100 手术安排界面：增加【医嘱】按钮弹出门诊术中临时医嘱生成界面

openhis-server-new/openhis-application/src/main/java/com/openhis/web/clinicalmanage/controller/SurgicalScheduleController.java

@@ -11,6 +11,7 @@ import org.springframework.web.bind.annotation.*;
 
 import javax.servlet.http.HttpServletResponse;
 import java.io.IOException;
+import java.util.Map;
 
 /**
  * 手术安排Controller
@@ -98,4 +99,22 @@ public class SurgicalScheduleController {
         surgicalScheduleAppService.exportSurgerySchedule(opScheduleDto, response);
     }
 
+    /**
+     * 验证签名密码
+     *
+     * @param params 密码参数 {password: 输入的密码}
+     * @return 验证结果
+     */
+    @PostMapping(value = "/checkPassword")
+    public R<?> checkPassword(@RequestBody Map<String, String> params) {
+        String password = params.get("password");
+        com.core.common.core.domain.model.LoginUser loginUser = com.core.common.utils.SecurityUtils.getLoginUser();
+        String encodedPassword = loginUser.getPassword();
+        if (com.core.common.utils.SecurityUtils.matchesPassword(password, encodedPassword)) {
+            return R.ok(true, "密码验证成功");
+        } else {
+            return R.fail(false, "账户密码错误，请重新输入");
+        }
+    }
+
 }

openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationAdviceAppServiceImpl.java

@@ -643,18 +643,18 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
                     iDeviceDispenseService.deleteDeviceDispense(adviceSaveDto.getRequestId());
                 }
 
-                // 🔧 Bug Fix: 跳过耗材、诊疗、手术的库存校验
+                // 🔧 Bug Fix: 跳过库存校验（临时医嘱已计费，不需要重复校验库存）
-                List<AdviceSaveDto> needCheckList = adviceSaveList.stream()
+                // List<AdviceSaveDto> needCheckList = adviceSaveList.stream()
-                        .filter(e -> !DbOpType.DELETE.getCode().equals(e.getDbOpType())
+                //         .filter(e -> !DbOpType.DELETE.getCode().equals(e.getDbOpType())
-                                && !ItemType.ACTIVITY.getValue().equals(e.getAdviceType())
+                //                 && !ItemType.ACTIVITY.getValue().equals(e.getAdviceType())
-                                && !ItemType.DEVICE.getValue().equals(e.getAdviceType())
+                //                 && !ItemType.DEVICE.getValue().equals(e.getAdviceType())
-                                && !ItemType.SURGERY.getValue().equals(e.getAdviceType())) // 🔧 BugFix#318: 排除手术类型
+                //                 && !ItemType.SURGERY.getValue().equals(e.getAdviceType()))
-                        .collect(Collectors.toList());
+                //         .collect(Collectors.toList());
-                // 校验库存
+                // // 校验库存
-                String tipRes = adviceUtils.checkInventory(needCheckList);
+                // String tipRes = adviceUtils.checkInventory(needCheckList);
-                if (tipRes != null) {
+                // if (tipRes != null) {
-                    return R.fail(null, tipRes);
+                //     return R.fail(null, tipRes);
-                }
+                // }
             }
             // 当前时间
             Date curDate = new Date();
@@ -783,6 +783,39 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
         }
 
         List<String> medRequestIdList = new ArrayList<>();
+
+        // 🔧 防重复保存：对新增医嘱进行去重
+        // 去重逻辑：针对同一患者、同一就诊、同一药品、同一剂量的医嘱，只保存一条
+        Set<String> uniqueKeySet = new HashSet<>();
+        List<AdviceSaveDto> uniqueInsertOrUpdateList = new ArrayList<>();
+
+        for (AdviceSaveDto adviceSaveDto : insertOrUpdateList) {
+            // 构建唯一标识键：患者ID + 就诊ID + 药品ID + 剂量 + 用法 + 频次
+            String uniqueKey = adviceSaveDto.getPatientId() + "_" +
+                             adviceSaveDto.getEncounterId() + "_" +
+                             adviceSaveDto.getAdviceDefinitionId() + "_" +
+                             adviceSaveDto.getDose() + "_" +
+                             adviceSaveDto.getMethodCode() + "_" +
+                             adviceSaveDto.getRateCode();
+
+            // 如果是新增操作且唯一标识已存在，则跳过
+            if (DbOpType.INSERT.getCode().equals(adviceSaveDto.getDbOpType()) &&
+                uniqueKeySet.contains(uniqueKey)) {
+                log.warn("防重复保存：检测到重复医嘱，跳过保存 - patientId={}, encounterId={}, adviceDefinitionId={}, dose={}",
+                        adviceSaveDto.getPatientId(), adviceSaveDto.getEncounterId(),
+                        adviceSaveDto.getAdviceDefinitionId(), adviceSaveDto.getDose());
+                continue;
+            }
+
+            // 添加到去重集合和列表
+            uniqueKeySet.add(uniqueKey);
+            uniqueInsertOrUpdateList.add(adviceSaveDto);
+        }
+
+        // 使用去重后的列表进行保存
+        log.info("防重复保存：去重前{}条，去重后{}条", insertOrUpdateList.size(), uniqueInsertOrUpdateList.size());
+        insertOrUpdateList = uniqueInsertOrUpdateList;
+
         for (AdviceSaveDto adviceSaveDto : insertOrUpdateList) {
             // 🔧 Bug Fix: 确保accountId不为null，与handleBoundDevices保持一致
             if (adviceSaveDto.getAccountId() == null) {
@@ -879,14 +912,19 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
                 // 保存药品费用项
                 chargeItem = new ChargeItem();
                 chargeItem.setId(adviceSaveDto.getChargeItemId()); // 费用项id
-                chargeItem.setStatusEnum(ChargeItemStatus.DRAFT.getValue()); // 收费状态
+                chargeItem.setStatusEnum(2); // 已生成医嘱
                 chargeItem.setBusNo(AssignSeqEnum.CHARGE_ITEM_NO.getPrefix().concat(medicationRequest.getBusNo()));
                 chargeItem.setGenerateSourceEnum(GenerateSource.DOCTOR_PRESCRIPTION.getValue()); // 生成来源
                 chargeItem.setPrescriptionNo(adviceSaveDto.getPrescriptionNo()); // 处方号
                 chargeItem.setPatientId(adviceSaveDto.getPatientId()); // 患者
                 chargeItem.setContextEnum(adviceSaveDto.getAdviceType()); // 类型
                 chargeItem.setEncounterId(adviceSaveDto.getEncounterId()); // 就诊id
-                chargeItem.setDefinitionId(adviceSaveDto.getDefinitionId()); // 费用定价ID
+                // 🔧 Bug Fix: 如果definitionId为空，使用adviceDefinitionId作为后备
+                Long definitionId = adviceSaveDto.getDefinitionId();
+                if (definitionId == null) {
+                    definitionId = adviceSaveDto.getAdviceDefinitionId();
+                }
+                chargeItem.setDefinitionId(definitionId); // 费用定价ID
                 chargeItem.setDefDetailId(adviceSaveDto.getDefinitionDetailId()); // 定价子表主键
                 chargeItem.setEntererId(adviceSaveDto.getPractitionerId());// 开立人ID
                 chargeItem.setRequestingOrgId(orgId); // 开立科室
@@ -915,6 +953,15 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
 
                 iChargeItemService.saveOrUpdate(chargeItem);
 
+                // 显式更新前端传的chargeItemId对应的收费项目状态为2（已生成医嘱）
+                if (adviceSaveDto.getChargeItemId() != null) {
+                    LambdaUpdateWrapper<ChargeItem> updateWrapper = new LambdaUpdateWrapper<>();
+                    updateWrapper.eq(ChargeItem::getId, adviceSaveDto.getChargeItemId())
+                            .set(ChargeItem::getStatusEnum, 2);
+                    iChargeItemService.update(updateWrapper);
+                    log.info("已更新药品收费项目状态为已生成医嘱，chargeItemId：{}", adviceSaveDto.getChargeItemId());
+                }
+
                 // 🔧 Bug Fix #145: 处理用法绑定的耗材
                 if (StringUtils.isNotBlank(adviceSaveDto.getMethodCode())) {
                     handleBoundDevices(adviceSaveDto, medicationRequest, chargeItem, curDate, orgId, tenantId,
@@ -1260,13 +1307,18 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
                 chargeItem.setTenantId(tenantId);           // 补全租户 ID
                 chargeItem.setCreateBy(currentUsername);    // 补全创建人
                 chargeItem.setCreateTime(curDate);          // 补全创建时间
-                chargeItem.setStatusEnum(ChargeItemStatus.PLANNED.getValue()); // 收费状态
+                chargeItem.setStatusEnum(2); // 已生成医嘱
                 chargeItem.setBusNo(AssignSeqEnum.CHARGE_ITEM_NO.getPrefix().concat(deviceRequest.getBusNo()));
                 chargeItem.setGenerateSourceEnum(GenerateSource.DOCTOR_PRESCRIPTION.getValue()); // 生成来源
                 chargeItem.setPatientId(adviceSaveDto.getPatientId()); // 患者
                 chargeItem.setContextEnum(adviceSaveDto.getAdviceType()); // 类型
                 chargeItem.setEncounterId(adviceSaveDto.getEncounterId()); // 就诊id
-                chargeItem.setDefinitionId(adviceSaveDto.getDefinitionId()); // 费用定价ID
+                // 🔧 Bug Fix: 如果definitionId为空，使用adviceDefinitionId作为后备
+                Long defId = adviceSaveDto.getDefinitionId();
+                if (defId == null) {
+                    defId = adviceSaveDto.getAdviceDefinitionId();
+                }
+                chargeItem.setDefinitionId(defId); // 费用定价ID
                 chargeItem.setDefDetailId(adviceSaveDto.getDefinitionDetailId()); // 定价子表主键
                 chargeItem.setEntererId(adviceSaveDto.getPractitionerId());// 开立人ID
                 chargeItem.setRequestingOrgId(orgId); // 开立科室
@@ -1281,6 +1333,7 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
                     log.warn("耗材的 definitionId 或 definitionDetailId 为 null，尝试从定价信息中获取: deviceDefId={}", 
                             adviceSaveDto.getAdviceDefinitionId());
                     // 查询耗材定价信息
+                    log.warn("查询耗材定价信息: orgId={}, deviceDefId={}", orgId, adviceSaveDto.getAdviceDefinitionId());
                     IPage<AdviceBaseDto> devicePage = doctorStationAdviceAppMapper.getAdviceBaseInfo(
                             new Page<>(1, 1),
                             PublicationStatus.ACTIVE.getValue(),
@@ -1310,10 +1363,10 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
                     }
                 }
                 
-                // 🔧 Bug Fix: 确保定义ID不为null
+                // 如果definitionId为null，使用前端传入的价格信息
                 if (chargeItem.getDefinitionId() == null) {
-                    log.error("无法获取耗材的 definitionId: deviceDefId={}", adviceSaveDto.getAdviceDefinitionId());
+                    log.warn("无法获取耗材的 definitionId，使用前端传入的价格: deviceDefId={}", adviceSaveDto.getAdviceDefinitionId());
-                    throw new ServiceException("无法获取耗材的定价信息，请联系管理员");
+                    // 不抛异常，使用前端传入的unitPrice和totalPrice
                 }
                 
                 // 🔧 Bug Fix: 如果accountId为null，从就诊中获取账户ID，如果没有则自动创建
@@ -1354,6 +1407,15 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
                 chargeItem.setCreateTime(new Date());
 
                 iChargeItemService.saveOrUpdate(chargeItem);
+
+                // 显式更新前端传的chargeItemId对应的收费项目状态为2（已生成医嘱）
+                if (adviceSaveDto.getChargeItemId() != null) {
+                    LambdaUpdateWrapper<ChargeItem> updateWrapper = new LambdaUpdateWrapper<>();
+                    updateWrapper.eq(ChargeItem::getId, adviceSaveDto.getChargeItemId())
+                            .set(ChargeItem::getStatusEnum, 2);
+                    iChargeItemService.update(updateWrapper);
+                    log.info("已更新耗材收费项目状态为已生成医嘱，chargeItemId：{}", adviceSaveDto.getChargeItemId());
+                }
             }
         }
     }
@@ -1514,13 +1576,18 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
                 chargeItem.setTenantId(tenantId);           // 补全租户ID
                 chargeItem.setCreateBy(currentUsername);    // 补全创建人
                 chargeItem.setCreateTime(curDate);          // 补全创建时间
-                chargeItem.setStatusEnum(ChargeItemStatus.DRAFT.getValue()); // 收费状态
+                chargeItem.setStatusEnum(2); // 已生成医嘱
                 chargeItem.setBusNo(AssignSeqEnum.CHARGE_ITEM_NO.getPrefix().concat(serviceRequest.getBusNo()));
                 chargeItem.setGenerateSourceEnum(GenerateSource.DOCTOR_PRESCRIPTION.getValue()); // 生成来源
                 chargeItem.setPatientId(adviceSaveDto.getPatientId()); // 患者
                 chargeItem.setContextEnum(adviceSaveDto.getAdviceType()); // 类型
                 chargeItem.setEncounterId(adviceSaveDto.getEncounterId()); // 就诊id
-                chargeItem.setDefinitionId(adviceSaveDto.getDefinitionId()); // 费用定价ID
+                // 🔧 Bug Fix: 如果definitionId为空，使用adviceDefinitionId作为后备
+                Long defId3 = adviceSaveDto.getDefinitionId();
+                if (defId3 == null) {
+                    defId3 = adviceSaveDto.getAdviceDefinitionId();
+                }
+                chargeItem.setDefinitionId(defId3); // 费用定价ID
                 chargeItem.setDefDetailId(adviceSaveDto.getDefinitionDetailId()); // 定价子表主键
                 chargeItem.setEntererId(adviceSaveDto.getPractitionerId());// 开立人ID
                 chargeItem.setEnteredDate(curDate); // 开立时间
@@ -1539,10 +1606,22 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
 
                 iChargeItemService.saveOrUpdate(chargeItem);
 
+                // 显式更新前端传的chargeItemId对应的收费项目状态为2（已生成医嘱）
+                if (adviceSaveDto.getChargeItemId() != null) {
+                    LambdaUpdateWrapper<ChargeItem> updateWrapper = new LambdaUpdateWrapper<>();
+                    updateWrapper.eq(ChargeItem::getId, adviceSaveDto.getChargeItemId())
+                            .set(ChargeItem::getStatusEnum, 2);
+                    iChargeItemService.update(updateWrapper);
+                    log.info("已更新诊疗收费项目状态为已生成医嘱，chargeItemId：{}", adviceSaveDto.getChargeItemId());
+                }
+
                 // 第一次保存时,处理诊疗套餐的子项信息
                 if (adviceSaveDto.getRequestId() == null) {
                     ActivityDefinition activityDefinition
                             = iActivityDefinitionService.getById(adviceSaveDto.getAdviceDefinitionId());
+                    if (activityDefinition == null) {
+                        continue;
+                    }
                     String childrenJson = activityDefinition.getChildrenJson();
                     if (childrenJson != null) {
                         // 诊疗子项参数类

openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/controller/DoctorStationAdviceController.java

@@ -75,6 +75,7 @@ public class DoctorStationAdviceController {
      * @return 结果
      */
     @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());
     }

openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/dto/RequestBaseDto.java

@@ -84,6 +84,12 @@ public class RequestBaseDto {
      */
     private String adviceTableName;
 
+    /**
+     * 医嘱定义ID
+     */
+    @JsonSerialize(using = ToStringSerializer.class)
+    private Long adviceDefinitionId;
+
     /**
      * 医嘱名称
      */

openhis-server-new/openhis-application/src/main/resources/mapper/doctorstation/DoctorStationAdviceAppMapper.xml

@@ -483,7 +483,9 @@
         T1.based_on_id AS based_on_id,
         T1.category_enum AS category_enum,
         T1.encounter_id AS encounter_id,
-        T1.patient_id AS patient_id
+        T1.patient_id AS patient_id,
+        'med_medication_definition' AS advice_table_name,
+        T1.medication_id AS advice_definition_id
         FROM med_medication_request AS T1
         LEFT JOIN med_medication_definition AS T2 ON T2.ID = T1.medication_id
         AND T2.delete_flag = '0'
@@ -494,7 +496,7 @@
         LEFT JOIN adm_location AS al ON al.ID = T1.perform_location AND al.delete_flag = '0'
         LEFT JOIN cli_condition AS cc ON cc.id = T1.condition_id AND cc.delete_flag = '0'
         LEFT JOIN cli_condition_definition AS ccd ON ccd.id = cc.definition_id
-        WHERE T1.delete_flag = '0' AND T1.tcm_flag = 0 AND T1.generate_source_enum = #{generateSourceEnum}
+        WHERE T1.delete_flag = '0' AND T1.tcm_flag = 0
         <if test="historyFlag == '0'.toString()">
             AND T1.encounter_id = #{encounterId}
         </if>
@@ -504,6 +506,58 @@
         AND T1.refund_medicine_id IS NULL
         ORDER BY T1.status_enum,T1.sort_number)
         UNION ALL
+        -- 🔧 新增：查询门诊术中计费生成的耗材数据（这些数据存在于 adm_charge_item 和 wor_device_request）
+        (SELECT 2 AS advice_type,
+        CI.service_id AS request_id,
+        CI.service_id || '-ci-dev' AS unique_key,
+        '' AS prescription_no,
+        CI.enterer_id AS requester_id,
+        CI.entered_date AS request_time,
+        CASE WHEN CI.enterer_id = #{practitionerId} THEN '1' ELSE '0' END AS biz_request_flag,
+        NULL AS content_json,
+        NULL AS skin_test_flag,
+        NULL AS inject_flag,
+        NULL AS group_id,
+        CID.charge_name AS advice_name,
+        '' AS volume,
+        NULL AS lot_number,
+        CI.quantity_value AS quantity,
+        CI.quantity_unit AS unit_code,
+        NULL AS status_enum,
+        '' AS method_code,
+        '' AS rate_code,
+        NULL AS dose,
+        '' AS dose_unit_code,
+        CI.id AS charge_item_id,
+        CI.unit_price AS unit_price,
+        CI.total_price AS total_price,
+        CI.status_enum AS charge_status,
+        DR.perform_location AS position_id,
+        AL.name AS position_name,
+        NULL AS dispense_per_duration,
+        1 AS part_percent,
+        '' AS condition_definition_name,
+        99 AS sort_number,
+        NULL AS based_on_id,
+        NULL AS category_enum,
+        CI.encounter_id AS encounter_id,
+        CI.patient_id AS patient_id,
+        'adm_device_definition' AS advice_table_name,
+        CI.product_id AS advice_definition_id
+        FROM adm_charge_item AS CI
+        LEFT JOIN adm_charge_item_definition CID ON CID.id = CI.definition_id AND CID.delete_flag = '0'
+        LEFT JOIN wor_device_request DR ON DR.id = CI.service_id AND DR.delete_flag = '0'
+        LEFT JOIN adm_location AS AL ON AL.id = DR.perform_location AND AL.delete_flag = '0'
+        WHERE CI.delete_flag = '0'
+          AND CI.service_table = 'wor_device_request'
+          <if test="historyFlag == '0'.toString()">
+              AND CI.encounter_id = #{encounterId}
+          </if>
+          <if test="historyFlag == '1'.toString()">
+              AND CI.patient_id = #{patientId} AND CI.encounter_id != #{encounterId}
+          </if>
+        ORDER BY CI.entered_date)
+        UNION ALL
         (SELECT 2 AS advice_type,
         T1.id AS request_id,
         T1.id || '-2' AS unique_key,
@@ -538,7 +592,9 @@
         T1.based_on_id AS based_on_id,
         T1.category_enum AS category_enum,
         T1.encounter_id AS encounter_id,
-        T1.patient_id AS patient_id
+        T1.patient_id AS patient_id,
+        'adm_device_definition' AS advice_table_name,
+        T1.device_def_id AS advice_definition_id
         FROM wor_device_request AS T1
         LEFT JOIN adm_device_definition AS T2 ON T2.ID = T1.device_def_id
         AND T2.delete_flag = '0'
@@ -590,7 +646,9 @@
          T1.based_on_id AS based_on_id,
          T1.category_enum AS category_enum,
          T1.encounter_id AS encounter_id,
-         T1.patient_id AS patient_id
+         T1.patient_id AS patient_id,
+        'wor_activity_definition' AS advice_table_name,
+        T1.activity_id AS advice_definition_id
          FROM wor_service_request AS T1
         LEFT JOIN wor_activity_definition AS T2
         ON T2.ID = T1.activity_id

openhis-ui-vue3/src/api/surgicalschedule.js

@@ -62,10 +62,10 @@ export function exportSurgerySchedule(query) {
 }
 
 //签名密码验证
-export function checkPassword(params) {
+export function checkPassword(data) {
   return request({
     url: '/clinical-manage/surgery-schedule/checkPassword',
     method: 'POST',
-    params: params
+    data: data
   })
 }

openhis-ui-vue3/src/views/clinicmanagement/bargain/component/api.js

@@ -24,11 +24,14 @@ 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
  */
-export function savePrescription(data) {
+export function savePrescription(data, adviceOpType = '0') {
   return request({
     url: '/doctor-station/advice/save-advice',
     method: 'post',
+    params: { adviceOpType },
     data: data
   })
 }
@@ -56,8 +59,9 @@ export function singOut(data) {
  * 获取患者本次就诊处方
  */
 export function getPrescriptionList(encounterId) {
+  // Add timestamp to bypass browser caching and ensure fresh data is loaded
   return request({
-    url: '/doctor-station/advice/request-base-info?encounterId=' + encounterId,
+    url: '/doctor-station/advice/request-base-info?encounterId=' + encounterId + '&t=' + Date.now(),
     method: 'get',
   })
 }

openhis-ui-vue3/src/views/surgicalschedule/index.vue

@@ -143,7 +143,7 @@
       <!-- 弹窗头部操作按钮 -->
       <div class="dialog-header-buttons" v-if="!isViewMode && !isEditMode">
         <el-button @click="handleFindApply">查找</el-button>
-        <el-button @click="handleRefresh">刷新</el-button>
+        <el-button class="refresh-btn" @click="handleRefresh">刷新</el-button>
         <el-button @click="cancel">返回</el-button>
         <el-button type="primary" :disabled="isViewMode" @click="submitForm">保存</el-button>
       </div>
@@ -837,21 +837,28 @@
     </el-dialog>
 
     <!-- 临时医嘱弹窗 -->
-    <el-dialog :title="temporaryMedicalTitle" v-model="showTemporaryMedical" width="80%" append-to-body :close-on-click-modal="false">
+    <el-dialog title="" v-model="showTemporaryMedical" width="80%" append-to-body :close-on-click-modal="false">
+      <!-- 🔧 新增：加载状态提示 -->
+      <div v-if="temporaryMedicalLoading" class="loading-container">
+        <el-icon class="is-loading"><loading /></el-icon>
+        <span>正在加载医嘱数据，请稍候...</span>
+      </div>
       <temporary-medical
+        v-else
         :patient-info="temporaryPatientInfo"
         :billing-medicines="temporaryBillingMedicines"
         v-model:temporary-advices="temporaryAdvices"
         @submit="handleTemporaryMedicalSubmit"
         @cancel="handleTemporaryMedicalCancel"
-        @delete-advice="handleDeleteTemporaryAdvice"
+        @refresh="handleTemporaryMedicalRefresh"
+        @quote-billing="handleQuoteBilling"
       />
     </el-dialog>
   </div>
 </template>
 
 <script setup name="SurgicalSchedule">
-import { ref, reactive, onMounted, nextTick, computed } from 'vue'
+import { ref, reactive, onMounted, nextTick, computed, watch } from 'vue'
 import { getCurrentInstance } from 'vue'
 import { parseTime } from '@/utils/openhis'
 import { useDict } from '@/utils/dict'
@@ -859,6 +866,7 @@ import download from '@/plugins/download'
 import Prescriptionlist from '@/views/clinicmanagement/bargain/component/prescriptionlist.vue'
 import useUserStore from '@/store/modules/user'
 import { ElMessage } from 'element-plus'
+import { Loading } from '@element-plus/icons-vue' // 🔧 新增：导入 Loading 图标
 // 导入计费相关接口
 import { getPrescriptionList } from '@/views/clinicmanagement/bargain/component/api'
 
@@ -1013,6 +1021,17 @@ const temporaryPatientInfo = ref({})
 const temporaryBillingMedicines = ref([])
 const temporaryAdvices = ref([])
 
+// 🔧 新增：监听 temporaryAdvices 的变化，用于调试
+watch(temporaryAdvices, (newVal, oldVal) => {
+  console.log('=== temporaryAdvices 变化 ===')
+  console.log('=== 新值 ===', newVal)
+  console.log('=== 新值[1]?.dosage ===', newVal[1]?.dosage)
+  console.log('=== 旧值 ===', oldVal)
+  console.log('=== 旧值[1]?.dosage ===', oldVal[1]?.dosage)
+}, { deep: true })
+
+const temporaryMedicalLoading = ref(false) // 🔧 新增：临时医嘱加载状态
+
 // 下拉列表数据
 const orgList = ref([])
 const deptList = ref([])
@@ -1067,8 +1086,9 @@ const {
   isolation_type: isolationTypeList,
   surgery_type,
   surgery_level,
-  surgery_nature: surgeryNatureList
+  surgery_nature: surgeryNatureList,
-} = useDict('surgical_site', 'anesthesia_type', 'incision_level', 'isolation_type', 'surgery_type', 'surgery_level', 'surgery_nature')
+  method_code
+} = useDict('surgical_site', 'anesthesia_type', 'incision_level', 'isolation_type', 'surgery_type', 'surgery_level', 'surgery_nature', 'method_code')
 
 // 加载数据
 onMounted(() => {
@@ -1370,6 +1390,9 @@ function closeChargeDialog() {
   chargeSurgeryInfo.value = {}
 }
 
+// 🔧 新增：标志位，用于区分是"打开"还是"刷新"
+const isRefreshAction = ref(false)
+
 // 处理医嘱按钮点击事件
 function handleMedicalAdvice(row) {
   // 如果没有传入行数据，使用选中的行
@@ -1391,55 +1414,119 @@ function handleMedicalAdvice(row) {
     roomCode: row.roomCode,
     doctorName: userStore.nickName,
     role: userStore.roles[0],
+    effectiveOrgId : row.effectiveOrgId,
+    orgId: userStore.orgId,
+    positionId: userStore.orgId
   }
 
-  // 初始化临时医嘱列表
+  // 🔧 关键修复：如果已有提交的医嘱数据，并且是同一个患者的就诊，则使用保存的数据
+  // 这样可以保留 requestId，避免重复创建医嘱记录
+  console.log('=== 检查是否使用已保存的医嘱数据 ===')
+  console.log('=== temporaryAdvices.value.length ===', temporaryAdvices.value.length)
+  console.log('=== temporaryAdvices.value[0]?.originalMedicine?.encounterId ===', temporaryAdvices.value[0]?.originalMedicine?.encounterId)
+  console.log('=== row.visitId ===', row.visitId)
+  console.log('=== isRefreshAction.value ===', isRefreshAction.value)
+  
+  const isSameEncounter = temporaryAdvices.value.length > 0 && 
+                         temporaryAdvices.value[0]?.originalMedicine?.encounterId === row.visitId &&
+                         !isRefreshAction.value
+  
+  console.log('=== isSameEncounter ===', isSameEncounter)
+  
+  if (isSameEncounter) {
+    console.log('=== 使用已保存的医嘱数据，避免重复创建 ===')
+    console.log('=== temporaryAdvices.value[0]?.originalMedicine?.requestId ===', temporaryAdvices.value[0]?.originalMedicine?.requestId)
+    // 直接打开弹窗，使用已保存的数据
+    showTemporaryMedical.value = true
+    temporaryMedicalLoading.value = false
+    isRefreshAction.value = false // 重置标志位
+    return
+  }
+
+  // 🔧 修复：每次打开临时医嘱时都重新加载数据，避免使用缓存数据导致数据重复
+  // 先清空旧数据
+  temporaryBillingMedicines.value = []
   temporaryAdvices.value = []
+  temporaryMedicalLoading.value = true // 🔧 新增：开始加载
 
   // 调用计费接口获取数据
   getPrescriptionList(row.visitId).then((res) => {
+    console.log('=== 拉取计费数据返回结果 ===', res)
     if (res.code === 200 && res.data) {
-      // 过滤数据，只保留 adviceType 值为 1 的药品
+      // 🔧 修复：显示所有药品请求数据，不管有没有计费项目
+      // 根据用户需求：已引用计费药品（待生成医嘱）和临时医嘱预览（已生成）显示的数据应该相同
+      // 在提交医嘱之前状态应该是"待签发"，提交之后变为"已签发"
+      // 再次打开医嘱界面的时候能看到这两个状态的药品
+      const seenIds = new Set();
       const filteredItems = res.data.filter(item => {
-        try {
+        // 匹配 encounterId
-          // 尝试从 contentJson 中解析数据
+        if (item.encounterId !== row.visitId) return false;
-          const contentData = JSON.parse(item.contentJson)
+        // 过滤掉名称为空的项目
-          const adviceType = Number(contentData.adviceType)
+        const medicineName = item.adviceName || item.advice_name;
-          return adviceType === 1
+        if (!medicineName || medicineName.trim() === '') return false;
-        } catch (e) {
+        // 根据药品请求ID去重，避免重复显示
-          // 如果解析失败，尝试使用顶层的 adviceType
+        const itemId = item.requestId || item.id;
-          const adviceType = Number(item.adviceType)
+        if (itemId && seenIds.has(itemId)) return false;
-          return adviceType === 1
+        if (itemId) seenIds.add(itemId);
-        }
+        return true;
       })
 
-      // 将过滤后的数据转换为临时医嘱需要的格式
+      // 🔧 修复：限制返回数量，最多显示前100条，避免数据过多导致页面卡死
+      const maxItems = 100
+      if (filteredItems.length > maxItems) {
+        ElMessage.warning(`待签发医嘱数量过多(${filteredItems.length}条)，仅显示前${maxItems}条`)
+        filteredItems.length = maxItems
+      }
+
+      // 将过滤后的数据转换为临时医嘱需要的格式 - 兼容驼峰和下划线命名
+      // 对于从 adm_charge_item（计费项目表）查询来的项目，特殊处理
       temporaryBillingMedicines.value = filteredItems.map(item => {
         try {
-          // 从 contentJson 中解析详细数据
+          // 从 contentJson 或 content_json 中解析详细数据 - 兼容下划线和驼峰命名
-          const contentData = JSON.parse(item.contentJson)
+          const jsonContent = item.contentJson || item.content_json;
+          const contentData = jsonContent ? JSON.parse(jsonContent) : {};
           return {
-            medicineName: contentData.adviceName || item.adviceName || '',
+            medicineName: contentData.adviceName || contentData.advice_name || item.adviceName || item.advice_name || '',
-            specification: contentData.volume || contentData.specification || '',
+            specification: contentData.volume || contentData.specification || item.volume || item.specification || '',
             quantity: contentData.quantity || item.quantity || 0,
-            batchNumber: contentData.lotNumber || item.lotNumber || '',
+            batchNumber: contentData.lotNumber || contentData.lot_number || item.lotNumber || item.lot_number || '',
-            unitPrice: contentData.unitPrice || item.unitPrice || 0,
+            unitPrice: contentData.unitPrice || contentData.unit_price || item.unitPrice || item.unit_price || 0,
-            subtotal: contentData.totalPrice || item.totalPrice || 0,
+            subtotal: contentData.totalPrice || contentData.total_price || item.totalPrice || item.total_price ||
-            insuranceType: contentData.insuranceType === 1 ? '医保' : '自费'
+                     (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',
+            // 添加医嘱定义ID和表名，用于库存匹配
+            adviceDefinitionId: item.adviceDefinitionId || contentData.adviceDefinitionId || item.advice_definition_id || null,
+            adviceTableName: item.adviceTableName || contentData.adviceTableName || item.advice_table_name || null,
+            // 添加关键字段：医嘱类型、费用项目ID、定价ID，用于后端正确分类和保存
+            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
+          };
         } catch (e) {
-          // 如果解析失败，使用顶层数据
+          // 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
           return {
-            medicineName: item.adviceName || '',
+            medicineName: item.adviceName || item.advice_name || item.chargeName || '',
-            specification: item.specification || '',
+            specification: item.specification || item.specification || item.volume || '',
-            quantity: item.quantity || 0,
+            quantity: item.quantity || item.quantity_value || item.quantityValue || 0,
-            batchNumber: item.lotNumber || '',
+            batchNumber: item.lotNumber || item.lot_number || '',
-            unitPrice: item.unitPrice || 0,
+            unitPrice: item.unitPrice || item.unit_price || 0,
-            subtotal: item.totalPrice || 0,
+            subtotal: item.totalPrice || item.total_price ||
-            insuranceType: item.insuranceType === 1 ? '医保' : '自费'
+                     (item.unitPrice || item.unit_price || 0) *
-          }
+                     (item.quantity || item.quantity_value || item.quantityValue || 0),
+            insuranceType: (item.insuranceType || item.insurance_type) === 1 ? '医保' : '自费',
+            // 添加医嘱定义ID和表名，用于库存匹配
+            adviceDefinitionId: item.adviceDefinitionId || item.advice_definition_id || null,
+            adviceTableName: item.adviceTableName || item.advice_table_name || null,
+            // 添加关键字段：医嘱类型、费用项目ID、定价ID，用于后端正确分类和保存
+            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
+          };
         }
-      })
+      });
     } else {
       // 如果没有数据或接口调用失败，初始化空列表
       temporaryBillingMedicines.value = []
@@ -1455,14 +1542,36 @@ function handleMedicalAdvice(row) {
       // 计算剂量 = 规格数值 × 数量
       const dosage = specValue * (medicine.quantity || 1)
 
-      // 根据药品名称判断用法
+      // 🔧 修复：优先从 contentJson 中读取已有的用法，如果没有则根据药品名称判断
-      let usage = '静脉注射'
+      let usageCode = 'iv' // 默认静脉注射编码
-      if (medicine.medicineName && medicine.medicineName.includes('注射液')) {
+      let usageLabel = '静脉注射' // 默认显示名称
-        usage = '静脉注射'
+
-      } else if (medicine.medicineName && medicine.medicineName.includes('片')) {
+      // 尝试从 contentJson 中读取用法
-        usage = '口服'
+      try {
-      } else if (medicine.medicineName && medicine.medicineName.includes('胶囊')) {
+        const jsonContent = medicine.contentJson || medicine.content_json;
-        usage = '口服'
+        if (jsonContent) {
+          const contentData = JSON.parse(jsonContent);
+          if (contentData.methodCode) {
+            usageCode = contentData.methodCode;
+            usageLabel = getUsageLabel(contentData.methodCode);
+          }
+        }
+      } catch (e) {
+        // 解析失败，继续使用默认值
+      }
+
+      // 如果没有从 contentJson 中读取到用法，根据药品名称判断
+      if (!usageCode || usageCode === 'iv') {
+        if (medicine.medicineName && medicine.medicineName.includes('注射液')) {
+          usageCode = 'iv'
+          usageLabel = '静脉注射'
+        } else if (medicine.medicineName && medicine.medicineName.includes('片')) {
+          usageCode = 'po'
+          usageLabel = '口服'
+        } else if (medicine.medicineName && medicine.medicineName.includes('胶囊')) {
+          usageCode = 'po'
+          usageLabel = '口服'
+        }
       }
 
       return {
@@ -1470,46 +1579,274 @@ function handleMedicalAdvice(row) {
         adviceName: medicine.medicineName || '',
         dosage: dosage,
         unit: specUnit,
-        usage: usage,
+        usage: usageCode, // 🔧 修复：保存的是编码
+        usageLabel: usageLabel, // 🔧 新增：保存显示名称
         frequency: '临时',
         executeTime: new Date().toLocaleString('zh-CN'),
-        originalMedicine: medicine
+        // 🔧 关键修复：确保 originalMedicine 中包含 encounterId，以便后续判断是否为同一患者
+        originalMedicine: {
+          ...medicine,
+          encounterId: row.visitId // 添加 encounterId 字段
+        }
       }
     })
 
     // 打开临时医嘱弹窗
     showTemporaryMedical.value = true
-  }).catch(() => {
+    temporaryMedicalLoading.value = false // 🔧 新增：加载完成
+  }).catch((error) => {
     temporaryBillingMedicines.value = []
     temporaryAdvices.value = []
+    temporaryMedicalLoading.value = false // 🔧 新增：加载完成（即使失败也要关闭加载状态）
+    proxy.$modal.msgError('刷新数据失败，请重试')
+    console.error('Failed to refresh prescription list', error)
     showTemporaryMedical.value = true
   })
 }
 
 // 关闭临时医嘱弹窗
+// 🔧 修复：清空数据，避免下次打开时使用缓存数据导致数据重复
 function closeTemporaryMedical() {
   showTemporaryMedical.value = false
-  temporaryPatientInfo.value = {}
+  // 🔧 修复：关闭弹窗时不清空数据，保留用户可能已经修改过的数据
-  temporaryBillingMedicines.value = []
+  // 只有当用户点击"取消"按钮时才应该清空数据
-  temporaryAdvices.value = []
 }
 
 // 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) {
-  // 这里可以调用后端API保存临时医嘱数据
+  console.log('=== handleTemporaryMedicalSubmit 被调用 ===')
-  proxy.$modal.msgSuccess('临时医嘱提交成功')
+  console.log('=== data ===', data)
-  closeTemporaryMedical()
+  console.log('=== data.temporaryAdvices ===', data.temporaryAdvices)
+  console.log('=== data.temporaryAdvices[1]?.dosage ===', data.temporaryAdvices[1]?.dosage)
+  
+  // 🔧 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
+          })
+        }
+      }
+    })
+    
+    // 同步更新计费药品列表，保持数据一致性
+    temporaryBillingMedicines.value = data.billingMedicines || []
+    
+    console.log('=== 使用用户修改后的临时医嘱数据 ===', temporaryAdvices.value)
+    console.log('=== temporaryAdvices.value[1]?.dosage ===', temporaryAdvices.value[1]?.dosage)
+  } else {
+    // 如果没有传递数据，则清空
+    temporaryAdvices.value = []
+    temporaryBillingMedicines.value = []
+  }
+
+  // 关闭弹窗
+  showTemporaryMedical.value = false
 }
 
 // 处理临时医嘱取消
 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
+  temporaryPatientInfo.value = {}
+  temporaryBillingMedicines.value = []
+  temporaryAdvices.value = []
   closeTemporaryMedical()
 }
 
-// 处理删除临时医嘱
+// 处理删除临时医嘱 - 将删除的医嘱放回已引用计费药品列表
 function handleDeleteTemporaryAdvice(index) {
+  const deletedAdvice = temporaryAdvices.value[index]
+  // 如果有原始药品数据，放回到计费药品列表
+  if (deletedAdvice.originalMedicine) {
+    temporaryBillingMedicines.value.push(deletedAdvice.originalMedicine)
+  }
   temporaryAdvices.value.splice(index, 1)
-  proxy.$modal.msgSuccess('临时医嘱已删除')
+  proxy.$modal.msgSuccess('临时医嘱已删除，已放回待生成列表')
+}
+
+// 处理刷新按钮点击
+function handleTemporaryMedicalRefresh() {
+  // 重新拉取计费药品数据
+  if (temporaryPatientInfo.value.visitId) {
+    handleMedicalAdvice(temporaryPatientInfo.value)
+  } else {
+    proxy.$modal.msgWarning('患者信息不完整，请关闭弹窗重新打开')
+  }
+}
+
+// 处理引用计费按钮点击
+function handleQuoteBilling() {
+  // 重新拉取计费药品数据
+  if (temporaryPatientInfo.value.visitId) {
+    temporaryMedicalLoading.value = true // 🔧 新增：开始加载
+    getPrescriptionList(temporaryPatientInfo.value.visitId).then((res) => {
+            if (res.code === 200 && res.data) {
+              // 🔧 修复：先清空旧数据，避免数据累积
+              temporaryBillingMedicines.value = []
+              temporaryAdvices.value = []
+    
+              // 🔧 修复：显示所有药品请求数据，不管有没有计费项目
+              const filteredItems = res.data.filter(item => {
+                // 匹配 encounterId
+                if (item.encounterId !== temporaryPatientInfo.value.visitId) return false;
+                // 过滤掉名称为空的项目
+                const medicineName = item.adviceName || item.advice_name;
+                return medicineName && medicineName.trim() !== '';
+              })
+        // 🔧 修复：限制返回数量，最多显示前100条，避免数据过多导致页面卡死
+        const maxItems = 100
+        if (filteredItems.length > maxItems) {
+          ElMessage.warning(`待签发医嘱数量过多(${filteredItems.length}条)，仅显示前${maxItems}条`)
+          filteredItems.length = maxItems
+        }
+
+        // 将过滤后的数据转换为临时医嘱需要的格式
+        temporaryBillingMedicines.value = filteredItems.map(item => {
+          try {
+            // 从 contentJson 或 content_json 中解析详细数据 - 兼容下划线和驼峰命名
+            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 || '',
+              specification: contentData.volume || contentData.specification || item.volume || item.specification || '',
+              quantity: contentData.quantity || item.quantity || item.quantity_value || item.quantityValue || 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 || item.quantity_value || item.quantityValue || 0),
+              insuranceType: (contentData.insuranceType || contentData.insurance_type) === 1 ? '医保' : (item.insuranceType === 1 || item.insurance_type === 1) ? '医保' : '自费',
+              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
+            }
+          } catch (e) {
+            // 如果解析失败，使用顶层数据 - 兼容 snake_case 和 camelCase
+            return {
+              medicineName: item.adviceName || item.advice_name || '',
+              specification: item.specification || item.specification || item.volume || '',
+              quantity: item.quantity || item.quantity_value || 0,
+              batchNumber: item.lotNumber || item.lot_number || '',
+              unitPrice: item.unitPrice || item.unit_price || 0,
+              subtotal: item.totalPrice || item.total_price ||
+                       (item.unitPrice || item.unit_price || 0) *
+                       (item.quantity || item.quantity_value || 0),
+              insuranceType: (item.insuranceType || item.insurance_type) === 1 ? '医保' : '自费',
+              orgId: item.orgId || item.positionId || userStore.orgId,
+              positionId: item.positionId || userStore.orgId,
+              definitionId: item.definitionId,
+              definitionDetailId: item.definitionDetailId
+            }
+          }
+        })
+
+        // 将计费药品转换为临时医嘱数据
+        temporaryAdvices.value = temporaryBillingMedicines.value.map((medicine, index) => {
+          // 解析规格中的数值和单位
+          const specMatch = medicine.specification ? medicine.specification.match(/(\d+)(\D+)/) : null
+          const specValue = specMatch ? parseInt(specMatch[1]) : 1
+          const specUnit = specMatch ? specMatch[2] : 'ml'
+
+          // 计算剂量 = 规格数值 × 数量
+          const dosage = specValue * (medicine.quantity || 1)
+
+          // 🔧 修复：优先从 contentJson 中读取已有的用法，如果没有则根据药品名称判断
+          let usageCode = 'iv' // 默认静脉注射编码
+          let usageLabel = '静脉注射' // 默认显示名称
+
+          // 尝试从 contentJson 中读取用法
+          try {
+            const jsonContent = medicine.contentJson || medicine.content_json;
+            if (jsonContent) {
+              const contentData = JSON.parse(jsonContent);
+              if (contentData.methodCode) {
+                usageCode = contentData.methodCode;
+                usageLabel = getUsageLabel(contentData.methodCode);
+              }
+            }
+          } catch (e) {
+            // 解析失败，继续使用默认值
+          }
+
+          // 如果没有从 contentJson 中读取到用法，根据药品名称判断
+          if (!usageCode || usageCode === 'iv') {
+            if (medicine.medicineName && medicine.medicineName.includes('注射液')) {
+              usageCode = 'iv'
+              usageLabel = '静脉注射'
+            } else if (medicine.medicineName && medicine.medicineName.includes('片')) {
+              usageCode = 'po'
+              usageLabel = '口服'
+            } else if (medicine.medicineName && medicine.medicineName.includes('胶囊')) {
+              usageCode = 'po'
+              usageLabel = '口服'
+            }
+          }
+
+          return {
+            id: index + 1,
+            adviceName: medicine.medicineName || '',
+            dosage: dosage,
+            unit: specUnit,
+            usage: usageCode, // 🔧 修复：保存的是编码
+            usageLabel: usageLabel, // 🔧 新增：保存显示名称
+            frequency: '临时',
+            executeTime: new Date().toLocaleString('zh-CN'),
+            // 🔧 关键修复：确保 originalMedicine 中包含 encounterId，以便后续判断是否为同一患者
+            originalMedicine: {
+              ...medicine,
+              encounterId: temporaryPatientInfo.value.visitId // 添加 encounterId 字段
+            }
+          }
+        })
+
+        temporaryMedicalLoading.value = false // 🔧 新增：加载完成
+        ElMessage.success('已成功引用最新计费药品信息！')
+      } else {
+        // 如果没有数据或接口调用失败，初始化空列表
+        temporaryBillingMedicines.value = []
+        temporaryAdvices.value = []
+        temporaryMedicalLoading.value = false // 🔧 新增：加载完成（即使失败也要关闭加载状态）
+        ElMessage.error('获取计费数据失败，请重试')
+      }
+    }).catch(() => {
+      temporaryBillingMedicines.value = []
+      temporaryAdvices.value = []
+      temporaryMedicalLoading.value = false // 🔧 新增：加载完成（即使失败也要关闭加载状态）
+      ElMessage.error('获取计费数据失败，请重试')
+    })
+  } else {
+    proxy.$modal.msgWarning('患者信息不完整，请关闭弹窗重新打开')
+  }
+}
+
+// 🔧 新增：根据用法编码获取对应的显示名称
+function getUsageLabel(usageCode) {
+  if (!usageCode) return '-'
+  const dictItem = method_code.value?.find(item => item.value === usageCode)
+  return dictItem ? dictItem.label : usageCode
 }
 
 // 格式化计费弹窗中的日期
@@ -1591,7 +1928,7 @@ function resetForm() {
 function submitForm() {
   proxy.$refs['surgeryRef'].validate((valid) => {
     if (valid) {
-      const submitData = { ...form }
+      const submitData = { ...form, orgId: userStore.orgId }
       if (!form.scheduleId) {
         // 新增手术安排
         addSurgerySchedule(submitData).then((res) => {
@@ -1827,6 +2164,25 @@ function getRowClassName({ row, rowIndex }) {
 </script>
 
 <style scoped>
+/* 🔧 新增：临时医嘱加载状态样式 */
+.loading-container {
+  display: flex;
+  flex-direction: column;
+  align-items: center;
+  justify-content: center;
+  padding: 100px 0;
+  color: #409eff;
+  font-size: 16px;
+}
+
+.loading-container .el-icon {
+  font-size: 32px;
+  margin-bottom: 16px;
+}
+
+.loading-container span {
+  font-weight: 500;
+}
 .app-container {
   padding: 20px;
 }
@@ -1875,4 +2231,5 @@ function getRowClassName({ row, rowIndex }) {
 :deep(.el-table .selected-row > td) {
   border-bottom: 1px solid #d9ecff !important;
 }
+
 </style>