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 10feadbd..3774d8ba 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
@@ -486,11 +486,46 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
             // 医嘱分类信息
             List<AdviceSaveDto> adviceSaveList = adviceSaveParam.getAdviceSaveList();
             
-            // 🔧 Bug Fix: 校验并补全patientId（如果为null，从encounter查询获取）
+            // 🔧 Bug Fix: 校验并补全patientId和encounterId（如果为null，尝试从医嘱记录获取）
             for (AdviceSaveDto adviceSaveDto : adviceSaveList) {
+                // 对于删除操作，如果encounterId为null，尝试从医嘱记录获取
+                if (adviceSaveDto.getEncounterId() == null && DbOpType.DELETE.getCode().equals(adviceSaveDto.getDbOpType())) {
+                    // 尝试从各类医嘱记录中获取encounterId
+                    Long requestId = adviceSaveDto.getRequestId();
+                    if (requestId != null) {
+                        // 尝试从药品医嘱获取
+                        MedicationRequest medRequest = iMedicationRequestService.getById(requestId);
+                        if (medRequest != null && medRequest.getEncounterId() != null) {
+                            adviceSaveDto.setEncounterId(medRequest.getEncounterId());
+                            adviceSaveDto.setPatientId(medRequest.getPatientId());
+                            log.info("BugFix: 删除药品医嘱时自动补全encounterId和patientId: requestId={}, encounterId={}, patientId={}", 
+                                    requestId, medRequest.getEncounterId(), medRequest.getPatientId());
+                        } else {
+                            // 尝试从耗材医嘱获取
+                            DeviceRequest devRequest = iDeviceRequestService.getById(requestId);
+                            if (devRequest != null && devRequest.getEncounterId() != null) {
+                                adviceSaveDto.setEncounterId(devRequest.getEncounterId());
+                                adviceSaveDto.setPatientId(devRequest.getPatientId());
+                                log.info("BugFix: 删除耗材医嘱时自动补全encounterId和patientId: requestId={}, encounterId={}, patientId={}", 
+                                        requestId, devRequest.getEncounterId(), devRequest.getPatientId());
+                            } else {
+                                // 尝试从诊疗医嘱获取
+                                ServiceRequest srvRequest = iServiceRequestService.getById(requestId);
+                                if (srvRequest != null && srvRequest.getEncounterId() != null) {
+                                    adviceSaveDto.setEncounterId(srvRequest.getEncounterId());
+                                    adviceSaveDto.setPatientId(srvRequest.getPatientId());
+                                    log.info("BugFix: 删除诊疗医嘱时自动补全encounterId和patientId: requestId={}, encounterId={}, patientId={}", 
+                                            requestId, srvRequest.getEncounterId(), srvRequest.getPatientId());
+                                }
+                            }
+                        }
+                    }
+                }
+                
                 // 首先检查encounterId是否为null
                 if (adviceSaveDto.getEncounterId() == null) {
-                    log.error("encounterId为null，无法保存医嘱");
+                    log.error("encounterId为null，无法保存医嘱, dbOpType={}, requestId={}, adviceType={}", 
+                            adviceSaveDto.getDbOpType(), adviceSaveDto.getRequestId(), adviceSaveDto.getAdviceType());
                     return R.fail(null, "就诊信息不完整，请重新选择患者后再试");
                 }
                 
@@ -634,6 +669,12 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
         List<Long> delRequestIdList = deleteList.stream().map(AdviceSaveDto::getRequestId).collect(Collectors.toList());
         if (!delRequestIdList.isEmpty()) {
             List<ChargeItem> chargeItemList = iChargeItemService.getChargeItemInfoByReqId(delRequestIdList);
+            // 🔧 BugFix#219: 过滤只保留药品类型的费用项
+            if (chargeItemList != null && !chargeItemList.isEmpty()) {
+                chargeItemList = chargeItemList.stream()
+                    .filter(ci -> CommonConstants.TableName.MED_MEDICATION_REQUEST.equals(ci.getServiceTable()))
+                    .collect(Collectors.toList());
+            }
             if (chargeItemList != null && !chargeItemList.isEmpty()) {
                 for (ChargeItem ci : chargeItemList) {
                     if (ChargeItemStatus.BILLED.getValue().equals(ci.getStatusEnum())) {
@@ -646,20 +687,12 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
             iMedicationRequestService.removeById(adviceSaveDto.getRequestId());
             // 删除已经产生的药品发放信息
             iMedicationDispenseService.deleteMedicationDispense(adviceSaveDto.getRequestId());
-            // 🔧 Bug Fix #219: 删除费用项前查询确认
+            // 🔧 Bug Fix #219: 删除费用项
             Long requestId = adviceSaveDto.getRequestId();
             String serviceTable = CommonConstants.TableName.MED_MEDICATION_REQUEST;
-            // 先查询费用项是否存在
-            List<ChargeItem> existingChargeItems = iChargeItemService.getChargeItemInfoByReqId(Arrays.asList(requestId));
-            if (existingChargeItems == null || existingChargeItems.isEmpty()) {
-                log.warn("BugFix#219: 删除药品医嘱时未找到费用项, requestId={}, serviceTable={}", requestId, serviceTable);
-            } else {
-                log.info("BugFix#219: 找到 {} 个费用项, 准备删除, requestId={}, serviceTable={}", 
-                    existingChargeItems.size(), requestId, serviceTable);
-                // 删除费用项
-                iChargeItemService.deleteByServiceTableAndId(serviceTable, requestId);
-                log.info("BugFix#219: 费用项删除完成, requestId={}", requestId);
-            }
+            // 直接删除费用项
+            iChargeItemService.deleteByServiceTableAndId(serviceTable, requestId);
+            log.info("BugFix#219: 药品医嘱删除完成, requestId={}, serviceTable={}", requestId, serviceTable);
             // 删除基于这个药品生成的需要执行的诊疗请求
             iServiceRequestService.remove(
                     new LambdaQueryWrapper<ServiceRequest>()
@@ -924,6 +957,12 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
         List<Long> delRequestIdList = deleteList.stream().map(AdviceSaveDto::getRequestId).collect(Collectors.toList());
         if (!delRequestIdList.isEmpty()) {
             List<ChargeItem> chargeItemList = iChargeItemService.getChargeItemInfoByReqId(delRequestIdList);
+            // 🔧 BugFix#219: 过滤只保留耗材类型的费用项
+            if (chargeItemList != null && !chargeItemList.isEmpty()) {
+                chargeItemList = chargeItemList.stream()
+                    .filter(ci -> CommonConstants.TableName.WOR_DEVICE_REQUEST.equals(ci.getServiceTable()))
+                    .collect(Collectors.toList());
+            }
             if (chargeItemList != null && !chargeItemList.isEmpty()) {
                 for (ChargeItem ci : chargeItemList) {
                     if (ChargeItemStatus.BILLED.getValue().equals(ci.getStatusEnum())) {
@@ -936,20 +975,12 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
             iDeviceRequestService.removeById(adviceSaveDto.getRequestId());
             // 删除已经产生的耗材发放信息
             iDeviceDispenseService.deleteDeviceDispense(adviceSaveDto.getRequestId());
-            // 🔧 Bug Fix #219: 删除费用项前查询确认
+            // 🔧 Bug Fix #219: 删除费用项
             Long requestId = adviceSaveDto.getRequestId();
             String serviceTable = CommonConstants.TableName.WOR_DEVICE_REQUEST;
-            // 先查询费用项是否存在
-            List<ChargeItem> existingChargeItems = iChargeItemService.getChargeItemInfoByReqId(Arrays.asList(requestId));
-            if (existingChargeItems == null || existingChargeItems.isEmpty()) {
-                log.warn("BugFix#219: 删除耗材医嘱时未找到费用项, requestId={}, serviceTable={}", requestId, serviceTable);
-            } else {
-                log.info("BugFix#219: 找到 {} 个费用项, 准备删除, requestId={}, serviceTable={}", 
-                    existingChargeItems.size(), requestId, serviceTable);
-                // 删除费用项
-                iChargeItemService.deleteByServiceTableAndId(serviceTable, requestId);
-                log.info("BugFix#219: 费用项删除完成, requestId={}", requestId);
-            }
+            // 直接删除费用项（使用serviceTable和serviceId作为条件）
+            iChargeItemService.deleteByServiceTableAndId(serviceTable, requestId);
+            log.info("BugFix#219: 耗材医嘱删除完成, requestId={}, serviceTable={}", requestId, serviceTable);
         }
 
         for (AdviceSaveDto adviceSaveDto : insertOrUpdateList) {
@@ -1087,6 +1118,12 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
         List<Long> delRequestIdList = deleteList.stream().map(AdviceSaveDto::getRequestId).collect(Collectors.toList());
         if (!delRequestIdList.isEmpty()) {
             List<ChargeItem> chargeItemList = iChargeItemService.getChargeItemInfoByReqId(delRequestIdList);
+            // 🔧 BugFix#219: 过滤只保留诊疗类型的费用项
+            if (chargeItemList != null && !chargeItemList.isEmpty()) {
+                chargeItemList = chargeItemList.stream()
+                    .filter(ci -> CommonConstants.TableName.WOR_SERVICE_REQUEST.equals(ci.getServiceTable()))
+                    .collect(Collectors.toList());
+            }
             if (chargeItemList != null && !chargeItemList.isEmpty()) {
                 for (ChargeItem ci : chargeItemList) {
                     if (ChargeItemStatus.BILLED.getValue().equals(ci.getStatusEnum())) {
@@ -1100,20 +1137,12 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
             iServiceRequestService.remove(
                     new LambdaQueryWrapper<ServiceRequest>().eq(ServiceRequest::getParentId,
                             adviceSaveDto.getRequestId()));// 删除诊疗套餐对应的子项
-            // 🔧 Bug Fix #219: 删除费用项前查询确认
+            // 🔧 Bug Fix #219: 删除费用项
             Long requestId = adviceSaveDto.getRequestId();
             String serviceTable = CommonConstants.TableName.WOR_SERVICE_REQUEST;
-            // 先查询费用项是否存在
-            List<ChargeItem> existingChargeItems = iChargeItemService.getChargeItemInfoByReqId(Arrays.asList(requestId));
-            if (existingChargeItems == null || existingChargeItems.isEmpty()) {
-                log.warn("BugFix#219: 删除诊疗医嘱时未找到费用项, requestId={}, serviceTable={}", requestId, serviceTable);
-            } else {
-                log.info("BugFix#219: 找到 {} 个费用项, 准备删除, requestId={}, serviceTable={}", 
-                    existingChargeItems.size(), requestId, serviceTable);
-                // 删除费用项
-                iChargeItemService.deleteByServiceTableAndId(serviceTable, requestId);
-                log.info("BugFix#219: 费用项删除完成, requestId={}", requestId);
-            }
+            // 直接删除费用项
+            iChargeItemService.deleteByServiceTableAndId(serviceTable, requestId);
+            log.info("BugFix#219: 诊疗医嘱删除完成, requestId={}, serviceTable={}", requestId, serviceTable);
         }
 
         for (AdviceSaveDto adviceSaveDto : insertOrUpdateList) {
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 3222adfa..47784003 100644
--- a/openhis-ui-vue3/src/views/doctorstation/components/prescription/prescriptionlist.vue
+++ b/openhis-ui-vue3/src/views/doctorstation/components/prescription/prescriptionlist.vue
@@ -2340,11 +2340,13 @@ function handleEmrTreatment() {
     }
   });
   getEmrDetail(props.patientInfo.encounterId).then((res) => {
+    // 🔧 BugFix#219: 添加空值检查
+    const contextJson = res.data?.contextJson ? JSON.parse(res.data.contextJson) : {};
     saveEmr({
       patientId: props.patientInfo.patientId,
       encounterId: props.patientInfo.encounterId,
       contextJson: {
-        ...JSON.parse(res.data.contextJson),
+        ...contextJson,
         treatment: treatment,
       },
     });