：签发应该处理区域一中所有待签发的药品（billingMedicines），而非区域二中已有数据（displayAdvices）
+  const itemsToSign = convertedAdvices.value
+  if (itemsToSign.length === 0) {
     ElMessage.warning('没有可保存的医嘱数据')
     return
   }
@@ -709,7 +686,7 @@ const handleSubmit = async () => {
     // 构建保存医嘱的请求参数
     const saveData = {
       organizationId: props.patientInfo.orgId || props.patientInfo.organizationId || 1, // 使用计费时的orgId
-      adviceSaveList: displayAdvices.value.map((advice, index) => {
+      adviceSaveList: itemsToSign.map((advice, index) => {
         // 获取原始药品数据
         const originalMedicine = advice.originalMedicine
 
@@ -764,53 +741,44 @@ const handleSubmit = async () => {
         // 重新序列化contentJson
         const updatedContentJson = JSON.stringify(contentJsonData);
 
-        // 构造请求参数（与门诊医生工作站完全一致）
+        // 🔧 构造请求参数：与计费弹窗 handleSave 保持完全一致的模式
+        // 先展开原始 contentJson 的所有字段，然后用当前值覆盖（保证不丢字段）
         return {
+          ...contentJsonData,
           // 基础信息
-          // 🔧 修复：dbOpType 的判断逻辑 - 如果有 requestId 则为修改，否则为新增
-          // 但对于从计费药品转换来的数据，即使没有 requestId，也应该先更新 chargeItemId
           dbOpType: originalMedicine?.requestId ? '2' : (originalMedicine?.chargeItemId ? '2' : '1'),
-          adviceType: originalMedicine?.adviceType || 1, // 使用原始类型或默认1
+          adviceType: originalMedicine?.adviceType || 1,
           requestId: originalMedicine?.requestId,
           chargeItemId: originalMedicine?.chargeItemId,
           contentJson: updatedContentJson,
           categoryCode: contentJsonData.categoryCode || originalMedicine?.categoryCode,
-          pharmacologyCategoryCode: contentJsonData.pharmacologyCategoryCode || originalMedicine?.pharmacologyCategoryCode,
           partPercent: originalMedicine?.partPercent || contentJsonData.partPercent || 1,
-          partAttributeEnum: originalMedicine?.partAttributeEnum || contentJsonData.partAttributeEnum,
           executeNum: contentJsonData.executeNum || originalMedicine?.executeNum || 1,
-          prescriptionNo: originalMedicine?.prescriptionNo,
 
           // 数量和单位：使用重新计算后的数量
           quantity: quantity,
-          dispensePerDuration: originalMedicine?.dispensePerDuration || contentJsonData.dispensePerDuration,
           unitCode: contentJsonData.unitCode || originalMedicine?.unitCode || advice.unit,
           unitPrice: unitPrice,
-          // 总价根据新的数量重新计算
           totalPrice: totalPrice,
           definitionId: originalMedicine?.definitionId ? String(originalMedicine.definitionId) : contentJsonData.definitionId ? String(contentJsonData.definitionId) : advice.definitionId ? String(advice.definitionId) : null,
           definitionDetailId: originalMedicine?.definitionDetailId ? String(originalMedicine.definitionDetailId) : contentJsonData.definitionDetailId ? String(contentJsonData.definitionDetailId) : advice.definitionDetailId ? String(advice.definitionDetailId) : null,
           lotNumber: originalMedicine?.lotNumber || contentJsonData.lotNumber,
 
           // 状态和类型
-          statusEnum: originalMedicine?.statusEnum || 2, // 默认状态：已发送
           categoryEnum: originalMedicine?.categoryEnum || contentJsonData.categoryEnum || 1,
 
-          // 药品/诊疗信息 - 🔧 修复：优先使用originalMedicine中的adviceDefinitionId和adviceTableName
-          // 🔧 关键修复：确保adviceDefinitionId不为null，使用definitionId作为后备
-          adviceDefinitionId: originalMedicine?.adviceDefinitionId || contentJsonData.adviceDefinitionId || advice.definitionId || contentJsonData.definitionId || definitionId,
+          // 药品/诊疗信息
+          adviceDefinitionId: originalMedicine?.adviceDefinitionId || contentJsonData.adviceDefinitionId || advice.definitionId || contentJsonData.definitionId,
           adviceTableName: originalMedicine?.adviceTableName || contentJsonData.adviceTableName || 'med_medication_definition',
           adviceName: advice.adviceName,
-          minUnitQuantity: originalMedicine?.minUnitQuantity || contentJsonData.minUnitQuantity,
 
           // 患者和就诊信息
           patientId: props.patientInfo.patientId,
-          practitionerId: currentUser.value.id || originalMedicine?.practitionerId, // 开方医生
+          practitionerId: currentUser.value.id || originalMedicine?.practitionerId,
           locationId: originalMedicine?.positionId || contentJsonData.locationId || props.patientInfo.orgId || props.patientInfo.positionId,
           positionId: originalMedicine?.positionId || contentJsonData.positionId,
           orgId: originalMedicine?.orgId || props.patientInfo.orgId || props.patientInfo.positionId,
-          performLocation: originalMedicine?.performLocation || contentJsonData.performLocation,
-          founderOrgId: currentUser.value.id || originalMedicine?.founderOrgId, // 开方人科室
+          founderOrgId: currentUser.value.id || originalMedicine?.founderOrgId,
           encounterId: props.patientInfo.visitId || contentJsonData.encounterId || originalMedicine?.encounterId,
           accountId: contentJsonData.accountId || originalMedicine?.accountId,
           conditionId: contentJsonData.conditionId || originalMedicine?.conditionId,
@@ -818,12 +786,10 @@ const handleSubmit = async () => {
           conditionDefinitionId: originalMedicine?.conditionDefinitionId || contentJsonData.conditionDefinitionId,
 
           // 治疗信息
-          therapyEnum: originalMedicine?.therapyEnum || contentJsonData.therapyEnum || 1, // 默认临时医嘱
-          // 🔧 修复：methodCode 使用编码，而不是中文名称
-          methodCode: methodCode, // 用法（使用编码）
-          rateCode: advice.frequency, // 频次
+          therapyEnum: originalMedicine?.therapyEnum || contentJsonData.therapyEnum || 1,
+          methodCode: methodCode,
+          rateCode: advice.frequency,
           dose: advice.dosage,
-          firstDose: originalMedicine?.firstDose || contentJsonData.firstDose,
           doseUnitCode: contentJsonData.doseUnitCode || originalMedicine?.doseUnitCode || advice.unit,
           skinTestFlag: originalMedicine?.skinTestFlag || contentJsonData.skinTestFlag,
           injectFlag: originalMedicine?.injectFlag || contentJsonData.injectFlag,
@@ -832,55 +798,30 @@ const handleSubmit = async () => {
           groupId: originalMedicine?.groupId,
           packageId: originalMedicine?.packageId || contentJsonData.packageId,
 
-          // 诊疗活动信息
-          activityId: contentJsonData.adviceDefinitionId || originalMedicine?.adviceDefinitionId, // 对于诊疗类型，使用 adviceDefinitionId 作为 activity_id
-
           // 医保信息
           ybClassEnum: originalMedicine?.ybClassEnum || contentJsonData.ybClassEnum,
 
-          // 中药信息
-          chineseHerbsDoseQuantity: originalMedicine?.chineseHerbsDoseQuantity || contentJsonData.chineseHerbsDoseQuantity || 1
+          // 🔧 补充：手术计费上下文
+          generateSourceEnum: 6,
+          sourceBillNo: props.patientInfo?.operCode || originalMedicine?.sourceBillNo || ''
         }
       })
     }
 
-    // 调用保存医嘱接口
-    // 如果已签名，则执行签发操作（'1'），否则执行保存操作（'0'）
-    const adviceOpType = isSigned.value ? '1' : '0'
-    const response = await savePrescription(saveData, adviceOpType)
+    // 🔧 修复：使用 savePrescription + adviceOpType='2'（后端 AdviceOpType: '2'=SIGN_ADVICE 签发）
+    const response = await savePrescription(saveData, '2')
 
     if (response.code === 200) {
       ElMessage.success('临时医嘱保存成功')
 
-      // 🔧 关键修复：处理后端返回的医嘱 ID
-      // 后端返回的 data 数组只包含新创建的医嘱记录的 ID，不包含已更新的记录
-      // 我们需要正确地映射这些 ID 到对应的临时医嘱数据
-      if (response.data && Array.isArray(response.data) && response.data.length > 0) {
-        // 创建一个索引，记录哪些记录是新创建的
-        let newDataIndex = 0
-        
-        displayAdvices.value.forEach((advice, index) => {
-          const originalMedicine = advice.originalMedicine || {}
-          // 如果这个记录没有 requestId，说明是新创建的
-          if (!originalMedicine.requestId) {
-            if (newDataIndex < response.data.length) {
-              // 更新 originalMedicine 中的 requestId
-              if (!displayAdvices.value[index].originalMedicine) {
-                displayAdvices.value[index].originalMedicine = {}
-              }
-              displayAdvices.value[index].originalMedicine.requestId = response.data[newDataIndex]
-              newDataIndex++
-            }
-          }
-        })
-      }
+      // 🔧 签名成功，后端已更新已有记录的 statusEnum 为 2
+      // 不需要手动更新 requestId（签名操作是 UPDATE，不是 INSERT，后端不返回新 ID）
 
-      // 🔧 修复：将保存后的医嘱数据（包含用户的修改和后端返回的 requestId）传递给父组件
-      // 这样父组件可以使用用户修改后的数据，而不是重新加载数据
+      // 🔧 修复：将保存后的医嘱数据传递给父组件
       const submitData = {
         patientInfo: props.patientInfo,
         billingMedicines: props.billingMedicines,
-        temporaryAdvices: displayAdvices.value, // 使用用户修改后的数据，包含后端返回的 requestId
+        temporaryAdvices: itemsToSign,
         signature: {
           doctorName: currentUser.value.name,
           signatureTime: signatureTime.value