diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationEmrAppServiceImpl.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationEmrAppServiceImpl.java
index 3e393873..38cc522c 100644
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationEmrAppServiceImpl.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationEmrAppServiceImpl.java
@@ -16,10 +16,12 @@ import java.util.Date;
 import java.sql.Timestamp;
 import com.openhis.common.enums.BindingType;
 import com.openhis.common.enums.EncounterStatus;
+import com.openhis.document.domain.DocRecord;
 import com.openhis.document.domain.Emr;
 import com.openhis.document.domain.EmrDetail;
 import com.openhis.document.domain.EmrDict;
 import com.openhis.document.domain.EmrTemplate;
+import com.openhis.document.service.IDocRecordService;
 import com.openhis.document.service.IEmrDetailService;
 import com.openhis.document.service.IEmrDictService;
 import com.openhis.document.service.IEmrService;
@@ -54,6 +56,9 @@ public class DoctorStationEmrAppServiceImpl implements IDoctorStationEmrAppServi
     @Resource
     IEmrDictService emrDictService;
 
+    @Resource
+    IDocRecordService docRecordService;
+
     @Resource
     private EncounterMapper encounterMapper;
 
@@ -128,14 +133,33 @@ public class DoctorStationEmrAppServiceImpl implements IDoctorStationEmrAppServi
 
     /**
      * 获取病历详情
+     * 同时检查门诊病历(emr表)和住院病历(doc_record表)
      *
      * @param encounterId 就诊id
      * @return 病历详情
      */
     @Override
     public R<?> getEmrDetail(Long encounterId) {
+        // 先查询门诊病历(emr表)
         Emr emrDetail = emrService.getOne(new LambdaQueryWrapper<Emr>().eq(Emr::getEncounterId, encounterId));
-        return R.ok(emrDetail);
+        if (emrDetail != null) {
+            return R.ok(emrDetail);
+        }
+
+        // 如果门诊病历为空，检查住院病历(doc_record表)
+        DocRecord docRecord = docRecordService.getOne(
+            new LambdaQueryWrapper<DocRecord>()
+                .eq(DocRecord::getEncounterId, encounterId)
+                .orderByDesc(DocRecord::getCreateTime)
+                .last("LIMIT 1")
+        );
+        if (docRecord != null) {
+            // 住院病历存在，也返回数据
+            return R.ok(docRecord);
+        }
+
+        // 都没有病历
+        return R.ok(null);
     }
 
     /**
diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/document/controller/DocDefinitionController.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/document/controller/DocDefinitionController.java
index 57e6955a..da031b30 100644
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/document/controller/DocDefinitionController.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/document/controller/DocDefinitionController.java
@@ -106,7 +106,9 @@ public class DocDefinitionController {
      * @return
      */
     @GetMapping("/treeList")
-    public R<?> getTreeList(DocDefinitonParam docDefinitonParam) {
+    public R<?> getTreeList(DocDefinitonParam docDefinitonParam,
+        @RequestParam(value = "useRanges", required = false) List<Integer> useRanges) {
+        docDefinitonParam.setUseRanges(useRanges);
         return iDocDefinitionAppService.getTreeList(docDefinitonParam);
     }
 
diff --git a/openhis-ui-vue3/src/views/inpatientDoctor/home/components/diagnosis/diagnosis.vue b/openhis-ui-vue3/src/views/inpatientDoctor/home/components/diagnosis/diagnosis.vue
index 5b6e1c7d..1f0d10e5 100644
--- a/openhis-ui-vue3/src/views/inpatientDoctor/home/components/diagnosis/diagnosis.vue
+++ b/openhis-ui-vue3/src/views/inpatientDoctor/home/components/diagnosis/diagnosis.vue
@@ -189,6 +189,7 @@ import {patientInfo} from '../../store/patient.js';
 import {ElMessage} from 'element-plus';
 // const diagnosisList = ref([]);
 const allowAdd = ref(false);
+const isSaving = ref(false);
 const tree = ref([]);
 const openDiagnosis = ref(false);
 const openAddDiagnosisDialog = ref(false);
@@ -229,15 +230,42 @@ watch(
   { deep: true }
 );
 
+// 监听患者信息变化，自动获取病历详情和诊断列表
+watch(
+  () => props.patientInfo,
+  (newVal) => {
+    if (newVal?.encounterId) {
+      getDetail(newVal.encounterId);
+      getList();
+    }
+  },
+  { immediate: true, deep: true }
+);
+
 function getDetail(encounterId) {
   if (!encounterId) {
     console.warn('未提供有效的就诊ID，无法获取病历详情');
+    allowAdd.value = false;
     return;
   }
   
-  getEmrDetail(encounterId).then((res) => {
-    allowAdd.value = res.data ? true : false;
-  });
+  console.log('正在获取病历详情，encounterId:', encounterId);
+  
+  getEmrDetail(encounterId)
+    .then((res) => {
+      console.log('病历详情API返回:', res);
+      if (res.code === 200) {
+        allowAdd.value = res.data ? true : false;
+        console.log('设置 allowAdd =', allowAdd.value, ', 病历数据:', res.data);
+      } else {
+        allowAdd.value = false;
+        console.warn('获取病历详情失败:', res.msg);
+      }
+    })
+    .catch((error) => {
+      console.error('获取病历详情异常:', error);
+      allowAdd.value = false;
+    });
 }
 
 function getList() {
@@ -245,7 +273,10 @@ function getList() {
     console.warn('患者就诊信息不完整，无法获取诊断数据');
     return;
   }
-  
+
+  // 初始化中医诊断列表
+  const newList = [];
+
   getEncounterDiagnosis(props.patientInfo.encounterId).then((res) => {
     if (res.code == 200) {
       const datas = (res.data || []).map((item) => {
@@ -405,30 +436,57 @@ function getTree() {
  * 添加西医诊断
  */
 function handleAddDiagnosis() {
-  proxy.$refs.formRef.validate((valid) => {
+  console.log('点击新增诊断按钮，allowAdd:', allowAdd.value);
+  
+  // 检查表单ref是否存在
+  if (!proxy.$refs.formRef) {
+    console.error('表单ref不存在');
+    // 直接添加诊断，不经过表单验证
+    addDiagnosisItem();
+    return;
+  }
+  
+  proxy.$refs.formRef.validate((valid, fields) => {
+    console.log('表单验证结果:', valid, '错误字段:', fields);
     if (valid) {
       if (!allowAdd.value) {
         proxy.$modal.msgWarning('请先填写病历');
         return;
       }
-      form.value.diagnosisList.push({
-        showPopover: false,
-        name: undefined,
-        verificationStatusEnum: 4,
-        medTypeCode: undefined,  // 不设默认值
-        diagSrtNo: form.value.diagnosisList.length + 1,
-        iptDiseTypeCode: 2,
-        diagnosisDesc: '',
-        diagnosisDoctor: props.patientInfo.practitionerName || props.patientInfo.doctorName || props.patientInfo.physicianName || userStore.name,
-        diagnosisTime: new Date().toLocaleString('zh-CN')
-      });
-      if (form.value.diagnosisList.length == 1) {
-        form.value.diagnosisList[0].maindiseFlag = 1;
+      addDiagnosisItem();
+    } else {
+      console.warn('表单验证失败:', fields);
+      // 验证失败时也允许添加（因为是新增空行）
+      if (allowAdd.value) {
+        console.log('验证失败但允许添加，强制添加诊断');
+        addDiagnosisItem();
       }
     }
   });
 }
 
+/**
+ * 添加诊断项
+ */
+function addDiagnosisItem() {
+  console.log('执行添加诊断，当前列表长度:', form.value.diagnosisList.length);
+  form.value.diagnosisList.push({
+    showPopover: false,
+    name: undefined,
+    verificationStatusEnum: 4,
+    medTypeCode: undefined,
+    diagSrtNo: form.value.diagnosisList.length + 1,
+    iptDiseTypeCode: 2,
+    diagnosisDesc: '',
+    diagnosisDoctor: props.patientInfo.practitionerName || props.patientInfo.doctorName || props.patientInfo.physicianName || userStore.name,
+    diagnosisTime: new Date().toLocaleString('zh-CN')
+  });
+  if (form.value.diagnosisList.length == 1) {
+    form.value.diagnosisList[0].maindiseFlag = 1;
+  }
+  console.log('添加完成，新列表长度:', form.value.diagnosisList.length);
+}
+
 // 添加中医诊断
 function handleAddTcmDiagonsis() {
   openAddDiagnosisDialog.value = true;
diff --git a/openhis-ui-vue3/src/views/inpatientDoctor/home/emr/index.vue b/openhis-ui-vue3/src/views/inpatientDoctor/home/emr/index.vue
index 1f558900..4603ab01 100644
--- a/openhis-ui-vue3/src/views/inpatientDoctor/home/emr/index.vue
+++ b/openhis-ui-vue3/src/views/inpatientDoctor/home/emr/index.vue
@@ -560,12 +560,12 @@ const loadLatestMedicalRecord = async () => {
   loading.value = true;
   try {
     // 获取患者的历史病历记录
-    // const res = await getRecordByEncounterIdList({
-    //   isPage: 0,
-    //   encounterId: patientInfo.value.encounterId,
-    //   patientId: patientInfo.value.patientId,
-    //   definitionId: currentSelectTemplate.value.id,
-    // });
+    const res = await getRecordByEncounterIdList({
+      isPage: 0,
+      encounterId: patientInfo.value.encounterId,
+      patientId: patientInfo.value.patientId,
+      definitionId: currentSelectTemplate.value.id,
+    });
 
     const historyRecords = res.data || [];
     if (historyRecords.length > 0) {
@@ -623,7 +623,8 @@ const loadLatestMedicalRecord = async () => {
       loading.value = false;
     }
   } catch (error) {
-    ElMessage.error('加载最新病历数据失败=====>', error);
+    console.error('加载最新病历数据失败:', error);
+    ElMessage.error('加载最新病历数据失败');
     // 出错时也清空选中状态
     selectedHistoryRecordId.value = '';
     // 出错时也要清空表单数据，避免显示之前患者的数据
diff --git a/openhis-ui-vue3/src/views/inpatientDoctor/home/index.vue b/openhis-ui-vue3/src/views/inpatientDoctor/home/index.vue
index dd2cc589..200c29f9 100644
--- a/openhis-ui-vue3/src/views/inpatientDoctor/home/index.vue
+++ b/openhis-ui-vue3/src/views/inpatientDoctor/home/index.vue
@@ -153,6 +153,7 @@ const handleItemClick = (node) => {
     updateLocalPatientInfo(node);
 
     diagnosisRef.value?.getList();
+    diagnosisRef.value?.getDetail(node?.encounterId);
     adviceRef.value?.getListInfo();
     adviceRef.value?.getDiagnosisInfo();
   }, 100); // 100ms 防抖延迟
@@ -189,6 +190,7 @@ watch(activeTabName, (newTab) => {
 provide('diagnosisInit', (value) => {
   currentPatientInfo.value = value;
   diagnosisRef.value.getList();
+  diagnosisRef.value.getDetail(value?.encounterId);
 });
 provide('getAdviceList', (value) => {
   adviceRef.value.getListInfo();