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 bffdacba..d0d3eb37 100644
--- a/openhis-ui-vue3/src/views/clinicmanagement/bargain/component/prescriptionlist.vue
+++ b/openhis-ui-vue3/src/views/clinicmanagement/bargain/component/prescriptionlist.vue
@@ -573,7 +573,11 @@ function selectAdviceBase(key, row) {
     }
   } else {
     // 诊疗：设置执行科室和价格
-    prescriptionList.value[rowIndex.value].orgId = JSON.parse(JSON.stringify(row)).positionId;
+    // 🔧 Bug Fix #238: 如果positionId为空，使用orgId作为默认值
+    const rowData = JSON.parse(JSON.stringify(row));
+    const selectedPositionId = rowData.positionId;
+    const selectedOrgId = rowData.orgId;
+    prescriptionList.value[rowIndex.value].orgId = selectedPositionId || selectedOrgId;
     if (row.priceList && row.priceList.length > 0) {
       prescriptionList.value[rowIndex.value].unitPrice = row.priceList[0].price;
     } else {
@@ -751,6 +755,11 @@ function handleSave() {
 
 // 单行处方保存
 function handleSaveSign(row, index) {
+  // 🔧 Bug Fix #238: 诊疗项目必须选择执行科室
+  if (row.adviceType === 3 && !row.orgId) {
+    proxy.$modal.msgWarning('诊疗项目必须选择执行科室');
+    return;
+  }
   proxy.$refs['formRef' + index].validate((valid) => {
     if (valid) {
       row.isEdit = false;
@@ -774,6 +783,11 @@ function handleSaveSign(row, index) {
           proxy.$modal.msgSuccess('保存成功');
           getListInfo(false);
           nextId.value == 1;
+          // 🔧 Bug Fix #238: 如果诊疗项目缺少执行科室，标记为需要修复的脏数据
+          if (row.adviceType === 3 && !row.orgId) {
+            console.warn('Bug #238: 检测到诊疗项目保存时缺少执行科室，请手动编辑修正:', row);
+            proxy.$modal.msgWarning('诊疗项目执行科室信息不完整，请编辑后重新保存');
+          }
         }
       });
     }