diff --git a/openhis-ui-vue3/src/views/doctorstation/components/diagnosis/infectiousDiseaseReportDialog.vue b/openhis-ui-vue3/src/views/doctorstation/components/diagnosis/infectiousDiseaseReportDialog.vue
index 1ca3faae..86d35613 100755
--- a/openhis-ui-vue3/src/views/doctorstation/components/diagnosis/infectiousDiseaseReportDialog.vue
+++ b/openhis-ui-vue3/src/views/doctorstation/components/diagnosis/infectiousDiseaseReportDialog.vue
@@ -23,7 +23,74 @@
       </el-card>
     </template>
 
+    <el-card class="report-form" shadow="never">
+      <el-form ref="formRef" :model="form" :rules="rules" label-position="top" :disabled="readOnly">
+        <!-- 患者姓名、家长姓名、身份证号 -->
+        <el-row :gutter="16" class="form-row">
+          <el-col :span="8" class="form-item">
+            <span class="form-label required">患者姓名</span>
+            <el-input v-model="form.patName" class="underline-input" disabled />
+          </el-col>
+          <el-col :span="8" class="form-item">
+            <span :class="['form-label', isChildPatient ? 'required' : '']">家长姓名</span>
+            <el-input v-model="form.parentName" class="underline-input" placeholder="≤14岁必填" />
+          </el-col>
+          <el-col :span="8" class="form-item">
+            <span class="form-label required">身份证号</span>
+            <el-input v-model="form.idNo" class="underline-input" maxlength="18"  @change="handleIdCardChange" />
+          </el-col>
+        </el-row>
 
+        <!-- 性别、出生日期、实足年龄 -->
+        <el-row :gutter="16" class="form-row align-bottom">
+          <el-col :span="6" class="form-item">
+            <span class="form-label required">性别</span>
+            <el-radio-group v-model="form.sex">
+              <el-radio label="男">男</el-radio>
+              <el-radio label="女">女</el-radio>
+              <el-radio label="未知">未知</el-radio>
+            </el-radio-group>
+          </el-col>
+          <el-col :span="10" class="form-item birth-date">
+            <span class="form-label required">出生日期</span>
+            <div class="date-inputs">
+              <el-input v-model="form.birthYear" class="underline-input small" maxlength="4" @change="calculateAge" />
+              <span>年</span>
+              <el-input v-model="form.birthMonth" class="underline-input small" maxlength="2" @change="calculateAge" />
+              <span>月</span>
+              <el-input v-model="form.birthDay" class="underline-input small" maxlength="2" @change="calculateAge" />
+              <span>日</span>
+            </div>
+          </el-col>
+          <el-col :span="8" class="form-item age-item">
+            <span class="form-label">或 实足年龄</span>
+            <div class="age-inputs">
+              <el-input v-model="form.age" class="underline-input small"/>
+              <el-select v-model="form.ageUnit" class="age-unit-select">
+                <el-option label="岁" value="岁" />
+                <el-option label="月" value="月" />
+                <el-option label="天" value="天" />
+              </el-select>
+            </div>
+          </el-col>
+        </el-row>
+
+        <!-- 工作单位 -->
+        <el-row :gutter="16" class="form-row">
+          <el-col :span="24" class="form-item full-width">
+            <span class="form-label">工作单位（学校）</span>
+            <el-input v-model="form.workplace" class="underline-input" />
+          </el-col>
+        </el-row>
+
+        <!-- 联系电话、紧急联系人电话 -->
+        <el-row :gutter="16" class="form-row">
+          <el-col :span="12" class="form-item">
+            <span class="form-label required">联系电话</span>
+            <el-input v-model="form.phone" class="underline-input" maxlength="11" />
+          </el-col>
+          <el-col :span="12" class="form-item">
+            <span class="form-label required">紧急联系人电话</span>
             <el-input v-model="form.contactPhone" class="underline-input" maxlength="11" />
           </el-col>
         </el-row>
diff --git a/openhis-ui-vue3/vite.config.js b/openhis-ui-vue3/vite.config.js
index da505fc3..8cff8bee 100755
--- a/openhis-ui-vue3/vite.config.js
+++ b/openhis-ui-vue3/vite.config.js
@@ -40,7 +40,7 @@ export default defineConfig(({ mode, command }) => {
       proxy: {
         // https://cn.vitejs.dev/config/#server-proxy
         '/dev-api': {
-          target: 'http://localhost:18083/openhis',
+          target: 'http://localhost:18080/openhis',
           changeOrigin: true,
           rewrite: (p) => p.replace(/^\/dev-api/, ''),
         },