diff --git a/admin/src/views/patient/reception/components/NoteTimeline.vue b/admin/src/views/patient/reception/components/NoteTimeline.vue
index df6a8935..dbe1f350 100644
--- a/admin/src/views/patient/reception/components/NoteTimeline.vue
+++ b/admin/src/views/patient/reception/components/NoteTimeline.vue
@@ -10,11 +10,25 @@
                     </div>
                 </div>
                 <div v-if="note.tongue_images?.length" class="timeline-images">
+                    <span class="images-label">舌苔照片</span>
                     <el-image
                         v-for="(url, idx) in note.tongue_images"
                         :key="idx"
-                        :src="url"
-                        :preview-src-list="note.tongue_images"
+                        :src="getImageUrl(url)"
+                        :preview-src-list="note.tongue_images.map(getImageUrl)"
+                        :initial-index="idx"
+                        fit="cover"
+                        class="timeline-thumb"
+                        preview-teleported
+                    />
+                </div>
+                <div v-if="note.report_files?.length" class="timeline-images">
+                    <span class="images-label">检查报告</span>
+                    <el-image
+                        v-for="(url, idx) in note.report_files"
+                        :key="idx"
+                        :src="getImageUrl(url)"
+                        :preview-src-list="note.report_files.map(getImageUrl)"
                         :initial-index="idx"
                         fit="cover"
                         class="timeline-thumb"
@@ -27,15 +41,21 @@
 </template>
 
 <script setup lang="ts">
+import useAppStore from '@/stores/modules/app'
+
 export interface DoctorNoteItem {
     id: number
     note_date: string
     content: string | null
     tongue_images: string[]
+    report_files: string[]
 }
 
 defineProps<{ notes: DoctorNoteItem[] }>()
 
+const appStore = useAppStore()
+const getImageUrl = (url: string) => appStore.getImageUrl(url)
+
 const splitLines = (content: string | null): string[] => {
     if (!content) return []
     return content.split('\n').filter(Boolean)
@@ -100,8 +120,14 @@ const splitLines = (content: string | null): string[] => {
 .timeline-images {
     display: flex;
     flex-wrap: wrap;
+    align-items: center;
     gap: 6px;
 }
+.images-label {
+    font-size: 12px;
+    color: #909399;
+    flex-shrink: 0;
+}
 .timeline-thumb {
     width: 64px;
     height: 64px;
diff --git a/server/app/adminapi/logic/doctor/DoctorNoteLogic.php b/server/app/adminapi/logic/doctor/DoctorNoteLogic.php
index b6378621..a7fe9f36 100644
--- a/server/app/adminapi/logic/doctor/DoctorNoteLogic.php
+++ b/server/app/adminapi/logic/doctor/DoctorNoteLogic.php
@@ -4,11 +4,12 @@ namespace app\adminapi\logic\doctor;
 
 use app\common\logic\BaseLogic;
 use app\common\model\doctor\DoctorNote;
+use app\common\service\FileService;
 
 class DoctorNoteLogic extends BaseLogic
 {
     /**
-     * 按 diagnosis_id + 当天 find-or-create，追加 content / tongue_images
+     * 按 diagnosis_id + 当天 find-or-create，追加 content / tongue_images / report_files
      */
     public static function addOrAppend(array $params): bool
     {
@@ -24,10 +25,8 @@ class DoctorNoteLogic extends BaseLogic
                 ->find();
 
             $newContent = trim($params['content'] ?? '');
-            $newImages  = $params['tongue_images'] ?? [];
-            if (is_string($newImages)) {
-                $newImages = json_decode($newImages, true) ?: [];
-            }
+            $newImages  = self::parseJsonArray($params['tongue_images'] ?? []);
+            $newReports = self::parseJsonArray($params['report_files'] ?? []);
 
             if ($existing) {
                 $data = [];
@@ -39,17 +38,17 @@ class DoctorNoteLogic extends BaseLogic
                 }
 
                 if (!empty($newImages)) {
-                    $prev = $existing->tongue_images;
-                    if (is_string($prev)) {
-                        $prev = json_decode($prev, true) ?: [];
-                    }
-                    if (!is_array($prev)) {
-                        $prev = [];
-                    }
+                    $prev = self::parseJsonArray($existing->tongue_images);
                     $merged = array_values(array_unique(array_merge($prev, $newImages)));
                     $data['tongue_images'] = json_encode($merged, JSON_UNESCAPED_UNICODE);
                 }
 
+                if (!empty($newReports)) {
+                    $prev = self::parseJsonArray($existing->report_files);
+                    $merged = array_values(array_unique(array_merge($prev, $newReports)));
+                    $data['report_files'] = json_encode($merged, JSON_UNESCAPED_UNICODE);
+                }
+
                 if (!empty($data)) {
                     $existing->save($data);
                 }
@@ -63,6 +62,9 @@ class DoctorNoteLogic extends BaseLogic
                     'tongue_images' => !empty($newImages)
                         ? json_encode($newImages, JSON_UNESCAPED_UNICODE)
                         : null,
+                    'report_files'  => !empty($newReports)
+                        ? json_encode($newReports, JSON_UNESCAPED_UNICODE)
+                        : null,
                 ]);
             }
 
@@ -91,14 +93,12 @@ class DoctorNoteLogic extends BaseLogic
                 ->toArray();
 
             foreach ($records as &$record) {
-                $images = $record['tongue_images'] ?? [];
-                if (is_string($images)) {
-                    $images = json_decode($images, true) ?: [];
-                }
-                if (!is_array($images)) {
-                    $images = [];
-                }
-                $record['tongue_images'] = $images;
+                $record['tongue_images'] = array_map(function ($url) {
+                    return empty($url) ? $url : FileService::getFileUrl($url);
+                }, self::parseJsonArray($record['tongue_images'] ?? []));
+                $record['report_files'] = array_map(function ($url) {
+                    return empty($url) ? $url : FileService::getFileUrl($url);
+                }, self::parseJsonArray($record['report_files'] ?? []));
             }
 
             return $records;
@@ -107,4 +107,14 @@ class DoctorNoteLogic extends BaseLogic
             return [];
         }
     }
+
+    private static function parseJsonArray($value): array
+    {
+        if (is_array($value)) return $value;
+        if (is_string($value)) {
+            $decoded = json_decode($value, true);
+            return is_array($decoded) ? $decoded : [];
+        }
+        return [];
+    }
 }
diff --git a/server/app/adminapi/logic/tcm/DiagnosisLogic.php b/server/app/adminapi/logic/tcm/DiagnosisLogic.php
index 5bf67ca2..ba2a0591 100644
--- a/server/app/adminapi/logic/tcm/DiagnosisLogic.php
+++ b/server/app/adminapi/logic/tcm/DiagnosisLogic.php
@@ -19,6 +19,8 @@ use app\common\model\tcm\Diagnosis;
 use app\common\model\tcm\DiagnosisAssignLog;
 use app\common\model\tcm\ImChatMessage;
 use app\common\model\DiagnosisViewRecord;
+use app\adminapi\logic\doctor\DoctorNoteLogic;
+use app\common\service\FileService;
 use think\facade\Db;
 /**
  * 中医辨房病因诊单逻辑
@@ -192,14 +194,37 @@ class DiagnosisLogic extends BaseLogic
                 $params['diagnosis_date'] = strtotime($params['diagnosis_date']);
             }
 
+            // 保存前记录旧的检查报告，用于对比新增
+            $oldReportFiles = [];
+            if (isset($params['report_files'])) {
+                $old = Diagnosis::where('id', $params['id'])->value('report_files');
+                if ($old) {
+                    $oldReportFiles = is_string($old) ? (json_decode($old, true) ?: []) : (array) $old;
+                }
+            }
+
             Diagnosis::update($params);
-            
+
+            // 检查报告有新增时同步到医生备注
+            if (isset($params['report_files'])) {
+                $newReportFiles = is_string($params['report_files'])
+                    ? (json_decode($params['report_files'], true) ?: [])
+                    : (array) $params['report_files'];
+                $added = array_values(array_diff($newReportFiles, $oldReportFiles));
+                if (!empty($added)) {
+                    DoctorNoteLogic::addOrAppend([
+                        'diagnosis_id' => (int) $params['id'],
+                        'report_files' => $added,
+                    ]);
+                }
+            }
+
             // 如果是编辑，也确保患者有 TRTC 账号
             $diagnosis = Diagnosis::find($params['id']);
             if ($diagnosis) {
                 self::createPatientTrtcAccount($diagnosis->patient_id);
             }
-            
+
             return true;
         } catch (\Exception $e) {
             self::setError($e->getMessage());
@@ -256,57 +281,30 @@ class DiagnosisLogic extends BaseLogic
         
  
         if (!empty($diagnosis['tongue_images'])) {
-    // 先尝试 JSON 解析（兼容旧数据）
-    $files = json_decode($diagnosis['tongue_images'], true);
-    if (is_array($files)) {
-        $diagnosis['tongue_images'] = $files;
-    } else {
-        // JSON 解析失败则按逗号分割
-        $diagnosis['tongue_images'] = array_filter(explode(',', $diagnosis['tongue_images'])) ?: [];
-    }
-    
-    // 为没有 http 前缀的图片添加域名
-    $domain = request()->domain();
-    $diagnosis['tongue_images'] = array_map(function($url) use ($domain) {
-        if (empty($url)) {
-            return $url;
+            $files = json_decode($diagnosis['tongue_images'], true);
+            if (is_array($files)) {
+                $diagnosis['tongue_images'] = $files;
+            } else {
+                $diagnosis['tongue_images'] = array_filter(explode(',', $diagnosis['tongue_images'])) ?: [];
+            }
+            $diagnosis['tongue_images'] = array_map(function($url) {
+                return empty($url) ? $url : FileService::getFileUrl($url);
+            }, $diagnosis['tongue_images']);
+        } else {
+            $diagnosis['tongue_images'] = [];
         }
-        // 如果已经包含 http:// 或 https://，则跳过
-        if (stripos($url, 'http://') === 0 || stripos($url, 'https://') === 0) {
-            return $url;
-        }
-        // 添加域名前缀
-        return $domain .'/'. $url;
-    }, $diagnosis['tongue_images']);
-} else {
-    $diagnosis['tongue_images'] = [];
-}
         
-        // 处理检查报告（JSON转数组）
-     if (!empty($diagnosis['report_files'])) {
-    // 先尝试 JSON 解析（兼容旧数据）
-    $files = json_decode($diagnosis['report_files'], true);
-    if (is_array($files)) {
-        $diagnosis['report_files'] = $files;
-    } else {
-        // JSON 解析失败则按逗号分割
-        $diagnosis['report_files'] = array_filter(explode(',', $diagnosis['report_files'])) ?: [];
-    }
-    
-    // 为没有 http 前缀的文件添加域名
-    $domain = request()->domain();
-    $diagnosis['report_files'] = array_map(function($url) use ($domain) {
-        if (empty($url)) {
-            return $url;
-        }
-        // 如果已经包含 http:// 或 https://，则跳过
-        if (stripos($url, 'http://') === 0 || stripos($url, 'https://') === 0) {
-            return $url;
-        }
-        // 添加域名前缀
-        return $domain . $url;
-    }, $diagnosis['report_files']);
-} else {
+        if (!empty($diagnosis['report_files'])) {
+            $files = json_decode($diagnosis['report_files'], true);
+            if (is_array($files)) {
+                $diagnosis['report_files'] = $files;
+            } else {
+                $diagnosis['report_files'] = array_filter(explode(',', $diagnosis['report_files'])) ?: [];
+            }
+            $diagnosis['report_files'] = array_map(function($url) {
+                return empty($url) ? $url : FileService::getFileUrl($url);
+            }, $diagnosis['report_files']);
+        } else {
     $diagnosis['report_files'] = [];
 }
         // 处理诊断日期格式
diff --git a/server/sql/1.9.20260421/add_doctor_note_table.sql b/server/sql/1.9.20260421/add_doctor_note_table.sql
index e11f290b..d0c3dc34 100644
--- a/server/sql/1.9.20260421/add_doctor_note_table.sql
+++ b/server/sql/1.9.20260421/add_doctor_note_table.sql
@@ -7,6 +7,7 @@ CREATE TABLE IF NOT EXISTS `zyt_doctor_note` (
   `note_date` date NOT NULL COMMENT '记录日期',
   `content` text DEFAULT NULL COMMENT '备注文字（多次追加以换行分隔，带时间戳前缀）',
   `tongue_images` json DEFAULT NULL COMMENT '舌苔/截屏照片路径数组',
+  `report_files` json DEFAULT NULL COMMENT '检查报告图片路径数组',
   `create_time` int(10) unsigned NOT NULL DEFAULT 0,
   `update_time` int(10) unsigned NOT NULL DEFAULT 0,
   `delete_time` int(10) unsigned DEFAULT NULL,
@@ -14,3 +15,7 @@ CREATE TABLE IF NOT EXISTS `zyt_doctor_note` (
   UNIQUE KEY `uk_diagnosis_date` (`diagnosis_id`, `note_date`),
   KEY `idx_doctor` (`doctor_id`)
 ) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COMMENT='医生接诊备注';
+
+
+ALTER TABLE `zyt_doctor_note` ADD COLUMN `report_files` json DEFAULT NULL COMMENT               
+  '检查报告图片路径数组' AFTER `tongue_images`;   
\ No newline at end of file