更新bug

.gitignore

@@ -1,33 +1,34 @@
-# Build and Release Folders
-bin-debug/
-bin-release/
-[Oo]bj/
-[Bb]in/
-
-# Other files and folders
-.settings/
-
-# Executables
-*.swf
-*.air
-*.ipa
-*.apk
-
-# Project files, i.e. `.project`, `.actionScriptProperties` and `.flexProperties`
-# should NOT be excluded as they contain compiler settings and other important
-# information for Eclipse / Flash Builder.
-
-/.idea
-/.codex-tasks
-/.trellis
-/.claude
-/.agent
-/.shared
-/.cursor
-/.codex
-/.agents
-/server/.spool
-/server/.claude
-/.spool
-TUICallKit-Vue3/.env
-/.codegraph
+# Build and Release Folders
+bin-debug/
+bin-release/
+[Oo]bj/
+[Bb]in/
+
+# Other files and folders
+.settings/
+
+# Executables
+*.swf
+*.air
+*.ipa
+*.apk
+
+# Project files, i.e. `.project`, `.actionScriptProperties` and `.flexProperties`
+# should NOT be excluded as they contain compiler settings and other important
+# information for Eclipse / Flash Builder.
+# 测试临时目录
+app/.test-tmp-stream/
+/.idea
+/.codex-tasks
+/.trellis
+/.claude
+/.agent
+/.shared
+/.cursor
+/.codex
+/.agents
+/server/.spool
+/server/.claude
+/.spool
+TUICallKit-Vue3/.env
+/.codegraph

.workbuddy/memory/2026-08-20.md

@@ -0,0 +1,59 @@
+# 2026-08-20 — 医生工作站 AI 问诊对话框布局优化
+
+## 改动
+- 文件: `app/src/doctor_workstation/ui/dialogs/ai_consult.py`
+- 模块: `AiConsultDialog` 右侧「智能分析」卡片 + 问诊对话卡片密度优化
+- 新增 helpers: `_InsightItem`, `_split_insight_segments`, `_split_numbered_list`, `_split_plain_paragraph`, `_split_label_or_sentence`, `_escape_html`
+- `_set_insights` 改成将稠密段落拆成 lead / list / plain 三类, 每类单独 QLabel 显示
+- CSS 新增 `AiConsultInsightMarker` / `AiConsultInsightText` / `AiConsultInsightPlaceholder`
+- 卡片 padding `10,8,10,8` → `14,12,14,14`; 卡间距 `8` → `10`
+- 聊天气泡垂直 margin `4` → `6`, chat_layout spacing `10` → `12`
+
+## 拆分策略
+- 文本以 `1./2、/3)/4）` 起头 → 视为完整编号列表
+- 文本中嵌入 `…：1.…2.…` → 拆出序言 + 编号列表
+- 短中文标签 `XX：YY` 开头 → 视为 lead, 标签部分加粗
+- 其余按 `。/；/;/` 分句 → 单独成行
+
+## 测试
+- 现有 `tests/test_ai_consult_ui.py` 通过 `widget.objectName() == "AiConsultRecordTitle"` 校验标题仍在, 未受影响
+- 暂未运行 UI 测试 (开发环境未装 PySide6); 解析逻辑单独脚本验证通过
+
+## 注意
+- PySide6 QSS 对 `QLabel` 的 `line-height` 支持有限; 主要靠 item 间距 `8px` 与 `padding:1px 0` 提供节奏
+- 如果后续接入 `AiConsultInsightText` 还嫌密集, 可再调 `body_host.setSpacing`
+
+---
+
+# 接诊台 AI 智能分析详情对话框 (`ReceptionAiAnalysisDialog`) 优化
+用户截图(`clipboard-2026-08-20T08-42-40`...)反馈: 「问诊详情 → AI 智能分析」卡片里的诊断建议 / 风险评估 / 治疗建议三段文字太稠密, 不利于阅读。
+
+## 关键差异
+这次的目标文件和上次不同 — 用户截图里出现 "诊断建议 / 风险评估 / 治疗建议" 标题, 而 `ai_consult.py` 用的是 "血糖控制评估 / 并发症风险评估 / 用药合理性评估"。实际是 `app/src/doctor_workstation/ui/pages/reception.py` 中的 `_ReceptionAiAnalysisDialog` 类。
+
+## 改动
+- 文件: `app/src/doctor_workstation/ui/pages/reception.py`
+- 新增 helpers (与 ai_consult.py 类似但导出名加 `_ai_` 前缀):
+  - `_ai_split_into_segments` / `_ai_split_numbered_list` / `_ai_split_plain_paragraph`
+  - `_ai_segments_to_html` / `_ai_narrative_structured_html`
+  - `_ai_split_label_or_sentence` / `_ai_escape_html`
+  - 正则: `_AI_INSIGHT_LIST_RE`, `_AI_INSIGHT_LIST_LOOKAHEAD_RE`, `_AI_INSIGHT_LABEL_RE`
+- `add_text_section` 闭包内多挂一个 RichText `_structured_labels[name]` 标签 (`.setObjectName(name + "Structured")`, `property="dialogAiStructured"`)
+- 原 PlainText `value_label` 仍存在 (`hide()` + `setMaximumHeight(0)`) 用于兼容既有 findChild 测试
+- `_render_model` 同步刷新两个结构化标签; 空 HTML 时回退显示原 label 文本
+- 风险评估 FlowLayout spacing `7×7` → `9×9`
+- `body_layout.setSpacing` `12` → `14`
+- 卡片 contentsMargins `14,13,16,15` → `16,14,18,16`
+- QSS: `dialogAiBody` 加 `line-height: 1.85`, 新增 `dialogAiStructured` 选择器 (line-height 175%); 风险 pill `min-height` `28` → `30`, padding `4 10` → `5 12`, font 12 → 12.5, border-radius `7` → `8`
+
+## 兼容约束
+- `tests/test_reception_parity_ui.py` 严格校验:
+  - `findChild(QLabel, "ReceptionAiAnalysisDialogDiagnosisText")` 必须能找到
+  - `.text()` 必须等于 `_ai_narrative_text` 归一化结果
+  - `.textFormat() == Qt.TextFormat.PlainText`
+- 因此 PlainText 标签必须原样保留, 仅做 `.hide()` + `setMaximumHeight(0)` (避免 QSS `>` 子选择器不被 Qt 支持)
+
+## 验证
+- `py_compile` 通过, 无 `SyntaxWarning`
+- 单独脚本跑过 4 组样本文本 (稠密段落 / 嵌入式编号列表 / 短句 / 纯编号列表), 拆分结果符合预期
+- 未在本机跑 UI 测试 (缺 PySide6)

admin/src/views/first_visit/conversion/index.vue

@@ -145,7 +145,7 @@
             <div class="panel-heading panel-heading--table">
                 <div>
                     <h2>明细数据列表</h2>
-                    <p>展开部门可查看人员明细；加粉=总进线=区间有效加粉（按员工+客户去重，须会话同意，剔除已删客户、继承客户、扫一扫/搜手机号/名片分享添加及区间前已加过的重加）；挂号=已支付且实收低于 10 元的订单，预约=有效预约记录；开口率=开口/加粉，挂号率=挂号/加粉，面诊率=面诊/挂号（看挂号后流失），预约率=面诊/预约（看预约后未面诊），面诊接诊率=接诊诊单/面诊，接诊率=接诊诊单/总进线</p>
+                    <p>展开部门可查看人员明细；加粉=总进线=区间有效加粉（按员工+客户去重，剔除已删客户、继承客户、扫一扫/搜手机号/名片分享添加及区间前已加过的重加）；挂号=已支付且实收低于 10 元的订单，预约=有效预约记录；开口率=开口/加粉，挂号率=挂号/加粉，面诊率=面诊/挂号（看挂号后流失），预约率=面诊/预约（看预约后未面诊），面诊接诊率=接诊诊单/面诊，接诊率=接诊诊单/总进线</p>
                 </div>
                 <span>{{ dashboard.rows.length }} 个顶层节点</span>
             </div>
@@ -335,7 +335,7 @@ const timeOptions = [
     { label: '自定义', value: 'custom' }
 ]
 const metricCards: Array<{ key: string; label: string; type: MetricType; hint: string }> = [
-    { key: 'add_fans_count', label: '加粉数', type: 'count', hint: '区间有效加粉：去重，须会话同意，剔除已删客户、继承客户、扫一扫/搜手机号/名片分享添加及区间前已加过的重加' },
+    { key: 'add_fans_count', label: '加粉数', type: 'count', hint: '区间有效加粉：去重，剔除已删客户、继承客户、扫一扫/搜手机号/名片分享添加及区间前已加过的重加' },
     { key: 'total_open_count', label: '开口数', type: 'count', hint: '来源于个人业绩录入' },
     { key: 'interview_count', label: '面诊', type: 'count', hint: '已完成预约' },
     { key: 'completed_order_count', label: '接诊诊单', type: 'count', hint: '业务订单，按创建人归属并过滤无效单' },

admin/src/views/patient/reception/index.vue

@@ -215,6 +215,7 @@ const PAGE_SIZE = 15
 interface QueueRow {
     id: number
     patient_id: number
+    source_patient_id?: number
     patient_name: string
     patient_phone?: string
     diagnosis_id?: number
@@ -436,19 +437,25 @@ const handleSearch = async () => {
 }
 
 const handleCall = async (row: QueueRow) => {
-    if (!row.patient_id) {
+    const sourcePatientId = Number(row.source_patient_id || 0)
+    const diagnosisId = Number(row.diagnosis_id || 0)
+    if (!sourcePatientId) {
         feedback.msgWarning('患者信息不完整')
         return
     }
+    if (!diagnosisId) {
+        feedback.msgWarning('预约信息不完整，无法发起聊天')
+        return
+    }
     try {
         const res = await getCallSignature({
-            patient_id: row.patient_id,
-            diagnosis_id: row.diagnosis_id || row.id
+            patient_id: sourcePatientId,
+            diagnosis_id: diagnosisId
         })
         chatDialogRef.value?.open({
-            patientId: row.patient_id,
+            patientId: sourcePatientId,
             patientName: row.patient_name,
-            diagnosisId: row.diagnosis_id || row.id,
+            diagnosisId,
             signatureData: res
         })
     } catch (error: any) {

admin/src/views/tcm/appointment/list.vue

@@ -996,34 +996,34 @@ const handleEdit = (row: any) => {
 }
 
 // 聊天
-const handleChat = async (row: any) => {
-    if (!row.patient_id) {
-        feedback.msgWarning('患者信息不完整')
-        return
-    }
-    
-    // 检查是否有诊单ID
-    if (!row.diagnosis_id && !row.id) {
-        feedback.msgWarning('预约信息不完整，无法发起聊天')
-        return
-    }
-    
-    try {
-        // 获取聊天签名信息
-        const res = await getCallSignature({ 
-            patient_id: row.patient_id,
-            diagnosis_id: row.diagnosis_id || row.id
-        })
-        
-        console.log('获取聊天签名成功:', res)
-        
-        // 直接打开聊天对话框，传入必要的参数
-        chatDialogRef.value?.open({
-            patientId: row.patient_id,
-            patientName: row.patient_name,
-            diagnosisId: row.diagnosis_id || row.id,
-            signatureData: res // 传入签名数据
-        })
+const handleChat = async (row: any) => {
+    const sourcePatientId = Number(row.source_patient_id || 0)
+    const diagnosisId = Number(row.diagnosis_id || 0)
+    if (!sourcePatientId) {
+        feedback.msgWarning('患者信息不完整')
+        return
+    }
+    if (!diagnosisId) {
+        feedback.msgWarning('预约信息不完整，无法发起聊天')
+        return
+    }
+
+    try {
+        // 获取聊天签名信息
+        const res = await getCallSignature({
+            patient_id: sourcePatientId,
+            diagnosis_id: diagnosisId
+        })
+
+        console.log('获取聊天签名成功:', res)
+
+        // 直接打开聊天对话框，传入必要的参数
+        chatDialogRef.value?.open({
+            patientId: sourcePatientId,
+            patientName: row.patient_name,
+            diagnosisId,
+            signatureData: res // 传入签名数据
+        })
     } catch (error: any) {
         console.error('获取聊天签名失败:', error)
         feedback.msgError(error.message || '获取聊天签名失败')

admin/src/views/tcm/appointment/list_h5.vue

@@ -642,22 +642,28 @@ const handleEdit = (row: any) => {
     }
     editRef.value?.open('edit', row.patient_id)
 }
-const handleChat = async (row: any) => {
-    if (!row.patient_id) {
-        feedback.msgWarning('患者信息不完整')
-        return
-    }
-    try {
-        const res = await getCallSignature({
-            patient_id: row.patient_id,
-            diagnosis_id: row.diagnosis_id || row.id
-        })
-        chatDialogRef.value?.open({
-            patientId: row.patient_id,
-            patientName: row.patient_name,
-            diagnosisId: row.diagnosis_id || row.id,
-            signatureData: res
-        })
+const handleChat = async (row: any) => {
+    const sourcePatientId = Number(row.source_patient_id || 0)
+    const diagnosisId = Number(row.diagnosis_id || 0)
+    if (!sourcePatientId) {
+        feedback.msgWarning('患者信息不完整')
+        return
+    }
+    if (!diagnosisId) {
+        feedback.msgWarning('预约信息不完整，无法发起聊天')
+        return
+    }
+    try {
+        const res = await getCallSignature({
+            patient_id: sourcePatientId,
+            diagnosis_id: diagnosisId
+        })
+        chatDialogRef.value?.open({
+            patientId: sourcePatientId,
+            patientName: row.patient_name,
+            diagnosisId,
+            signatureData: res
+        })
     } catch (e: any) {
         feedback.msgError(e?.msg || e?.message || '获取通话签名失败')
     }

app/scripts/render_patient_appointment_density.py

@@ -61,6 +61,7 @@ def _appointment_rows() -> list[dict[str, Any]]:
                 "id": 801 + index,
                 "diagnosis_id": 901 + index,
                 "patient_id": 401 + index,
+                "source_patient_id": 401 + index,
                 "patient_name": names[index % len(names)],
                 "patient_phone": f"1380013{8000 + index}",
                 "gender": 2 if index % 2 == 0 else 1,
@@ -77,6 +78,11 @@ def _appointment_rows() -> list[dict[str, Any]]:
                 "status_desc": "已挂号",
                 "revisit_time": "复诊" if index % 2 else "初诊",
                 "unserved_days": index,
+                "video_call_hint": (
+                    {"state": "live", "label": "视频通话进行中"}
+                    if index == 0
+                    else {"state": "idle", "label": "等待医生发起"}
+                ),
             }
         )
     return rows
@@ -161,15 +167,17 @@ def render() -> list[Path]:
             raise RuntimeError(
                 f"appointment table only exposes {appointment_slots} ordinary rows"
             )
-        if width == 1024 and not appointments.video_panel.isHidden():
-            raise RuntimeError("narrow appointment viewport did not collapse the video panel")
+        if appointments.content_layout.count() != 1:
+            raise RuntimeError("appointment list still reserves a secondary side panel")
+        if appointments.table_card.width() != appointments.content_host.width():
+            raise RuntimeError("appointment table does not fill the content viewport")
         appointment_path = output / f"appointments_{width}x{height}.png"
         if not shell.grab().save(str(appointment_path), "PNG"):
             raise RuntimeError(f"failed to save {appointment_path}")
         paths.append(appointment_path)
         print(
             f"{width}x{height}: patient_slots={patient_slots}, "
-            f"appointment_slots={appointment_slots}, video_hidden={appointments.video_panel.isHidden()}"
+            f"appointment_slots={appointment_slots}, table_full_width=True"
         )
         shell.close()
         application.processEvents()

app/src/doctor_workstation/services/api_client.py

@@ -5,7 +5,8 @@ from __future__ import annotations
 import json
 import time
 from collections.abc import Callable, Iterator, Mapping
-from threading import Lock, RLock
+from contextlib import contextmanager
+from threading import Condition, RLock
 from typing import Any
 from urllib.parse import urljoin, urlsplit, urlunsplit
 
@@ -23,15 +24,6 @@ from doctor_workstation.core.errors import (
     WorkWechatBindingRequiredError,
 )
 
-# One shared transport lock serializes every HTTP exchange in the process.
-# The GUI fires page loads, dialog bundles and polling timers from many
-# QThreadPool workers that all share a single ``httpx.Client``.  Concurrent
-# TLS handshakes on one shared SSLContext have repeatedly crashed the
-# process inside libcrypto (access violation at a stable offset), so all
-# network traffic now goes through this single lock.  Requests stay
-# off-thread, so the GUI never blocks; only the network itself is serialized.
-_HTTP_TRANSPORT_LOCK = Lock()
-
 
 class ApiClient:
     """A small, testable client implementing the admin API contract.
@@ -42,6 +34,7 @@ class ApiClient:
     """
 
     API_VERSION = "1.9.4"
+    DEFAULT_MAX_PARALLEL_REQUESTS = 8
 
     def __init__(
         self,
@@ -55,6 +48,7 @@ class ApiClient:
         transport: httpx.BaseTransport | None = None,
         client: httpx.Client | None = None,
         sleep: Callable[[float], None] = time.sleep,
+        max_parallel_requests: int = DEFAULT_MAX_PARALLEL_REQUESTS,
     ) -> None:
         """Create a client without performing any network requests."""
 
@@ -64,6 +58,8 @@ class ApiClient:
             raise ValueError("retry_backoff must be non-negative")
         if client is not None and transport is not None:
             raise ValueError("pass either client or transport, not both")
+        if max_parallel_requests <= 0:
+            raise ValueError("max_parallel_requests must be positive")
         self.base_url = self.normalise_base_url(base_url)
         self.timeout = timeout
         self.max_retries = max_retries
@@ -71,10 +67,68 @@ class ApiClient:
         self._sleep = sleep
         self._token = token.strip()
         self._lock = RLock()
+        self._transport_lock = RLock()
+        self._client_condition = Condition(RLock())
+        self._available_clients: list[httpx.Client] = []
+        self._pooled_clients: list[httpx.Client] = []
+        self._active_requests = 0
+        self._closing = False
+        self._closed = False
+        self._max_parallel_requests = max_parallel_requests
+        # Production requests use a bounded pool of independent clients.  This
+        # permits unrelated patient requests to run concurrently without
+        # sharing the SSLContext that previously caused native TLS crashes.
+        # A pool also works across PySide QRunnable boundaries, where Python
+        # thread-local state is not retained reliably.
+        # Explicit clients/transports remain on one locked client because
+        # their ownership and thread-safety contracts are unknown.
+        self._uses_client_pool = client is None and transport is None
         self._owns_client = client is None
         self._stream_transport = transport
         self._verify = verify
-        self._client = client or httpx.Client(transport=transport, verify=verify)
+        self._client = (
+            None
+            if self._uses_client_pool
+            else client or httpx.Client(transport=transport, verify=verify)
+        )
+
+    @contextmanager
+    def _borrow_client(self) -> Iterator[httpx.Client]:
+        """Yield a safe synchronous client for the calling worker thread."""
+
+        if not self._uses_client_pool:
+            with self._transport_lock:
+                with self._client_condition:
+                    if self._closing or self._closed:
+                        raise RuntimeError("ApiClient is closed")
+                if self._client is None:  # Defensive; this mode always has one.
+                    raise RuntimeError("ApiClient transport is unavailable")
+                yield self._client
+            return
+
+        with self._client_condition:
+            while True:
+                if self._closing or self._closed:
+                    raise RuntimeError("ApiClient is closed")
+                if self._available_clients:
+                    pooled_client = self._available_clients.pop()
+                    break
+                if len(self._pooled_clients) < self._max_parallel_requests:
+                    pooled_client = httpx.Client(verify=self._verify)
+                    self._pooled_clients.append(pooled_client)
+                    break
+                self._client_condition.wait()
+            self._active_requests += 1
+        try:
+            yield pooled_client
+        finally:
+            with self._client_condition:
+                self._active_requests -= 1
+                self._available_clients.append(pooled_client)
+                if self._active_requests == 0:
+                    self._client_condition.notify_all()
+                else:
+                    self._client_condition.notify()
 
     @staticmethod
     def normalise_base_url(base_url: str) -> str:
@@ -184,9 +238,9 @@ class ApiClient:
     ) -> Iterator[dict[str, Any]]:
         """POST JSON and yield parsed server-sent events on an isolated client.
 
-        Streaming deliberately does not use ``_HTTP_TRANSPORT_LOCK`` or the
-        process-wide JSON client.  A diagnosis response can remain open for
-        more than a minute and must not block unrelated page requests.
+        Streaming deliberately does not use the bounded short-request client
+        pool.  A diagnosis response can remain open for more than a minute and
+        must not consume capacity needed by unrelated page requests.
         """
 
         url = self._endpoint_url(endpoint)
@@ -245,8 +299,8 @@ class ApiClient:
         if parsed.scheme not in {"http", "https"} or not parsed.netloc:
             raise ValueError("url must resolve to an absolute http(s) URL")
         try:
-            with _HTTP_TRANSPORT_LOCK:
-                response = self._client.get(
+            with self._borrow_client() as client:
+                response = client.get(
                     target,
                     headers={"Accept": "image/*,application/octet-stream;q=0.8"},
                     timeout=self.timeout,
@@ -324,10 +378,10 @@ class ApiClient:
         attempts = self.max_retries + 1 if verb == "GET" else 1
         response: httpx.Response | None = None
         request_timeout = self.timeout if timeout is None else timeout
-        with _HTTP_TRANSPORT_LOCK:
+        with self._borrow_client() as client:
             for attempt in range(attempts):
                 try:
-                    response = self._client.request(
+                    response = client.request(
                         verb,
                         url,
                         params=dict(params) if params is not None else None,
@@ -360,9 +414,42 @@ class ApiClient:
     def close(self) -> None:
         """Close the internally-created HTTP transport."""
 
-        if self._owns_client:
-            with _HTTP_TRANSPORT_LOCK:
-                self._client.close()
+        with self._client_condition:
+            if self._closed:
+                return
+            if self._closing:
+                while not self._closed:
+                    self._client_condition.wait()
+                return
+            self._closing = True
+            self._client_condition.notify_all()
+
+        clients: list[httpx.Client] = []
+        if self._uses_client_pool:
+            with self._client_condition:
+                while self._active_requests:
+                    self._client_condition.wait()
+                clients = list(self._pooled_clients)
+                self._available_clients.clear()
+                self._pooled_clients.clear()
+        else:
+            with self._transport_lock:
+                if self._owns_client and self._client is not None:
+                    clients = [self._client]
+
+        close_error: Exception | None = None
+        for client in clients:
+            try:
+                client.close()
+            except Exception as error:  # Close every transport before surfacing one failure.
+                if close_error is None:
+                    close_error = error
+        with self._client_condition:
+            self._closed = True
+            self._closing = False
+            self._client_condition.notify_all()
+        if close_error is not None:
+            raise close_error
 
     def __enter__(self) -> ApiClient:
         """Return this client for use as a context manager."""

app/src/doctor_workstation/services/local_audio_queue.py

@@ -0,0 +1,602 @@
+"""Persistent local-audio capture and COS upload queue.
+
+Local call recordings are medical records.  They must survive application
+restarts and failed network requests, so the queue deliberately keeps the
+audio file after a successful upload as well as after a failed one.
+"""
+
+from __future__ import annotations
+
+import queue
+import sqlite3
+import threading
+from collections.abc import Callable
+from concurrent.futures import Future
+from contextlib import suppress
+from dataclasses import dataclass
+from datetime import UTC, datetime
+from os import PathLike
+from pathlib import Path
+from typing import Any
+from uuid import uuid4
+
+from platformdirs import user_data_path
+
+_MAX_UPLOAD_WORKERS = 3
+_RETRYABLE_STATUSES = {"pending", "failed"}
+_RECOVERY_LOCK = threading.Lock()
+_RECOVERED_DATABASES: set[Path] = set()
+_MANAGER_LOCK = threading.Lock()
+_MANAGERS: dict[tuple[int, Path], LocalAudioUploadManager] = {}
+
+
+def _utc_now() -> str:
+    return datetime.now(UTC).isoformat(timespec="seconds")
+
+
+def _clean_room_id(value: Any) -> str:
+    room_id = str(value or "").strip()
+    return "" if room_id == "0" else room_id
+
+
+def _clean_call_record_id(value: Any, *, required: bool) -> int | None:
+    if value in (None, "") and not required:
+        return None
+    try:
+        call_record_id = int(value)
+    except (TypeError, ValueError) as error:
+        raise ValueError("通话记录 ID 无效。") from error
+    if call_record_id <= 0:
+        raise ValueError("通话记录 ID 无效。")
+    return call_record_id
+
+
+def _default_root() -> Path:
+    return (
+        user_data_path(
+            "ZhenyangDoctorWorkstation",
+            appauthor="ZhenYangTang",
+            ensure_exists=True,
+        )
+        / "local-call-audio"
+    )
+
+
+@dataclass(frozen=True, slots=True)
+class LocalAudioRecord:
+    id: int
+    session_id: str
+    diagnosis_id: int
+    call_record_id: int | None
+    room_id: str
+    mime_type: str
+    file_path: Path
+    size_bytes: int
+    status: str
+    error_text: str
+    uploaded_url: str
+    attempts: int
+    created_at: str
+    updated_at: str
+    uploaded_at: str
+
+    @property
+    def exists(self) -> bool:
+        return self.file_path.is_file()
+
+
+class LocalAudioQueueStore:
+    """SQLite-backed manifest for durable local call recordings."""
+
+    def __init__(self, root: str | PathLike[str] | None = None) -> None:
+        self.root = Path(root).expanduser().resolve() if root else _default_root().resolve()
+        self.files_dir = self.root / "files"
+        self.files_dir.mkdir(parents=True, exist_ok=True)
+        self.database_path = self.root / "queue.sqlite3"
+        self._initialize()
+
+    def _connect(self) -> sqlite3.Connection:
+        connection = sqlite3.connect(self.database_path, timeout=10.0)
+        connection.row_factory = sqlite3.Row
+        connection.execute("PRAGMA busy_timeout = 10000")
+        return connection
+
+    def _initialize(self) -> None:
+        with self._connect() as connection:
+            connection.execute("PRAGMA journal_mode = WAL")
+            # Serialise schema inspection and ALTER TABLE across two workstation
+            # processes. The second process waits, then re-checks the columns.
+            connection.execute("BEGIN IMMEDIATE")
+            connection.execute(
+                """
+                CREATE TABLE IF NOT EXISTS local_audio_uploads (
+                    id INTEGER PRIMARY KEY AUTOINCREMENT,
+                    session_id TEXT NOT NULL UNIQUE,
+                    diagnosis_id INTEGER NOT NULL,
+                    call_record_id INTEGER,
+                    room_id TEXT NOT NULL DEFAULT '',
+                    mime_type TEXT NOT NULL,
+                    file_path TEXT NOT NULL,
+                    size_bytes INTEGER NOT NULL DEFAULT 0,
+                    status TEXT NOT NULL,
+                    error_text TEXT NOT NULL DEFAULT '',
+                    uploaded_url TEXT NOT NULL DEFAULT '',
+                    attempts INTEGER NOT NULL DEFAULT 0,
+                    created_at TEXT NOT NULL,
+                    updated_at TEXT NOT NULL,
+                    uploaded_at TEXT NOT NULL DEFAULT ''
+                )
+                """
+            )
+            columns = {
+                str(row["name"])
+                for row in connection.execute(
+                    "PRAGMA table_info(local_audio_uploads)"
+                ).fetchall()
+            }
+            if "room_id" not in columns:
+                connection.execute(
+                    "ALTER TABLE local_audio_uploads "
+                    "ADD COLUMN room_id TEXT NOT NULL DEFAULT ''"
+                )
+            connection.execute(
+                "CREATE INDEX IF NOT EXISTS idx_local_audio_diagnosis "
+                "ON local_audio_uploads(diagnosis_id, id DESC)"
+            )
+        # Recover interrupted work once per process. Creating the management
+        # dialog while a worker is active must not move that worker back to
+        # ``pending`` and accidentally upload the same medical file twice.
+        with _RECOVERY_LOCK:
+            if self.database_path in _RECOVERED_DATABASES:
+                return
+            with self._connect() as connection:
+                now = _utc_now()
+                connection.execute(
+                    """
+                    UPDATE local_audio_uploads
+                       SET status = 'pending',
+                           error_text = '应用上次退出时上传尚未完成，可重试。',
+                           updated_at = ?
+                     WHERE status = 'uploading'
+                    """,
+                    (now,),
+                )
+                connection.execute(
+                    """
+                    UPDATE local_audio_uploads
+                       SET status = 'invalid',
+                           error_text = '应用上次退出时录音尚未完成。',
+                           updated_at = ?
+                     WHERE status = 'recording'
+                    """,
+                    (now,),
+                )
+            _RECOVERED_DATABASES.add(self.database_path)
+
+    @staticmethod
+    def _from_row(row: sqlite3.Row) -> LocalAudioRecord:
+        raw_call_record_id = row["call_record_id"]
+        return LocalAudioRecord(
+            id=int(row["id"]),
+            session_id=str(row["session_id"]),
+            diagnosis_id=int(row["diagnosis_id"]),
+            call_record_id=(
+                int(raw_call_record_id) if raw_call_record_id not in (None, "") else None
+            ),
+            room_id=_clean_room_id(row["room_id"]),
+            mime_type=str(row["mime_type"]),
+            file_path=Path(str(row["file_path"])).resolve(),
+            size_bytes=int(row["size_bytes"] or 0),
+            status=str(row["status"]),
+            error_text=str(row["error_text"] or ""),
+            uploaded_url=str(row["uploaded_url"] or ""),
+            attempts=int(row["attempts"] or 0),
+            created_at=str(row["created_at"]),
+            updated_at=str(row["updated_at"]),
+            uploaded_at=str(row["uploaded_at"] or ""),
+        )
+
+    def begin_recording(
+        self,
+        *,
+        session_id: str,
+        diagnosis_id: int,
+        mime_type: str,
+        call_record_id: int | None = None,
+        room_id: str = "",
+    ) -> LocalAudioRecord:
+        suffix = ".ogg" if mime_type.startswith("audio/ogg") else ".webm"
+        timestamp = datetime.now().strftime("%Y%m%d-%H%M%S")
+        name = f"call-{int(diagnosis_id)}-{timestamp}-{uuid4().hex[:10]}{suffix}.part"
+        path = (self.files_dir / name).resolve()
+        now = _utc_now()
+        clean_call_record_id = _clean_call_record_id(call_record_id, required=False)
+        clean_room_id = _clean_room_id(room_id)
+        with self._connect() as connection:
+            cursor = connection.execute(
+                """
+                INSERT INTO local_audio_uploads (
+                    session_id, diagnosis_id, call_record_id, room_id,
+                    mime_type, file_path,
+                    status, created_at, updated_at
+                ) VALUES (?, ?, ?, ?, ?, ?, 'recording', ?, ?)
+                """,
+                (
+                    session_id,
+                    int(diagnosis_id),
+                    clean_call_record_id,
+                    clean_room_id,
+                    mime_type,
+                    str(path),
+                    now,
+                    now,
+                ),
+            )
+            record_id = int(cursor.lastrowid)
+        record = self.get(record_id)
+        if record is None:  # pragma: no cover - SQLite insert/read invariant.
+            raise RuntimeError("无法创建本地录音记录。")
+        return record
+
+    def finalize_recording(self, record_id: int, *, size_bytes: int) -> LocalAudioRecord:
+        record = self.require(record_id)
+        if record.status != "recording":
+            raise RuntimeError("本地录音记录状态不允许完成。")
+        if record.file_path.suffix == ".part":
+            final_path = record.file_path.with_suffix("")
+            record.file_path.replace(final_path)
+        else:
+            final_path = record.file_path
+        now = _utc_now()
+        with self._connect() as connection:
+            connection.execute(
+                """
+                UPDATE local_audio_uploads
+                   SET file_path = ?, size_bytes = ?, status = 'pending',
+                       error_text = '', updated_at = ?
+                 WHERE id = ?
+                """,
+                (str(final_path), int(size_bytes), now, int(record_id)),
+            )
+        return self.require(record_id)
+
+    def mark_invalid(self, record_id: int, message: str) -> LocalAudioRecord:
+        record = self.require(record_id)
+        size = record.file_path.stat().st_size if record.file_path.is_file() else 0
+        now = _utc_now()
+        with self._connect() as connection:
+            connection.execute(
+                """
+                UPDATE local_audio_uploads
+                   SET size_bytes = ?, status = 'invalid', error_text = ?, updated_at = ?
+                 WHERE id = ?
+                """,
+                (size, str(message)[:1000], now, int(record_id)),
+            )
+        return self.require(record_id)
+
+    def bind_identity(
+        self,
+        record_id: int,
+        *,
+        call_record_id: int,
+        room_id: str = "",
+    ) -> LocalAudioRecord:
+        """Bind one recording to a call without overwriting a different identity."""
+
+        clean_call_record_id = _clean_call_record_id(call_record_id, required=True)
+        assert clean_call_record_id is not None
+        clean_room_id = _clean_room_id(room_id)
+        now = _utc_now()
+        with self._connect() as connection:
+            cursor = connection.execute(
+                """
+                UPDATE local_audio_uploads
+                   SET call_record_id = CASE
+                           WHEN call_record_id IS NULL THEN ?
+                           ELSE call_record_id
+                       END,
+                       room_id = CASE
+                           WHEN room_id = '' AND ? <> '' THEN ?
+                           ELSE room_id
+                       END,
+                       updated_at = ?
+                 WHERE id = ?
+                   AND (call_record_id IS NULL OR call_record_id = ?)
+                   AND (? = '' OR room_id = '' OR room_id = ?)
+                """,
+                (
+                    clean_call_record_id,
+                    clean_room_id,
+                    clean_room_id,
+                    now,
+                    int(record_id),
+                    clean_call_record_id,
+                    clean_room_id,
+                    clean_room_id,
+                ),
+            )
+            if cursor.rowcount != 1:
+                exists = connection.execute(
+                    "SELECT 1 FROM local_audio_uploads WHERE id = ?",
+                    (int(record_id),),
+                ).fetchone()
+                if exists is None:
+                    raise LookupError("本地录音记录不存在。")
+                raise RuntimeError("本地录音的通话记录 ID 或房间号发生冲突。")
+        return self.require(record_id)
+
+    def set_call_record_id(self, record_id: int, call_record_id: int) -> None:
+        self.bind_identity(record_id, call_record_id=call_record_id)
+
+    def update_status(self, record_id: int, status: str, message: str = "") -> None:
+        if status not in {"pending", "uploading", "uploaded", "failed", "invalid"}:
+            raise ValueError("unsupported local-audio status")
+        now = _utc_now()
+        with self._connect() as connection:
+            connection.execute(
+                """
+                UPDATE local_audio_uploads
+                   SET status = ?, error_text = ?, updated_at = ?
+                 WHERE id = ?
+                """,
+                (status, str(message)[:1000], now, int(record_id)),
+            )
+
+    def get(self, record_id: int) -> LocalAudioRecord | None:
+        with self._connect() as connection:
+            row = connection.execute(
+                "SELECT * FROM local_audio_uploads WHERE id = ?",
+                (int(record_id),),
+            ).fetchone()
+        return self._from_row(row) if row is not None else None
+
+    def require(self, record_id: int) -> LocalAudioRecord:
+        record = self.get(record_id)
+        if record is None:
+            raise LookupError("本地录音记录不存在。")
+        return record
+
+    def list_records(self, *, diagnosis_id: int | None = None) -> list[LocalAudioRecord]:
+        with self._connect() as connection:
+            if diagnosis_id is None:
+                rows = connection.execute(
+                    "SELECT * FROM local_audio_uploads ORDER BY id DESC"
+                ).fetchall()
+            else:
+                rows = connection.execute(
+                    """
+                    SELECT * FROM local_audio_uploads
+                     WHERE diagnosis_id = ?
+                     ORDER BY id DESC
+                    """,
+                    (int(diagnosis_id),),
+                ).fetchall()
+        return [self._from_row(row) for row in rows]
+
+    def claim_upload(self, record_id: int) -> LocalAudioRecord | None:
+        now = _utc_now()
+        with self._connect() as connection:
+            cursor = connection.execute(
+                """
+                UPDATE local_audio_uploads
+                   SET status = 'uploading', error_text = '', attempts = attempts + 1,
+                       updated_at = ?
+                 WHERE id = ? AND status IN ('pending', 'failed')
+                """,
+                (now, int(record_id)),
+            )
+            if cursor.rowcount != 1:
+                return None
+        return self.require(record_id)
+
+    def mark_uploaded(self, record_id: int, uploaded_url: str = "") -> None:
+        now = _utc_now()
+        with self._connect() as connection:
+            connection.execute(
+                """
+                UPDATE local_audio_uploads
+                   SET status = 'uploaded', uploaded_url = ?, error_text = '',
+                       uploaded_at = ?, updated_at = ?
+                 WHERE id = ?
+                """,
+                (str(uploaded_url)[:2000], now, now, int(record_id)),
+            )
+
+    def mark_failed(self, record_id: int, message: str) -> None:
+        now = _utc_now()
+        with self._connect() as connection:
+            connection.execute(
+                """
+                UPDATE local_audio_uploads
+                   SET status = 'failed', error_text = ?, updated_at = ?
+                 WHERE id = ?
+                """,
+                (str(message)[:1000] or "上传失败。", now, int(record_id)),
+            )
+
+    def retry(self, record_id: int) -> LocalAudioRecord:
+        record = self.require(record_id)
+        if record.status not in {"failed", "pending"}:
+            raise RuntimeError("当前录音状态不允许重试上传。")
+        if not record.file_path.is_file() or record.file_path.stat().st_size <= 0:
+            raise RuntimeError("本地录音文件不存在或为空。")
+        now = _utc_now()
+        with self._connect() as connection:
+            connection.execute(
+                """
+                UPDATE local_audio_uploads
+                   SET status = 'pending', error_text = '', updated_at = ?
+                 WHERE id = ?
+                """,
+                (now, int(record_id)),
+            )
+        return self.require(record_id)
+
+
+def _upload_url(result: Any) -> str:
+    if not isinstance(result, dict):
+        return ""
+    data = result.get("data")
+    payload = data if isinstance(data, dict) else result
+    for key in ("file_url", "fileUrl", "url", "recording_url"):
+        value = payload.get(key)
+        if value:
+            return str(value)
+    return ""
+
+
+class LocalAudioUploadManager:
+    """Small daemon worker pool that uploads up to three recordings at once."""
+
+    def __init__(
+        self,
+        repository: Any,
+        store: LocalAudioQueueStore,
+        *,
+        max_workers: int = _MAX_UPLOAD_WORKERS,
+    ) -> None:
+        self.repository = repository
+        self.store = store
+        self.max_workers = max(1, min(int(max_workers), 8))
+        self._jobs: queue.Queue[tuple[int, Future[bool]]] = queue.Queue()
+        self._active: dict[int, Future[bool]] = {}
+        self._upload_listeners: set[Callable[[LocalAudioRecord], None]] = set()
+        self._lock = threading.Lock()
+        for index in range(self.max_workers):
+            threading.Thread(
+                target=self._worker,
+                name=f"local-audio-upload-{index + 1}",
+                daemon=True,
+            ).start()
+
+    def submit(self, record_id: int) -> Future[bool]:
+        record_id = int(record_id)
+        with self._lock:
+            existing = self._active.get(record_id)
+            if existing is not None:
+                return existing
+            future: Future[bool] = Future()
+            self._active[record_id] = future
+        self._jobs.put((record_id, future))
+        return future
+
+    def add_upload_listener(
+        self,
+        listener: Callable[[LocalAudioRecord], None],
+    ) -> None:
+        with self._lock:
+            self._upload_listeners.add(listener)
+
+    def remove_upload_listener(
+        self,
+        listener: Callable[[LocalAudioRecord], None],
+    ) -> None:
+        with self._lock:
+            self._upload_listeners.discard(listener)
+
+    def _notify_uploaded(self, record_id: int) -> None:
+        try:
+            record = self.store.require(record_id)
+        except Exception:
+            return
+        with self._lock:
+            listeners = tuple(self._upload_listeners)
+        for listener in listeners:
+            with suppress(Exception):
+                listener(record)
+
+    def submit_retryable(self, *, diagnosis_id: int | None = None) -> list[Future[bool]]:
+        futures: list[Future[bool]] = []
+        for record in self.store.list_records(diagnosis_id=diagnosis_id):
+            if record.status in _RETRYABLE_STATUSES:
+                futures.append(self.submit(record.id))
+        return futures
+
+    def submit_pending(self, *, diagnosis_id: int | None = None) -> list[Future[bool]]:
+        """Resume only queued work; failed uploads require an explicit retry."""
+
+        return [
+            self.submit(record.id)
+            for record in self.store.list_records(diagnosis_id=diagnosis_id)
+            if record.status == "pending"
+        ]
+
+    def _worker(self) -> None:
+        while True:
+            record_id, future = self._jobs.get()
+            try:
+                try:
+                    succeeded = self._upload(record_id)
+                except Exception as error:  # Defensive boundary around a daemon worker.
+                    with suppress(Exception):
+                        self.store.mark_failed(
+                            record_id,
+                            str(error) or "本地录音上传失败。",
+                        )
+                    succeeded = False
+                if not future.done():
+                    future.set_result(succeeded)
+            finally:
+                with self._lock:
+                    self._active.pop(record_id, None)
+                self._jobs.task_done()
+
+    def _upload(self, record_id: int) -> bool:
+        record = self.store.claim_upload(record_id)
+        if record is None:
+            current = self.store.get(record_id)
+            return bool(current and current.status == "uploaded")
+        if not record.file_path.is_file() or record.file_path.stat().st_size <= 0:
+            self.store.mark_failed(record.id, "本地录音文件不存在或为空。")
+            return False
+        if record.call_record_id is None or record.call_record_id <= 0:
+            self.store.mark_failed(record.id, "未保存对应的通话记录编号，暂不能上传。")
+            return False
+        upload = getattr(self.repository, "upload_call_recording", None)
+        if not callable(upload):
+            self.store.mark_failed(record.id, "当前服务未提供本地录音上传接口。")
+            return False
+        try:
+            result = upload(
+                path=record.file_path,
+                diagnosis_id=record.diagnosis_id,
+                call_record_id=record.call_record_id,
+                mime_type=record.mime_type,
+            )
+        except Exception as error:
+            self.store.mark_failed(record.id, str(error) or "本地录音上传 COS 失败。")
+            return False
+        uploaded_url = _upload_url(result)
+        if not uploaded_url:
+            self.store.mark_failed(record.id, "服务器未返回本地录音文件地址。")
+            return False
+        self.store.mark_uploaded(record.id, uploaded_url)
+        self._notify_uploaded(record.id)
+        return True
+
+
+def get_local_audio_upload_manager(
+    repository: Any,
+    store: LocalAudioQueueStore | None = None,
+) -> tuple[LocalAudioQueueStore, LocalAudioUploadManager]:
+    """Return one three-worker uploader per repository and manifest.
+
+    Video windows and the recording-management dialog may be opened many times
+    during a workstation session. Sharing the pool prevents each window from
+    creating another set of background threads while SQLite's atomic claim still
+    protects against duplicate uploads across processes.
+    """
+
+    resolved_store = store or LocalAudioQueueStore()
+    key = (id(repository), resolved_store.database_path)
+    with _MANAGER_LOCK:
+        manager = _MANAGERS.get(key)
+        if manager is None:
+            manager = LocalAudioUploadManager(
+                repository,
+                resolved_store,
+                max_workers=_MAX_UPLOAD_WORKERS,
+            )
+            _MANAGERS[key] = manager
+    return resolved_store, manager

app/src/doctor_workstation/services/mock_repository.py

@@ -2588,8 +2588,11 @@ class DemoDoctorRepository:
                 "room_id": "manual-upload",
                 "status": 2,
                 "status_text": "已结束",
-                "recording_status_text": "待上传",
-                "recording_urls_list": [],
+                "recording_status_text": "待上传",
+                "recording_urls_list": [],
+                "local_audio_status": 0,
+                "local_audio_status_text": "无本地录音",
+                "local_audio_urls_list": [],
                 "transcription_status": "not_started",
                 "transcription_status_text": "未生成文字",
                 "transcript_text": "",
@@ -2633,25 +2636,60 @@ class DemoDoctorRepository:
             record["recording_status_text"] = "录制完成"
             return deepcopy(record)
 
-    def upload_call_recording(
-        self,
-        path: str | PathLike[str],
-        diagnosis_id: int,
-        *,
-        call_record_id: int | None = None,
-    ) -> dict[str, Any]:
-        """Upload then attach a demo video using the production sequence."""
-
-        file_url = self.upload_material(path, "video")
-        target_id = call_record_id
-        if target_id is None:
-            target_id = int(self.create_manual_call_record(diagnosis_id)["id"])
-        self.attach_local_call_recording(diagnosis_id, file_url, call_record_id=target_id)
-        return {
-            "diagnosis_id": diagnosis_id,
-            "call_record_id": target_id,
-            "file_url": file_url,
-        }
+    def upload_call_recording(
+        self,
+        path: str | PathLike[str],
+        diagnosis_id: int,
+        *,
+        call_record_id: int | None = None,
+        mime_type: str = "audio/webm",
+    ) -> dict[str, Any]:
+        """Upload then attach a demo local-audio file using the production sequence."""
+
+        source_path = Path(path)
+        is_audio = source_path.suffix.lower() in {
+            ".ogg",
+            ".opus",
+            ".mp3",
+            ".wav",
+            ".m4a",
+            ".aac",
+            ".amr",
+            ".wma",
+        } or (
+            source_path.suffix.lower() == ".webm"
+            and str(mime_type or "").lower().startswith("audio/")
+        )
+        file_url = self.upload_material(path, "file" if is_audio else "video")
+        target_id = call_record_id
+        if target_id is None:
+            target_id = int(self.create_manual_call_record(diagnosis_id)["id"])
+        if is_audio:
+            with self._lock:
+                record = next(
+                    (
+                        row
+                        for row in self._call_records.setdefault(diagnosis_id, [])
+                        if int(row.get("id") or 0) == int(target_id)
+                    ),
+                    None,
+                )
+                if record is None:
+                    raise RepositoryNotFoundError("call record not found")
+                urls = record.setdefault("local_audio_urls_list", [])
+                if file_url not in urls:
+                    urls.append(file_url)
+                record["local_audio_status"] = 2
+                record["local_audio_status_text"] = "已保存"
+        else:
+            self.attach_local_call_recording(diagnosis_id, file_url, call_record_id=target_id)
+        return {
+            "diagnosis_id": diagnosis_id,
+            "call_record_id": target_id,
+            "file_url": file_url,
+            "media_kind": "local_audio" if is_audio else "video",
+            "completed": True,
+        }
 
     def list_im_chat_messages(
         self, diagnosis_id: int, *, only_archived: bool = True
@@ -2890,8 +2928,11 @@ class DemoDoctorRepository:
             replay = {
                 **record,
                 "status_text": "呼叫中",
-                "recording_status_text": "未录制",
-                "recording_urls_list": [],
+                "recording_status_text": "未录制",
+                "recording_urls_list": [],
+                "local_audio_status": 0,
+                "local_audio_status_text": "无本地录音",
+                "local_audio_urls_list": [],
                 "transcription_status": "not_started",
                 "transcription_status_text": "未生成文字",
                 "transcript_text": "",
@@ -2903,13 +2944,21 @@ class DemoDoctorRepository:
             self._call_records.setdefault(diagnosis_id, []).insert(0, replay)
             return deepcopy(record)
 
-    def end_call(self, diagnosis_id: int) -> dict[str, Any]:
+    def end_call(
+        self, diagnosis_id: int, *, call_record_id: int | str | None = None
+    ) -> dict[str, Any]:
         """Persistently mark the demo call record ended."""
 
         with self._lock:
-            record = self._calls.get(diagnosis_id)
-            if record is None:
-                raise RepositoryNotFoundError(f"active call for {diagnosis_id} not found")
+            record = self._calls.get(diagnosis_id)
+            if record is None:
+                raise RepositoryNotFoundError(f"active call for {diagnosis_id} not found")
+            if call_record_id is not None and str(record.get("id") or "") != str(
+                call_record_id
+            ):
+                raise RepositoryNotFoundError(
+                    f"active call record {call_record_id} for {diagnosis_id} not found"
+                )
             record["status"] = "ended"
             record["ended_at"] = datetime.now().replace(microsecond=0).isoformat(sep=" ")
             replay = next(
@@ -2930,15 +2979,27 @@ class DemoDoctorRepository:
                 )
             return deepcopy(record)
 
-    def bind_call_room(self, diagnosis_id: int, room_id: str) -> dict[str, Any]:
+    def bind_call_room(
+        self,
+        diagnosis_id: int,
+        room_id: str,
+        *,
+        call_record_id: int | str | None = None,
+    ) -> dict[str, Any]:
         """Persist the room identifier on the active demo call."""
 
         if not room_id.strip():
             raise ValueError("room_id is required")
         with self._lock:
-            record = self._calls.get(diagnosis_id)
-            if record is None:
-                raise RepositoryNotFoundError(f"active call for {diagnosis_id} not found")
+            record = self._calls.get(diagnosis_id)
+            if record is None:
+                raise RepositoryNotFoundError(f"active call for {diagnosis_id} not found")
+            if call_record_id is not None and str(record.get("id") or "") != str(
+                call_record_id
+            ):
+                raise RepositoryNotFoundError(
+                    f"active call record {call_record_id} for {diagnosis_id} not found"
+                )
             record["room_id"] = room_id.strip()
             record["status"] = "connected"
             replay = next(
@@ -2957,9 +3018,10 @@ class DemoDoctorRepository:
                         "status_text": "通话中",
                     }
                 )
-            return {
-                "diagnosis_id": diagnosis_id,
-                "room_id": room_id.strip(),
+            return {
+                "diagnosis_id": diagnosis_id,
+                "call_record_id": record["id"],
+                "room_id": room_id.strip(),
                 "cloud_recording": {"started": False, "message": "演示模式不录制"},
             }
 

app/src/doctor_workstation/services/repository.py

@@ -2,16 +2,18 @@
 
 from __future__ import annotations
 
-import mimetypes
-import re
-import time
+import mimetypes
+import re
+import time
 from collections.abc import Callable, Iterator, Mapping, Sequence
-from contextlib import suppress
-from datetime import date
+from contextlib import suppress
+from datetime import date
+from inspect import Parameter, signature
 from io import BytesIO
 from os import PathLike
-from pathlib import Path
-from typing import Any, Final, Literal, Protocol
+from pathlib import Path
+from typing import Any, Final, Literal, Protocol
+from uuid import uuid4
 
 from doctor_workstation.core.errors import (
     ApiBusinessError,
@@ -631,14 +633,15 @@ class DoctorRepository(Protocol):
     ) -> Any:
         """Attach one uploaded replay URI to a call record."""
 
-    def upload_call_recording(
-        self,
-        path: str | PathLike[str],
-        diagnosis_id: int,
-        *,
-        call_record_id: int | None = None,
-    ) -> dict[str, Any]:
-        """Upload a local video then attach it to a real call record."""
+    def upload_call_recording(
+        self,
+        path: str | PathLike[str],
+        diagnosis_id: int,
+        *,
+        call_record_id: int | None = None,
+        mime_type: str = "audio/webm",
+    ) -> dict[str, Any]:
+        """Upload a locally captured call recording to a real call record."""
 
     def list_im_chat_messages(
         self, diagnosis_id: int, *, only_archived: bool = True
@@ -699,11 +702,19 @@ class DoctorRepository(Protocol):
     def start_call(self, diagnosis_id: int, patient_id: int, *, call_type: int = 2) -> Any:
         """Create a call record."""
 
-    def end_call(self, diagnosis_id: int) -> Any:
-        """End the active diagnosis call."""
-
-    def bind_call_room(self, diagnosis_id: int, room_id: str) -> Any:
-        """Bind a TRTC room to the active call."""
+    def end_call(
+        self, diagnosis_id: int, *, call_record_id: int | str | None = None
+    ) -> Any:
+        """End the exact active call when its server identity is available."""
+
+    def bind_call_room(
+        self,
+        diagnosis_id: int,
+        room_id: str,
+        *,
+        call_record_id: int | str | None = None,
+    ) -> Any:
+        """Bind a TRTC room to the exact active call and start cloud recording."""
 
     def start_call_transcription(
         self,
@@ -2322,31 +2333,75 @@ class RemoteDoctorRepository:
             body["call_record_id"] = call_record_id
         return self.client.post("tcm.diagnosis/attachLocalCallRecording", body)
 
-    def upload_call_recording(
-        self,
-        path: str | PathLike[str],
-        diagnosis_id: int,
-        *,
-        call_record_id: int | None = None,
-    ) -> dict[str, Any]:
-        """Perform the same upload/create/attach sequence as ``CallRecordPanel``."""
-
-        if diagnosis_id <= 0:
-            raise ValueError("diagnosis_id must be positive")
-        # Match the admin component exactly: upload first so a failed upload does
-        # not leave behind an empty synthetic call record.
-        file_url = self.upload_material(path, "video")
-        target_id = call_record_id
-        if target_id is None:
-            target_id = int(self.create_manual_call_record(diagnosis_id).get("id") or 0)
-            if target_id <= 0:
-                raise ApiProtocolError("tcm.diagnosis/createManualCallRecord returned no id")
-        self.attach_local_call_recording(diagnosis_id, file_url, call_record_id=target_id)
-        return {
-            "diagnosis_id": diagnosis_id,
-            "call_record_id": target_id,
-            "file_url": file_url,
-        }
+    def upload_call_recording(
+        self,
+        path: str | PathLike[str],
+        diagnosis_id: int,
+        *,
+        call_record_id: int | None = None,
+        mime_type: str = "audio/webm",
+    ) -> dict[str, Any]:
+        """Chunk-upload one local audio recording and attach it atomically."""
+
+        if diagnosis_id <= 0:
+            raise ValueError("diagnosis_id must be positive")
+        if call_record_id is not None and call_record_id <= 0:
+            raise ValueError("call_record_id must be positive")
+        recording_path = Path(path).expanduser().resolve()
+        if not recording_path.is_file():
+            raise ValueError(f"recording file does not exist: {recording_path}")
+        file_size = recording_path.stat().st_size
+        if file_size <= 0:
+            raise ValueError("recording file must not be empty")
+
+        chunk_size = 4 * 1024 * 1024
+        chunk_total = (file_size + chunk_size - 1) // chunk_size
+        upload_id = f"local_audio_{uuid4().hex}"
+        file_name = recording_path.name
+        clean_mime = str(mime_type or "audio/webm").strip()[:120] or "audio/webm"
+        final_result: Mapping[str, Any] | None = None
+        bound_call_record_id = call_record_id
+        with recording_path.open("rb") as stream:
+            for chunk_index in range(chunk_total):
+                content = stream.read(chunk_size)
+                if not content:
+                    raise ApiProtocolError("local recording ended before all chunks were read")
+                result = self.client.post_multipart(
+                    "tcm.diagnosis/uploadCallRecording",
+                    files={"file": (file_name, content, clean_mime)},
+                    data={
+                        "diagnosis_id": diagnosis_id,
+                        "call_record_id": bound_call_record_id or 0,
+                        "upload_id": upload_id,
+                        "file_name": file_name,
+                        "file_size": file_size,
+                        "mime_type": clean_mime,
+                        "chunk_index": chunk_index,
+                        "chunk_total": chunk_total,
+                    },
+                )
+                final_result = _require_mapping(
+                    result,
+                    "tcm.diagnosis/uploadCallRecording",
+                )
+                returned_id = int(final_result.get("call_record_id") or 0)
+                if returned_id <= 0:
+                    raise ApiProtocolError(
+                        "uploadCallRecording returned no call_record_id"
+                    )
+                if bound_call_record_id is None:
+                    bound_call_record_id = returned_id
+                elif returned_id != bound_call_record_id:
+                    raise ApiProtocolError(
+                        "uploadCallRecording returned a different call_record_id"
+                    )
+
+        if final_result is None or not bool(final_result.get("completed")):
+            raise ApiProtocolError("uploadCallRecording did not complete the local audio upload")
+        file_url = str(final_result.get("file_url") or "").strip()
+        if not file_url:
+            raise ApiProtocolError("uploadCallRecording returned no COS file URL")
+        return dict(final_result)
 
     def list_im_chat_messages(
         self, diagnosis_id: int, *, only_archived: bool = True
@@ -2546,20 +2601,53 @@ class RemoteDoctorRepository:
             )
         return {"call_record_id": call_record_id}
 
-    def end_call(self, diagnosis_id: int) -> Any:
-        """End the active call/recording associated with a diagnosis."""
-
-        return self.client.post("tcm.diagnosis/endCall", {"diagnosis_id": diagnosis_id})
-
-    def bind_call_room(self, diagnosis_id: int, room_id: str) -> Any:
-        """Bind the actual TRTC room to the active call record."""
-
-        if not room_id.strip():
-            raise ValueError("room_id is required")
-        return self.client.post(
-            "tcm.diagnosis/bindCallRoom",
-            {"diagnosis_id": diagnosis_id, "room_id": room_id.strip()},
-        )
+    @staticmethod
+    def _optional_call_record_id(call_record_id: int | str | None) -> int | str | None:
+        if call_record_id is None:
+            return None
+        if isinstance(call_record_id, bool) or not str(call_record_id).strip():
+            raise ValueError("call_record_id must be a positive identifier")
+        try:
+            normalized = int(str(call_record_id).strip())
+        except (TypeError, ValueError) as exc:
+            raise ValueError("call_record_id must be a positive identifier") from exc
+        if normalized <= 0:
+            raise ValueError("call_record_id must be a positive identifier")
+        return normalized
+
+    def end_call(
+        self, diagnosis_id: int, *, call_record_id: int | str | None = None
+    ) -> Any:
+        """Stop COS cloud recording and end the exact call record."""
+
+        body: dict[str, Any] = {"diagnosis_id": diagnosis_id}
+        normalized_id = self._optional_call_record_id(call_record_id)
+        if normalized_id is not None:
+            body["call_record_id"] = normalized_id
+        return self.client.post("tcm.diagnosis/endCall", body)
+
+    def bind_call_room(
+        self,
+        diagnosis_id: int,
+        room_id: str,
+        *,
+        call_record_id: int | str | None = None,
+    ) -> Any:
+        """Bind the actual TRTC room and auto-start COS cloud recording."""
+
+        if not room_id.strip():
+            raise ValueError("room_id is required")
+        body: dict[str, Any] = {
+            "diagnosis_id": diagnosis_id,
+            "room_id": room_id.strip(),
+        }
+        normalized_id = self._optional_call_record_id(call_record_id)
+        if normalized_id is not None:
+            body["call_record_id"] = normalized_id
+        return self.client.post(
+            "tcm.diagnosis/bindCallRoom",
+            body,
+        )
 
     @staticmethod
     def _transcription_identity(
@@ -2767,24 +2855,40 @@ def _require_mapping(value: object, endpoint: str) -> Mapping[str, Any]:
     return value
 
 
-def _client_request(
+def _client_request(
     client: Any,
     method: str,
     endpoint: str,
     payload: Mapping[str, Any] | None = None,
     *,
     timeout: float | None = None,
-) -> Any:
-    """Call get/post, ignoring timeout kwargs that test doubles do not accept."""
-
-    fn = getattr(client, method)
-    params = dict(payload or {})
-    try:
-        if timeout is None:
-            return fn(endpoint, params)
-        return fn(endpoint, params, timeout=timeout)
-    except TypeError:
-        return fn(endpoint, params)
+) -> Any:
+    """Call get/post once, omitting timeout for legacy test doubles.
+
+    Capability is determined before invocation.  Catching ``TypeError`` from
+    the call itself is unsafe for POST because the transport may already have
+    submitted the write before raising, and a fallback call would duplicate it.
+    """
+
+    fn = getattr(client, method)
+    params = dict(payload or {})
+    if timeout is not None:
+        try:
+            parameters = signature(fn).parameters.values()
+        except (TypeError, ValueError):
+            parameters = ()
+        accepts_timeout = any(
+            parameter.kind is Parameter.VAR_KEYWORD
+            or (
+                parameter.name == "timeout"
+                and parameter.kind
+                in {Parameter.POSITIONAL_OR_KEYWORD, Parameter.KEYWORD_ONLY}
+            )
+            for parameter in parameters
+        )
+        if accepts_timeout:
+            return fn(endpoint, params, timeout=timeout)
+    return fn(endpoint, params)
 
 
 def _material_kind(

app/src/doctor_workstation/ui/diagnosis_index_widgets.py

@@ -260,11 +260,32 @@ def _appointment_status(record: Any) -> int:
     return _as_int(status, -1)
 
 
-def _appointment_active(record: Any) -> bool:
-    return _has_appointment(record) and _appointment_status(record) == 1
-
-
-def _single_cancellable_appointment(record: Any) -> Any | None:
+def _appointment_active(record: Any) -> bool:
+    return _has_appointment(record) and _appointment_status(record) == 1
+
+
+def video_call_state(record: Any) -> str:
+    """Return the server-owned state of the latest video-call session."""
+
+    return str(
+        first_value(
+            record,
+            "video_call_hint.state",
+            "video_hint.state",
+            "video_hint",
+            default="none",
+        )
+        or "none"
+    ).strip().lower()
+
+
+def video_call_is_live(record: Any) -> bool:
+    """Only a room already opened by the doctor may be joined from this list."""
+
+    return video_call_state(record) == "live"
+
+
+def _single_cancellable_appointment(record: Any) -> Any | None:
     """Return the sole cancellable appointment, never an ambiguous row-level fallback."""
 
     if not _has_appointment(record) or _appointment_status(record) not in {1, 4}:
@@ -317,12 +338,34 @@ def _video_ids_complete(record: Any) -> bool:
     )
 
 
-def _prescription_action_label(record: Any, *, force_open: bool = False) -> str:
-    if force_open:
-        return "开方"
-    audit = _as_int(first_value(record, "prescription_audit_status", "audit_status"), -1)
-    voided = _as_int(first_value(record, "prescription_void_status", "void_status"), 0)
-    return "查看处方" if audit == 1 and voided != 1 else "开方"
+def prescription_action(record: Any, *, force_open: bool = False) -> tuple[str, str]:
+    """Return the label and immutable click intent for the current appointment."""
+
+    if force_open:
+        return "开方", "open"
+    audit = _as_int(first_value(record, "prescription_audit_status", "audit_status"), -1)
+    voided = _as_int(first_value(record, "prescription_void_status", "void_status"), 0)
+    explicit_current = first_value(record, "current_has_prescription", default=None)
+    if explicit_current is not None:
+        has_current = _as_bool(explicit_current)
+    elif _as_int(first_value(record, "current_prescription_id", default=0)) > 0:
+        has_current = True
+    else:
+        explicit_legacy = first_value(record, "has_prescription", default=None)
+        has_current = (
+            _as_bool(explicit_legacy)
+            if explicit_legacy is not None
+            else audit in {0, 1, 2}
+        )
+    if not has_current:
+        return "开方", "open"
+    if audit == 1 and voided != 1:
+        return "查看处方", "view"
+    return "编辑处方", "edit"
+
+
+def _prescription_action_label(record: Any, *, force_open: bool = False) -> str:
+    return prescription_action(record, force_open=force_open)[0]
 
 
 class FlowLayout(QLayout):
@@ -1486,25 +1529,32 @@ class DiagnosisTableHost(QFrame):
         layout.setContentsMargins(3, 2, 3, 2)
         layout.setAlignment(Qt.AlignmentFlag.AlignCenter)
         video_capable = self.action_policy.get("video_call", False)
-        if video_capable and _appointment_active(record):
-            button = QToolButton(host)
-            button.setText("进入视频问诊")
-            button.setProperty("rowLink", "primary")
-            button.setCursor(Qt.CursorShape.PointingHandCursor)
-            button.setToolTip("进入医生端视频问诊（将使用摄像头和麦克风）")
-            button.setEnabled(_video_ids_complete(record))
-            if not button.isEnabled():
-                button.setToolTip("患者、诊单或挂号标识不完整，无法进入视频问诊")
-            button.clicked.connect(
-                lambda _checked=False, item=record: self.video_requested.emit(item)
-            )
-            layout.addWidget(button)
-        else:
-            status = "—"
-            if video_capable:
-                status = {3: "已完成", 4: "已过号"}.get(
-                    _appointment_status(record), "未挂号" if not _has_appointment(record) else "—"
-                )
+        call_state = video_call_state(record)
+        if video_capable and _appointment_active(record) and call_state == "live":
+            button = QToolButton(host)
+            button.setText("进入视频问诊")
+            button.setProperty("rowLink", "primary")
+            button.setCursor(Qt.CursorShape.PointingHandCursor)
+            button.setToolTip("医生已发起视频会话，点击进入（将使用摄像头和麦克风）")
+            button.setEnabled(_video_ids_complete(record))
+            if not button.isEnabled():
+                button.setToolTip("患者、诊单或挂号标识不完整，无法进入视频问诊")
+            button.clicked.connect(
+                lambda _checked=False, item=record: self.video_requested.emit(item)
+            )
+            layout.addWidget(button)
+        else:
+            status = "—"
+            if video_capable:
+                if call_state == "pending_room":
+                    status = "等待接通"
+                elif _appointment_active(record):
+                    status = "暂无通话"
+                else:
+                    status = {3: "已完成", 4: "已过号"}.get(
+                        _appointment_status(record),
+                        "未挂号" if not _has_appointment(record) else "—",
+                    )
             label = QLabel(display_text(status), host)
             label.setProperty("fixedMuted", True)
             label.setAlignment(Qt.AlignmentFlag.AlignCenter)
@@ -2201,7 +2251,8 @@ __all__ = [
     "DiagnosisLoadingOverlay",
     "DiagnosisPager",
     "DiagnosisTableHost",
-    "DiagnosisTableModel",
-    "FlowLayout",
-    "FlowWidget",
-]
+    "DiagnosisTableModel",
+    "FlowLayout",
+    "FlowWidget",
+    "prescription_action",
+]

app/src/doctor_workstation/ui/dialogs/ai_consult.py

@@ -3,7 +3,9 @@
 from __future__ import annotations
 
 import json
+import re
 from collections.abc import Mapping, Sequence
+from collections import namedtuple
 from datetime import datetime
 from threading import Event
 from typing import Any
@@ -214,6 +216,32 @@ QDialog#AiConsultDialog QLabel#AiConsultBody {
     background-color: transparent;
     font-size: 12px;
 }
+QDialog#AiConsultDialog QLabel#AiConsultInsightMarker {
+    color: #5B67F1;
+    background-color: #EEF1FF;
+    border: 1px solid #DDE3FA;
+    border-radius: 9px;
+    min-width: 26px;
+    max-width: 26px;
+    min-height: 22px;
+    max-height: 22px;
+    font-size: 11px;
+    font-weight: 700;
+    padding: 0;
+}
+QDialog#AiConsultDialog QLabel#AiConsultInsightText {
+    color: #3F4E75;
+    background-color: transparent;
+    font-size: 12.5px;
+    padding: 1px 0;
+    line-height: 22px;
+}
+QDialog#AiConsultDialog QLabel#AiConsultInsightPlaceholder {
+    color: #8A94B3;
+    background-color: transparent;
+    font-size: 12px;
+    padding: 2px 0;
+}
 QDialog#AiConsultDialog QLabel#AiConsultTag[level="high"] {
     color: #F15B67;
     background-color: #FFF1F3;
@@ -994,6 +1022,149 @@ def _analysis_markdown(analysis: Mapping[str, Any]) -> str:
     return "\n\n".join(parts)
 
 
+_InsightItem = namedtuple("_InsightItem", "kind marker label text")
+
+_INSIGHT_LIST_RE = re.compile(r"^\s*(\d{1,2})\s*([\.、)）]\s*)")
+_INSIGHT_LIST_LOOKAHEAD_RE = re.compile(r"(?:^|(?<=[：:；;。\s]))(\d{1,2})\s*([\.、)）])\s*")
+_INSIGHT_LABEL_RE = re.compile(r"^([\u4e00-\u9fa5A-Za-z（）()·\s]{1,12})[：:]\s*(.*)$")
+
+
+def _split_insight_segments(text: str) -> list[_InsightItem]:
+    """把较稠密的分析段落拆成结构化条目,便于分条阅读。
+
+    识别模式:
+    - 数字编号开头 (1. / 2、 / 3) / 4)） 作为 list_item
+    - 文本中嵌入的编号列表 (如 "...阶段：1. 肾功评估：... 2. 代谢评估：...")
+      也会被识别,编号前的内容视为序言
+    - "短中文标签：内容" 中含 已知事实 / 建议 / 信息缺口 / 综合推断 等
+      可作为 lead_item, 标签部分加粗
+    - 其余按 。 / ； 分句, 每句成一个 plain_item
+
+    每种类型都会渲染成独立 QLabel, 以改善阅读节奏。
+    """
+    raw = display_text(text, "").strip()
+    if not raw:
+        return []
+
+    # 检查是否包含嵌入式编号列表: 先找第一次出现 "。 数字。 " 或 "...：数字。 "
+    lookahead_match = _INSIGHT_LIST_LOOKAHEAD_RE.search(raw)
+    starts_with_list = _INSIGHT_LIST_RE.match(raw) is not None
+
+    if not starts_with_list and lookahead_match is not None:
+        # 切出序言 + 多个列表条目; 序言尽量停在最近的句末标点 / 冒号处
+        # 注意: lookahead 是 zero-width 的 lookbehind, 所以 start() 即编号数字位置
+        list_start = lookahead_match.start()
+        preamble_candidate = raw[:list_start].rstrip()
+        sentence_tail = re.search(r"[。；;][^。；;]*$", preamble_candidate)
+        if sentence_tail is not None:
+            preamble = preamble_candidate[: sentence_tail.end()].rstrip("。；;：: \t")
+        else:
+            preamble = preamble_candidate.rstrip("：: \t")
+        body = raw[list_start:].lstrip()
+        items: list[_InsightItem] = []
+        if preamble:
+            items.extend(_split_plain_paragraph(preamble))
+        items.extend(_split_numbered_list(body))
+        return items
+
+    if starts_with_list:
+        return _split_numbered_list(raw)
+
+    return _split_plain_paragraph(raw)
+
+
+def _split_numbered_list(text: str) -> list[_InsightItem]:
+    """把一段文本按编号列表解析；开头的非编号内容视为序言。"""
+    items: list[_InsightItem] = []
+    cursor = 0
+    length = len(text)
+    prefix_consumed = False
+    while cursor < length:
+        remainder = text[cursor:]
+        list_match = _INSIGHT_LIST_RE.match(remainder)
+        if list_match is None:
+            # 剩余部分按含序言的段落处理 (无编号前缀, 仍按句末分条)
+            tail = remainder.strip()
+            if tail and not prefix_consumed:
+                items.extend(_split_plain_paragraph(tail))
+            elif tail:
+                # 已消费过编号, 余下尾段按段落继续分条
+                items.extend(_split_plain_paragraph(tail))
+            break
+        prefix_consumed = True
+        marker = f"{list_match.group(1)}."
+        after_marker = remainder[list_match.end():]
+        # 在本条内找到最近的句末标点; 或下一个编号之前
+        sentence_match = re.search(r"[。；;\n]", after_marker)
+        candidate_ends: list[int] = []
+        if sentence_match is not None:
+            candidate_ends.append(sentence_match.end())
+        next_marker_match = re.search(
+            r"\s\d{1,2}\s*[\.、)）]",
+            after_marker,
+        )
+        if next_marker_match is not None:
+            candidate_ends.append(next_marker_match.start() + 1)
+        if candidate_ends:
+            inner_end = min(candidate_ends)
+        else:
+            inner_end = len(after_marker)
+        segment = after_marker[:inner_end].strip("。；; \n").strip()
+        if segment:
+            items.append(_split_label_or_sentence(segment, marker=marker))
+        cursor += list_match.end() + inner_end
+        while cursor < length and text[cursor] in "。；;\n":
+            cursor += 1
+    return items
+
+
+def _split_plain_paragraph(text: str) -> list[_InsightItem]:
+    items: list[_InsightItem] = []
+    if not text.strip():
+        return items
+
+    cursor = 0
+    length = len(text)
+    while cursor < length:
+        remainder = text[cursor:]
+        sentence_match = re.search(r"[。；;\n]", remainder)
+        if sentence_match is not None:
+            segment = remainder[: sentence_match.start()].strip()
+            if segment:
+                items.append(_split_label_or_sentence(segment))
+            cursor += sentence_match.end()
+            continue
+        tail = remainder.strip()
+        if tail:
+            items.append(_split_label_or_sentence(tail))
+        break
+    return items
+
+
+def _split_label_or_sentence(segment: str, *, marker: str | None = None) -> _InsightItem:
+    """对单段片段进一步检查是否含 '标签：内容' 结构。"""
+    label_match = _INSIGHT_LABEL_RE.match(segment)
+    if label_match:
+        label = label_match.group(1).strip()
+        body = label_match.group(2).strip()
+        if label and body:
+            kind = "list" if marker else "lead"
+            return _InsightItem(kind=kind, marker=marker or "", label=label, text=body)
+    if marker:
+        return _InsightItem(kind="list", marker=marker, label="", text=segment)
+    return _InsightItem(kind="plain", marker="", label="", text=segment)
+
+
+def _escape_html(value: str) -> str:
+    """转义富文本片段,防止分析文本中带 HTML/Markdown 误伤样式。"""
+    return (
+        (value or "")
+        .replace("&", "&amp;")
+        .replace("<", "&lt;")
+        .replace(">", "&gt;")
+    )
+
+
 class _FlowRow(QWidget):
     def __init__(self, parent: QWidget | None = None) -> None:
         super().__init__(parent)
@@ -1059,7 +1230,7 @@ class _ChatBubble(QWidget):
     ) -> None:
         super().__init__(parent)
         row = QHBoxLayout(self)
-        row.setContentsMargins(8, 4, 8, 4)
+        row.setContentsMargins(8, 6, 8, 6)
         row.setSpacing(8)
         avatar = QLabel("医" if role == "doctor" else "患" if role == "patient" else "AI")
         avatar.setObjectName("AiConsultRole")
@@ -1383,7 +1554,7 @@ class AiConsultDialog(QDialog):
         self.chat_host = QWidget()
         self.chat_layout = QVBoxLayout(self.chat_host)
         self.chat_layout.setContentsMargins(16, 16, 16, 8)
-        self.chat_layout.setSpacing(10)
+        self.chat_layout.setSpacing(12)
         self.chat_layout.addStretch(1)
         self.chat_scroll.setWidget(self.chat_host)
         scroll_bar = self.chat_scroll.verticalScrollBar()
@@ -1576,7 +1747,7 @@ class AiConsultDialog(QDialog):
         insight_title.setObjectName("AiConsultSection")
         layout.addWidget(insight_title)
         self.insight_host = QVBoxLayout()
-        self.insight_host.setSpacing(8)
+        self.insight_host.setSpacing(10)
         layout.addLayout(self.insight_host)
 
         tools_title = QLabel("快捷工具")
@@ -1708,27 +1879,78 @@ class AiConsultDialog(QDialog):
             card = QFrame()
             card.setObjectName("AiConsultInsightRow")
             _style_surface(card)
-            inner = QHBoxLayout(card)
-            inner.setContentsMargins(10, 8, 10, 8)
-            text = QVBoxLayout()
-            text.setSpacing(2)
+            outer = QVBoxLayout(card)
+            outer.setContentsMargins(14, 12, 14, 14)
+            outer.setSpacing(10)
+
+            header_row = QHBoxLayout()
+            header_row.setSpacing(8)
+            header_row.setContentsMargins(0, 0, 0, 0)
             heading = QLabel(title)
             heading.setObjectName("AiConsultRecordTitle")
-            body = QLabel(detail)
-            body.setObjectName("AiConsultBody")
-            body.setWordWrap(True)
-            text.addWidget(heading)
-            text.addWidget(body)
-            inner.addLayout(text, 1)
+            header_row.addWidget(heading, 1)
             badge = QLabel(tag)
             badge.setObjectName("AiConsultTag")
             _style_surface(badge)
             badge.setProperty("level", level)
             badge.style().unpolish(badge)
             badge.style().polish(badge)
-            inner.addWidget(badge, 0, Qt.AlignmentFlag.AlignTop)
+            header_row.addWidget(badge, 0, Qt.AlignmentFlag.AlignTop)
+            outer.addLayout(header_row)
+
+            body_host = QVBoxLayout()
+            body_host.setSpacing(8)
+            body_host.setContentsMargins(0, 0, 0, 0)
+            segments = _split_insight_segments(detail)
+            if not segments:
+                placeholder = QLabel(detail or "暂无数据")
+                placeholder.setObjectName("AiConsultInsightPlaceholder")
+                placeholder.setWordWrap(True)
+                body_host.addWidget(placeholder)
+            else:
+                for segment in segments:
+                    body_host.addWidget(self._build_insight_item(segment))
+            outer.addLayout(body_host)
             self.insight_host.addWidget(card)
 
+    def _build_insight_item(self, item: _InsightItem) -> QWidget:
+        row = QWidget()
+        layout = QHBoxLayout(row)
+        layout.setContentsMargins(0, 0, 0, 0)
+        layout.setSpacing(8)
+
+        marker_label: QLabel | None = None
+        if item.kind == "list" and item.marker:
+            marker_label = QLabel(item.marker)
+            marker_label.setObjectName("AiConsultInsightMarker")
+            marker_label.setAlignment(
+                Qt.AlignmentFlag.AlignTop | Qt.AlignmentFlag.AlignHCenter
+            )
+
+        text_label = QLabel()
+        text_label.setObjectName("AiConsultInsightText")
+        text_label.setWordWrap(True)
+        text_label.setTextInteractionFlags(
+            Qt.TextInteractionFlag.TextSelectableByMouse
+        )
+        text_label.setTextFormat(Qt.TextFormat.RichText)
+
+        if item.label:
+            html_label = _escape_html(item.label)
+            html_body = _escape_html(item.text or "")
+            text_label.setText(
+                f"<span style='color:#15224A;font-weight:600;'>{html_label}</span>"
+                f"<span style='color:#7A87A8;'>：</span>"
+                f"<span style='color:#3F4E75;'>{html_body}</span>"
+            )
+        else:
+            text_label.setText(_escape_html(item.text or ""))
+
+        if marker_label is not None:
+            layout.addWidget(marker_label, 0, Qt.AlignmentFlag.AlignTop)
+        layout.addWidget(text_label, 1)
+        return row
+
     def _apply_header(
         self,
         payload: Mapping[str, Any],

app/src/doctor_workstation/ui/dialogs/diagnosis.py

@@ -3,6 +3,7 @@
 from __future__ import annotations
 
 import re
+import sqlite3
 from collections.abc import Mapping, Sequence
 from contextlib import suppress
 from typing import Any
@@ -69,6 +70,7 @@ from ..widgets import (
     page_total,
     run_async,
 )
+from .local_audio_queue import LocalAudioQueueDialog
 from .prescription_ai import can_open_diagnosis_ai_report, present_diagnosis_ai_report
 
 _PHONE_PERMISSION = "tcm.diagnosis/phonePlain"
@@ -747,6 +749,7 @@ class DiagnosisDialog(QDialog):
     """
 
     saved = Signal()
+    _local_audio_upload_completed = Signal(int, int)
 
     def __init__(
         self,
@@ -841,6 +844,10 @@ class DiagnosisDialog(QDialog):
         self._recording_players: list[RecordingPlayerDialog] = []
         self._inline_recording_cells: list[RecordingPlaybackCell] = []
         self._last_order_detail_dialog: QDialog | None = None
+        self._local_audio_dialog: LocalAudioQueueDialog | None = None
+        self._local_audio_upload_manager: Any = None
+        self._local_audio_upload_listener: Any = None
+        self._video_reload_pending = False
         self._orders_page = 1
         self._orders_page_size = 10
         self._orders_total = 0
@@ -868,6 +875,10 @@ class DiagnosisDialog(QDialog):
         self._daily_panels: list[DailyRecordPanel] = []
         self._owner = None
         self._owner_filter_installed = False
+        self._local_audio_upload_completed.connect(
+            self._local_audio_upload_succeeded,
+            type=Qt.ConnectionType.QueuedConnection,
+        )
 
         self.setObjectName("DiagnosisDialogRoot")
         self.setWindowFlags(Qt.WindowType.Dialog | Qt.WindowType.FramelessWindowHint)
@@ -1433,6 +1444,11 @@ class DiagnosisDialog(QDialog):
         hint.setWordWrap(True)
         toolbar.addWidget(hint, 1)
         toolbar.addStretch(1)
+        self.local_audio_queue_button = QPushButton("本机录音文件")
+        self.local_audio_queue_button.setObjectName("DiagnosisLocalAudioQueueButton")
+        self.local_audio_queue_button.setAccessibleName("查看本机录音文件及上传状态")
+        self.local_audio_queue_button.clicked.connect(self._open_local_audio_queue)
+        toolbar.addWidget(self.local_audio_queue_button)
         self.video_upload_button = QPushButton("上传本地回放")
         self.video_upload_button.setProperty("variant", "primary")
         self.video_upload_button.clicked.connect(
@@ -1556,10 +1572,10 @@ class DiagnosisDialog(QDialog):
             ),
             "video": (
                 ("录制回放", 440),
+                ("房间号", 180),
                 ("开始时间", 170),
                 ("结束时间", 170),
                 ("通话类型", 100),
-                ("房间号", 180),
                 ("时长", 110),
                 ("状态", 90),
                 ("录制 / 文字", 120),
@@ -1695,6 +1711,10 @@ class DiagnosisDialog(QDialog):
             )
         self.prescribe_button.setVisible(self._editable and self._can_prescribe)
         self.video_upload_button.setVisible(self._editable and self._can_video_upload)
+        self.local_audio_queue_button.setVisible(self._can_video_upload)
+        self.local_audio_queue_button.setEnabled(
+            self._diagnosis_id > 0 and self._can_video_upload
+        )
         offset_visible = self._editable and self._can_offset
         self.order_offset.setVisible(offset_visible)
         self.order_offset_save.setVisible(offset_visible)
@@ -1914,6 +1934,10 @@ class DiagnosisDialog(QDialog):
             with suppress(RuntimeError):
                 self._last_order_detail_dialog.close()
             self._last_order_detail_dialog = None
+        if self._local_audio_dialog is not None:
+            with suppress(RuntimeError):
+                self._local_audio_dialog.close()
+            self._local_audio_dialog = None
         self._diagnosis_id = int(diagnosis_id)
         self._patient_id = 0
         self._editable = bool(
@@ -1939,6 +1963,7 @@ class DiagnosisDialog(QDialog):
             self._tab_generations[key] += 1
         self._loaded_tabs.clear()
         self._loading_tabs.clear()
+        self._video_reload_pending = False
         self._daily_todo_status = None
         self._orders_page = 1
         self._orders_total = 0
@@ -2208,6 +2233,8 @@ class DiagnosisDialog(QDialog):
         self._ensure_tab_loaded(self._current_tab_key(), force=True)
 
     def _invalidate_requests(self) -> None:
+        self._stop_watching_local_audio_uploads()
+        self._video_reload_pending = False
         self._generation += 1
         self._save_generation += 1
         self._orders_generation += 1
@@ -2232,6 +2259,11 @@ class DiagnosisDialog(QDialog):
             with suppress(RuntimeError):
                 order_dialog.close()
         self._last_order_detail_dialog = None
+        local_audio_dialog = getattr(self, "_local_audio_dialog", None)
+        if local_audio_dialog is not None:
+            with suppress(RuntimeError):
+                local_audio_dialog.close()
+        self._local_audio_dialog = None
         if hasattr(self, "readonly_loading"):
             self.readonly_loading.hide()
         if hasattr(self, "drawer_loading"):
@@ -2474,7 +2506,11 @@ class DiagnosisDialog(QDialog):
     def _tab_changed(self, _index: int) -> None:
         self._sync_save_button()
         if self._authoritative_detail_loaded and not self._standalone_readonly:
-            self._ensure_tab_loaded(self._current_tab_key())
+            key = self._current_tab_key()
+            if key == "video":
+                self._reload_video_records(self._diagnosis_id)
+            else:
+                self._ensure_tab_loaded(key)
 
     def _load_visible_readonly_sections(self) -> None:
         permission_map = {key: codes for key, _label, codes in _TAB_DEFINITIONS}
@@ -2635,6 +2671,8 @@ class DiagnosisDialog(QDialog):
                 panel.set_messages(rows)
         if not self._standalone_readonly and self._current_tab_key() == key:
             self._clear_message()
+        if key == "video":
+            self._flush_video_reload_if_pending(diagnosis_id)
 
     def _tab_load_error(
         self,
@@ -2650,6 +2688,8 @@ class DiagnosisDialog(QDialog):
         self._set_tab_error(key, text)
         if not self._standalone_readonly and self._current_tab_key() == key:
             self._show_message(text, "danger", action_text="重试")
+        if key == "video":
+            self._flush_video_reload_if_pending(diagnosis_id)
 
     def _load_daily_range(self, start: str, end: str, *, force: bool = False) -> None:
         key = "daily"
@@ -3116,6 +3156,91 @@ class DiagnosisDialog(QDialog):
             "video",
         )
 
+    def _open_local_audio_queue(self) -> None:
+        if self._diagnosis_id <= 0 or not self._can_video_upload:
+            self._show_message("当前账号无本机录音上传权限或接口不可用。", "warning")
+            return
+        current = self._local_audio_dialog
+        if current is not None and current.isVisible():
+            current.raise_()
+            current.activateWindow()
+            return
+        try:
+            dialog = LocalAudioQueueDialog(
+                self.repository,
+                self._diagnosis_id,
+                self,
+            )
+        except (OSError, RuntimeError, sqlite3.Error) as error:
+            self._show_message(f"无法打开本机录音文件：{error}", "danger")
+            return
+        self._local_audio_dialog = dialog
+        opened_diagnosis_id = self._diagnosis_id
+        self._watch_local_audio_uploads(dialog.manager)
+
+        def clear_dialog(_result: int) -> None:
+            if self._local_audio_dialog is dialog:
+                self._local_audio_dialog = None
+
+        dialog.finished.connect(clear_dialog)
+        dialog.open()
+        # Opening the queue commonly follows a background upload that completed
+        # before this dialog existed, so also refresh the server-backed rows now.
+        self._reload_video_records(opened_diagnosis_id)
+
+    def _local_audio_upload_succeeded(
+        self,
+        diagnosis_id: int,
+        _call_record_id: int,
+    ) -> None:
+        if self._local_audio_upload_manager is None:
+            return
+        self._reload_video_records(diagnosis_id)
+
+    def _reload_video_records(self, diagnosis_id: int) -> None:
+        if int(diagnosis_id) != self._diagnosis_id:
+            return
+        if "video" in self._loading_tabs:
+            self._video_reload_pending = True
+            return
+        self._video_reload_pending = False
+        self._loaded_tabs.discard("video")
+        self._ensure_tab_loaded("video", force=True)
+
+    def _watch_local_audio_uploads(self, manager: Any) -> None:
+        if self._local_audio_upload_manager is manager:
+            return
+        self._stop_watching_local_audio_uploads()
+
+        def notify(record: Any) -> None:
+            with suppress(RuntimeError):
+                self._local_audio_upload_completed.emit(
+                    int(record.diagnosis_id),
+                    int(record.call_record_id or 0),
+                )
+
+        manager.add_upload_listener(notify)
+        self._local_audio_upload_manager = manager
+        self._local_audio_upload_listener = notify
+
+    def _stop_watching_local_audio_uploads(self) -> None:
+        manager = self._local_audio_upload_manager
+        listener = self._local_audio_upload_listener
+        self._local_audio_upload_manager = None
+        self._local_audio_upload_listener = None
+        if manager is not None and listener is not None:
+            with suppress(Exception):
+                manager.remove_upload_listener(listener)
+
+    def _flush_video_reload_if_pending(self, diagnosis_id: int) -> None:
+        if not self._video_reload_pending or diagnosis_id != self._diagnosis_id:
+            return
+        self._video_reload_pending = False
+        QTimer.singleShot(
+            0,
+            lambda expected_id=diagnosis_id: self._reload_video_records(expected_id),
+        )
+
     def _sync_chat_archive(self) -> None:
         if not self._can_chat_sync or self._diagnosis_id <= 0:
             self._show_message("当前账号无聊天归档同步权限或接口不可用。", "warning")
@@ -3616,6 +3741,7 @@ class DiagnosisDialog(QDialog):
         self._stop_inline_recordings()
         matrix: list[tuple[Any, ...]] = []
         row_urls: list[list[str]] = []
+        row_audio_urls: list[list[str]] = []
         record_ids: list[int] = []
         transcripts: list[str] = []
         for row in rows:
@@ -3629,6 +3755,22 @@ class DiagnosisDialog(QDialog):
                 if url and url not in normalized:
                     normalized.append(url)
             row_urls.append(normalized)
+            raw_audio_urls = first_value(
+                row,
+                "local_audio_urls_list",
+                "local_audio_urls",
+                default=[],
+            ) or []
+            if isinstance(raw_audio_urls, str) or not isinstance(
+                raw_audio_urls, Sequence
+            ):
+                raw_audio_urls = [raw_audio_urls]
+            normalized_audio: list[str] = []
+            for candidate in raw_audio_urls:
+                url = str(candidate or "").strip()
+                if url and url not in normalized_audio:
+                    normalized_audio.append(url)
+            row_audio_urls.append(normalized_audio)
             record_ids.append(_int(first_value(row, "id", "call_record_id"), 0))
             transcript = self._call_transcript_text(row)
             transcripts.append(transcript)
@@ -3651,22 +3793,41 @@ class DiagnosisDialog(QDialog):
             recording_status = first_value(
                 row, "recording_status_text", "record_status_text", "record_status"
             )
+            local_audio_status = first_value(
+                row,
+                "local_audio_status_text",
+                default="本机录音已保存" if normalized_audio else "无本机录音",
+            )
             transcript_status = first_value(
                 row,
                 "transcription_status_text",
                 "transcript_status_text",
                 default="文字已生成" if transcript else "未生成文字",
             )
+            room_id = str(
+                first_value(
+                    row,
+                    "room_id_text",
+                    "room_id",
+                    "room_no",
+                    default="",
+                )
+                or ""
+            ).strip()
             matrix.append(
                 (
                     "" if normalized else "暂无录制回放",
+                    room_id or "历史记录未保存",
                     first_value(row, "start_time_text", "start_time"),
                     first_value(row, "end_time_text", "end_time"),
                     call_type,
-                    first_value(row, "room_id", "room_no"),
                     first_value(row, "duration_text", "duration"),
                     status,
-                    f"{display_text(recording_status)}\n{display_text(transcript_status)}",
+                    (
+                        f"云端视频：{display_text(recording_status)}\n"
+                        f"本机录音：{display_text(local_audio_status)}\n"
+                        f"转写文字：{display_text(transcript_status)}"
+                    ),
                     "",
                 )
             )
@@ -3692,6 +3853,19 @@ class DiagnosisDialog(QDialog):
                         item.setText("")
                 call_record_id = record_ids[row_index]
                 actions: list[QPushButton] = []
+                audio_urls = row_audio_urls[row_index]
+                if audio_urls and call_record_id > 0:
+                    play_audio = self._action_button(
+                        "播放录音", f"播放通话记录 #{call_record_id} 的本机混音录音"
+                    )
+                    play_audio.setObjectName("DiagnosisLocalAudioPlayback")
+                    play_audio.setProperty("callRecordId", call_record_id)
+                    play_audio.clicked.connect(
+                        lambda _checked=False, target=audio_urls[0]: self._open_recording_player(
+                            target
+                        )
+                    )
+                    actions.append(play_audio)
                 transcript = transcripts[row_index]
                 if transcript and call_record_id > 0:
                     view_transcript = self._action_button(

app/src/doctor_workstation/ui/dialogs/local_audio_queue.py

@@ -0,0 +1,625 @@
+"""Local call-audio upload queue shown from a diagnosis video-history tab."""
+
+from __future__ import annotations
+
+from collections.abc import Mapping
+from datetime import datetime, timedelta, timezone
+from pathlib import Path
+from typing import Any
+
+from PySide6.QtCore import Qt, QTimer, QUrl
+from PySide6.QtGui import QColor, QDesktopServices
+from PySide6.QtWidgets import (
+    QAbstractItemView,
+    QDialog,
+    QFrame,
+    QHBoxLayout,
+    QHeaderView,
+    QLabel,
+    QPushButton,
+    QTableWidget,
+    QTableWidgetItem,
+    QVBoxLayout,
+    QWidget,
+)
+
+from ...services.local_audio_queue import (
+    LocalAudioQueueStore,
+    LocalAudioRecord,
+    LocalAudioUploadManager,
+    get_local_audio_upload_manager,
+)
+from ..widgets import run_async
+
+_STATUS_LABELS = {
+    "recording": "录制中",
+    "pending": "待上传",
+    "uploading": "上传中",
+    "uploaded": "已上传",
+    "failed": "上传失败",
+    "invalid": "无效录音",
+}
+_STATUS_COLORS = {
+    "recording": "#5364F5",
+    "pending": "#B26A00",
+    "uploading": "#2F6FEB",
+    "uploaded": "#07966B",
+    "failed": "#DC4054",
+    "invalid": "#7886AA",
+}
+_BUSINESS_TIMEZONE = timezone(timedelta(hours=8))
+
+_LOCAL_AUDIO_QSS = """
+QDialog#LocalAudioQueueDialog {
+    background: #F6F8FD;
+    color: #111F46;
+}
+QFrame#LocalAudioQueueHeader, QFrame#LocalAudioQueueSummary,
+QFrame#LocalAudioQueueTableCard, QFrame#LocalAudioQueueFooter {
+    background: #FFFFFF;
+    border: 1px solid #E2E7F4;
+    border-radius: 14px;
+}
+QLabel#LocalAudioQueueTitle {
+    color: #111F46;
+    font-size: 20px;
+    font-weight: 700;
+}
+QLabel#LocalAudioQueueSubtitle, QLabel#LocalAudioQueueHint {
+    color: #6E7C9F;
+    font-size: 13px;
+}
+QLabel[queueSummary="true"] {
+    background: #F3F5FB;
+    border: 1px solid #E6EAF5;
+    border-radius: 10px;
+    color: #3F4E75;
+    font-size: 13px;
+    font-weight: 600;
+    padding: 8px 12px;
+}
+QPushButton {
+    min-height: 34px;
+    border: 1px solid #D9E0F2;
+    border-radius: 9px;
+    background: #FFFFFF;
+    color: #354365;
+    padding: 0 14px;
+    font-weight: 600;
+}
+QPushButton:hover { background: #F1F3FF; border-color: #AEB8FF; }
+QPushButton:disabled { color: #A5AFC6; background: #F7F8FC; }
+QPushButton[variant="primary"] {
+    color: #FFFFFF;
+    background: #5661F4;
+    border-color: #5661F4;
+}
+QPushButton[variant="danger"] { color: #D83E51; background: #FFF6F7; }
+QTableWidget#LocalAudioQueueTable {
+    background: #FFFFFF;
+    alternate-background-color: #FAFBFE;
+    border: 0;
+    gridline-color: #E8ECF5;
+    color: #263452;
+    selection-background-color: #EEF1FF;
+    selection-color: #111F46;
+}
+QTableWidget#LocalAudioQueueTable::item { padding: 8px; }
+QHeaderView::section {
+    background: #F5F7FC;
+    color: #53617F;
+    border: 0;
+    border-bottom: 1px solid #E1E6F1;
+    padding: 10px 8px;
+    font-weight: 700;
+}
+"""
+
+
+def _human_size(size: int) -> str:
+    value = max(0, int(size))
+    if value < 1024:
+        return f"{value} B"
+    if value < 1024 * 1024:
+        return f"{value / 1024:.1f} KB"
+    return f"{value / 1024 / 1024:.1f} MB"
+
+
+def _display_time(value: str) -> str:
+    raw = str(value or "").strip()
+    if not raw:
+        return "—"
+    try:
+        parsed = datetime.fromisoformat(raw.replace("Z", "+00:00"))
+    except ValueError:
+        return raw.replace("T", " ")
+    if parsed.tzinfo is not None:
+        parsed = parsed.astimezone(_BUSINESS_TIMEZONE)
+    return parsed.strftime("%Y-%m-%d %H:%M:%S")
+
+
+class LocalAudioQueueDialog(QDialog):
+    """Persistent local-audio list with concurrent upload and retry."""
+
+    def __init__(
+        self,
+        repository: Any,
+        diagnosis_id: int | None,
+        parent: QWidget | None = None,
+        *,
+        store: LocalAudioQueueStore | None = None,
+        manager: LocalAudioUploadManager | None = None,
+    ) -> None:
+        super().__init__(parent)
+        self.repository = repository
+        self._global_scope = diagnosis_id is None
+        self.diagnosis_id = int(diagnosis_id) if diagnosis_id is not None else None
+        if manager is None:
+            self.store, self.manager = get_local_audio_upload_manager(repository, store)
+        else:
+            self.store = store or manager.store
+            self.manager = manager
+        self._signature: tuple[Any, ...] = ()
+        self._room_fetch_generation = 0
+        self._room_fetch_inflight: set[int] = set()
+        self._room_fetch_attempted: set[int] = set()
+        self._room_fetch_errors: dict[int, str] = {}
+        self._closed = False
+
+        self.setObjectName("LocalAudioQueueDialog")
+        self.setProperty("businessDialog", True)
+        self.setWindowTitle(
+            "本机录音上传管理" if self._global_scope else "本机录音文件"
+        )
+        self.setModal(True)
+        self.setMinimumSize(760, 480)
+        self.resize(1160, 620)
+        self.setStyleSheet(_LOCAL_AUDIO_QSS)
+        self._build_ui()
+
+        self.poll_timer = QTimer(self)
+        self.poll_timer.setInterval(500)
+        self.poll_timer.timeout.connect(self.refresh_records)
+        self.poll_timer.start()
+        self.manager.submit_pending(diagnosis_id=self.diagnosis_id)
+        self.refresh_records(force=True)
+
+    def _build_ui(self) -> None:
+        root = QVBoxLayout(self)
+        root.setContentsMargins(18, 18, 18, 18)
+        root.setSpacing(12)
+
+        header = QFrame()
+        header.setObjectName("LocalAudioQueueHeader")
+        header_layout = QVBoxLayout(header)
+        header_layout.setContentsMargins(18, 14, 18, 14)
+        header_layout.setSpacing(4)
+        self.title_label = QLabel(
+            "本机录音上传管理" if self._global_scope else "本机录音文件"
+        )
+        self.title_label.setObjectName("LocalAudioQueueTitle")
+        header_layout.addWidget(self.title_label)
+        if self._global_scope:
+            subtitle_text = (
+                "集中查看所有诊单的本机录音上传记录；成功文件和未成功文件都会保留。"
+                "最多同时上传 3 个文件，失败后可重试。"
+            )
+        else:
+            subtitle_text = (
+                "每次通话的本地录音会先保存在本机，再上传到 COS；最多同时上传 3 个文件。"
+                "上传失败不会删除文件，可随时重试。"
+            )
+        subtitle = QLabel(subtitle_text)
+        subtitle.setObjectName("LocalAudioQueueSubtitle")
+        subtitle.setWordWrap(True)
+        header_layout.addWidget(subtitle)
+        root.addWidget(header)
+
+        summary = QFrame()
+        summary.setObjectName("LocalAudioQueueSummary")
+        summary_layout = QHBoxLayout(summary)
+        summary_layout.setContentsMargins(12, 10, 12, 10)
+        summary_layout.setSpacing(8)
+        self.summary_total = self._summary_label()
+        self.summary_pending = self._summary_label()
+        self.summary_uploading = self._summary_label()
+        self.summary_uploaded = self._summary_label()
+        self.summary_failed = self._summary_label()
+        for label in (
+            self.summary_total,
+            self.summary_pending,
+            self.summary_uploading,
+            self.summary_uploaded,
+            self.summary_failed,
+        ):
+            summary_layout.addWidget(label)
+        summary_layout.addStretch(1)
+        self.upload_pending_button = QPushButton("上传待处理")
+        self.upload_pending_button.setObjectName("LocalAudioUploadPendingButton")
+        self.upload_pending_button.setProperty("variant", "primary")
+        self.upload_pending_button.clicked.connect(self._upload_pending)
+        summary_layout.addWidget(self.upload_pending_button)
+        self.retry_failed_button = QPushButton("重试全部失败")
+        self.retry_failed_button.setObjectName("LocalAudioRetryAllButton")
+        self.retry_failed_button.setProperty("variant", "danger")
+        self.retry_failed_button.clicked.connect(self._retry_all_failed)
+        summary_layout.addWidget(self.retry_failed_button)
+        refresh_button = QPushButton("刷新")
+        refresh_button.setObjectName("LocalAudioRefreshButton")
+        refresh_button.clicked.connect(self._manual_refresh)
+        summary_layout.addWidget(refresh_button)
+        root.addWidget(summary)
+
+        card = QFrame()
+        card.setObjectName("LocalAudioQueueTableCard")
+        card_layout = QVBoxLayout(card)
+        card_layout.setContentsMargins(1, 1, 1, 1)
+        headers = ["录制时间"]
+        if self._global_scope:
+            headers.append("诊单 ID")
+        headers.extend(
+            [
+                "通话记录 ID",
+                "房间号",
+                "音频文件",
+                "大小",
+                "上传状态",
+                "失败原因",
+                "操作",
+            ]
+        )
+        self._diagnosis_column = 1 if self._global_scope else None
+        self._call_column = 2 if self._global_scope else 1
+        self._room_column = 3 if self._global_scope else 2
+        self._file_column = 4 if self._global_scope else 3
+        self._size_column = 5 if self._global_scope else 4
+        self._status_column = 6 if self._global_scope else 5
+        self._error_column = 7 if self._global_scope else 6
+        self._action_column = 8 if self._global_scope else 7
+
+        self.table = QTableWidget(0, len(headers))
+        self.table.setObjectName("LocalAudioQueueTable")
+        self.table.setHorizontalHeaderLabels(headers)
+        self.table.verticalHeader().hide()
+        self.table.setAlternatingRowColors(True)
+        self.table.setEditTriggers(QAbstractItemView.EditTrigger.NoEditTriggers)
+        self.table.setSelectionBehavior(QAbstractItemView.SelectionBehavior.SelectRows)
+        self.table.setSelectionMode(QAbstractItemView.SelectionMode.SingleSelection)
+        self.table.setWordWrap(False)
+        header_view = self.table.horizontalHeader()
+        header_view.setSectionResizeMode(QHeaderView.ResizeMode.Interactive)
+        header_view.setSectionResizeMode(
+            self._file_column, QHeaderView.ResizeMode.Stretch
+        )
+        header_view.setSectionResizeMode(
+            self._error_column, QHeaderView.ResizeMode.Stretch
+        )
+        self.table.setColumnWidth(0, 160)
+        if self._diagnosis_column is not None:
+            self.table.setColumnWidth(self._diagnosis_column, 90)
+        self.table.setColumnWidth(self._call_column, 90)
+        self.table.setColumnWidth(self._room_column, 180)
+        self.table.setColumnWidth(self._size_column, 88)
+        self.table.setColumnWidth(self._status_column, 100)
+        self.table.setColumnWidth(self._action_column, 190)
+        card_layout.addWidget(self.table)
+        root.addWidget(card, 1)
+
+        footer = QFrame()
+        footer.setObjectName("LocalAudioQueueFooter")
+        footer_layout = QHBoxLayout(footer)
+        footer_layout.setContentsMargins(14, 9, 14, 9)
+        hint = QLabel("已上传文件仍保留在本机；请按机构的数据保留制度定期归档。")
+        hint.setObjectName("LocalAudioQueueHint")
+        footer_layout.addWidget(hint, 1)
+        close_button = QPushButton("关闭")
+        close_button.setObjectName("LocalAudioQueueCloseButton")
+        close_button.setProperty("variant", "primary")
+        close_button.clicked.connect(self.accept)
+        footer_layout.addWidget(close_button)
+        root.addWidget(footer)
+
+    @staticmethod
+    def _summary_label() -> QLabel:
+        label = QLabel()
+        label.setProperty("queueSummary", True)
+        return label
+
+    def _records(self) -> list[LocalAudioRecord]:
+        return self.store.list_records(diagnosis_id=self.diagnosis_id)
+
+    def refresh_records(self, *, force: bool = False) -> None:
+        records = self._records()
+        self._schedule_room_lookups(records)
+        signature = tuple(
+            (
+                record.id,
+                record.diagnosis_id,
+                record.status,
+                record.error_text,
+                record.call_record_id,
+                record.room_id,
+                record.size_bytes,
+                record.uploaded_url,
+                record.exists,
+                record.attempts,
+                self._room_fetch_state(record),
+            )
+            for record in records
+        )
+        if not force and signature == self._signature:
+            return
+        self._signature = signature
+        self._update_summary(records)
+        self.table.setRowCount(len(records))
+        for row, record in enumerate(records):
+            self.table.setRowHeight(row, 54)
+            self._set_item(row, 0, _display_time(record.created_at))
+            if self._diagnosis_column is not None:
+                self._set_item(row, self._diagnosis_column, str(record.diagnosis_id))
+            self._set_item(
+                row, self._call_column, str(record.call_record_id or "待关联")
+            )
+            room_text, room_tooltip = self._room_display(record)
+            room_item = self._set_item(row, self._room_column, room_text)
+            room_item.setToolTip(room_tooltip)
+            file_item = self._set_item(row, self._file_column, record.file_path.name)
+            file_item.setToolTip(str(record.file_path))
+            self._set_item(row, self._size_column, _human_size(record.size_bytes))
+            status_item = self._set_item(
+                row,
+                self._status_column,
+                _STATUS_LABELS.get(record.status, record.status),
+            )
+            status_item.setForeground(QColor(_STATUS_COLORS.get(record.status, "#53617F")))
+            status_item.setToolTip(
+                f"已尝试 {record.attempts} 次"
+                + (f"\nCOS：{record.uploaded_url}" if record.uploaded_url else "")
+            )
+            error_item = self._set_item(
+                row, self._error_column, record.error_text or "—"
+            )
+            error_item.setToolTip(record.error_text)
+            self.table.setCellWidget(row, self._action_column, self._actions(record))
+
+    def _room_fetch_state(self, record: LocalAudioRecord) -> str:
+        diagnosis_id = record.diagnosis_id
+        if record.room_id:
+            return record.room_id
+        if diagnosis_id in self._room_fetch_inflight:
+            return "loading"
+        if diagnosis_id in self._room_fetch_errors:
+            return f"error:{self._room_fetch_errors[diagnosis_id]}"
+        if diagnosis_id in self._room_fetch_attempted:
+            return "missing"
+        return "idle"
+
+    def _room_display(self, record: LocalAudioRecord) -> tuple[str, str]:
+        if record.room_id:
+            return record.room_id, record.room_id
+        if record.call_record_id is None:
+            return "—", "尚未关联通话记录，无法取得房间号。"
+        diagnosis_id = record.diagnosis_id
+        if diagnosis_id in self._room_fetch_inflight:
+            return "查询中…", "正在从服务端通话记录查询房间号。"
+        error = self._room_fetch_errors.get(diagnosis_id)
+        if error:
+            return "获取失败", error
+        return "未记录", "服务端通话记录未保存房间号。"
+
+    def _schedule_room_lookups(self, records: list[LocalAudioRecord]) -> None:
+        if self._closed:
+            return
+        method = getattr(self.repository, "list_call_records", None)
+        if not callable(method):
+            method = getattr(self.repository, "get_call_records", None)
+        if not callable(method):
+            return
+
+        target_ids: dict[int, set[int]] = {}
+        for record in records:
+            call_record_id = int(record.call_record_id or 0)
+            if record.room_id or call_record_id <= 0:
+                continue
+            target_ids.setdefault(record.diagnosis_id, set()).add(call_record_id)
+        diagnosis_ids = tuple(
+            sorted(
+                diagnosis_id
+                for diagnosis_id in target_ids
+                if diagnosis_id not in self._room_fetch_inflight
+                and diagnosis_id not in self._room_fetch_attempted
+            )
+        )
+        if not diagnosis_ids:
+            return
+
+        generation = self._room_fetch_generation
+        self._room_fetch_inflight.update(diagnosis_ids)
+        self._room_fetch_attempted.update(diagnosis_ids)
+
+        def load_rooms() -> tuple[dict[tuple[int, int], str], dict[int, str]]:
+            rooms: dict[tuple[int, int], str] = {}
+            errors: dict[int, str] = {}
+            for diagnosis_id in diagnosis_ids:
+                try:
+                    payload = method(diagnosis_id)
+                    rows = payload if isinstance(payload, list) else []
+                    for row in rows:
+                        if not isinstance(row, Mapping):
+                            continue
+                        raw_record_id = row.get("id", row.get("call_record_id"))
+                        try:
+                            call_record_id = int(raw_record_id or 0)
+                        except (TypeError, ValueError):
+                            continue
+                        if call_record_id not in target_ids[diagnosis_id]:
+                            continue
+                        room_id = str(
+                            row.get("room_id")
+                            or row.get("roomId")
+                            or row.get("room_id_text")
+                            or row.get("room_no")
+                            or ""
+                        ).strip()
+                        if room_id and room_id != "0":
+                            rooms[(diagnosis_id, call_record_id)] = room_id
+                except Exception as error:
+                    errors[diagnosis_id] = str(error)[:300] or "房间号获取失败。"
+            return rooms, errors
+
+        run_async(
+            load_rooms,
+            on_success=lambda result: self._apply_room_lookups(
+                generation,
+                diagnosis_ids,
+                result,
+            ),
+            on_error=lambda error: self._fail_room_lookups(
+                generation,
+                diagnosis_ids,
+                error,
+            ),
+        )
+
+    def _apply_room_lookups(
+        self,
+        generation: int,
+        diagnosis_ids: tuple[int, ...],
+        result: tuple[dict[tuple[int, int], str], dict[int, str]],
+    ) -> None:
+        if self._closed or generation != self._room_fetch_generation:
+            return
+        rooms, errors = result
+        self._room_fetch_inflight.difference_update(diagnosis_ids)
+        self._room_fetch_errors.update(errors)
+        records_by_key: dict[tuple[int, int], list[LocalAudioRecord]] = {}
+        for record in self._records():
+            if record.call_record_id is None:
+                continue
+            key = (record.diagnosis_id, record.call_record_id)
+            records_by_key.setdefault(key, []).append(record)
+        for key, room_id in rooms.items():
+            for record in records_by_key.get(key, []):
+                try:
+                    self.store.bind_identity(
+                        record.id,
+                        call_record_id=key[1],
+                        room_id=room_id,
+                    )
+                except (LookupError, RuntimeError, ValueError) as error:
+                    self._room_fetch_errors[key[0]] = str(error)[:300]
+        self.refresh_records(force=True)
+
+    def _fail_room_lookups(
+        self,
+        generation: int,
+        diagnosis_ids: tuple[int, ...],
+        error: Exception,
+    ) -> None:
+        if self._closed or generation != self._room_fetch_generation:
+            return
+        self._room_fetch_inflight.difference_update(diagnosis_ids)
+        message = str(error)[:300] or "房间号获取失败。"
+        self._room_fetch_errors.update(
+            {diagnosis_id: message for diagnosis_id in diagnosis_ids}
+        )
+        self.refresh_records(force=True)
+
+    def _manual_refresh(self) -> None:
+        self._room_fetch_generation += 1
+        self._room_fetch_inflight.clear()
+        self._room_fetch_attempted.clear()
+        self._room_fetch_errors.clear()
+        self.refresh_records(force=True)
+
+    def _set_item(self, row: int, column: int, text: str) -> QTableWidgetItem:
+        item = QTableWidgetItem(str(text))
+        item.setTextAlignment(Qt.AlignmentFlag.AlignVCenter | Qt.AlignmentFlag.AlignLeft)
+        self.table.setItem(row, column, item)
+        return item
+
+    def _update_summary(self, records: list[LocalAudioRecord]) -> None:
+        counts = {status: 0 for status in _STATUS_LABELS}
+        for record in records:
+            counts[record.status] = counts.get(record.status, 0) + 1
+        self.summary_total.setText(f"全部 {len(records)}")
+        self.summary_pending.setText(f"待上传 {counts['pending']}")
+        self.summary_uploading.setText(f"上传中 {counts['uploading']}")
+        self.summary_uploaded.setText(f"已上传 {counts['uploaded']}")
+        self.summary_failed.setText(f"失败 {counts['failed']}")
+        self.upload_pending_button.setEnabled(counts["pending"] > 0)
+        self.retry_failed_button.setEnabled(counts["failed"] > 0)
+
+    def _actions(self, record: LocalAudioRecord) -> QWidget:
+        host = QWidget()
+        layout = QHBoxLayout(host)
+        layout.setContentsMargins(4, 5, 4, 5)
+        layout.setSpacing(5)
+        if record.status == "pending":
+            upload = QPushButton("上传")
+            upload.setAccessibleName(f"上传录音 {record.file_path.name}")
+            upload.clicked.connect(lambda _checked=False, record_id=record.id: self._upload_one(record_id))
+            layout.addWidget(upload)
+        elif record.status == "failed":
+            retry = QPushButton("重试")
+            retry.setProperty("variant", "danger")
+            retry.setAccessibleName(f"重试上传录音 {record.file_path.name}")
+            retry.clicked.connect(lambda _checked=False, record_id=record.id: self._retry_one(record_id))
+            layout.addWidget(retry)
+        elif record.status == "uploading":
+            busy = QPushButton("上传中")
+            busy.setEnabled(False)
+            layout.addWidget(busy)
+        if record.exists:
+            reveal = QPushButton("打开位置")
+            reveal.setAccessibleName(f"打开录音文件位置 {record.file_path.name}")
+            reveal.clicked.connect(
+                lambda _checked=False, path=record.file_path: self._open_location(path)
+            )
+            layout.addWidget(reveal)
+        layout.addStretch(1)
+        return host
+
+    def _upload_pending(self) -> None:
+        self.manager.submit_pending(diagnosis_id=self.diagnosis_id)
+        self.refresh_records(force=True)
+
+    def _upload_one(self, record_id: int) -> None:
+        self.manager.submit(record_id)
+        self.refresh_records(force=True)
+
+    def _retry_one(self, record_id: int) -> None:
+        try:
+            self.store.retry(record_id)
+        except (OSError, RuntimeError, LookupError) as error:
+            self._show_local_error(str(error))
+            return
+        self.manager.submit(record_id)
+        self.refresh_records(force=True)
+
+    def _retry_all_failed(self) -> None:
+        for record in self._records():
+            if record.status != "failed":
+                continue
+            try:
+                self.store.retry(record.id)
+            except (OSError, RuntimeError, LookupError):
+                continue
+            self.manager.submit(record.id)
+        self.refresh_records(force=True)
+
+    def _show_local_error(self, message: str) -> None:
+        self.summary_failed.setText(str(message)[:160])
+        self.summary_failed.setToolTip(str(message))
+
+    @staticmethod
+    def _open_location(path: Path) -> None:
+        target = path.parent if path.parent.is_dir() else path
+        QDesktopServices.openUrl(QUrl.fromLocalFile(str(target)))
+
+    def done(self, result: int) -> None:
+        self._closed = True
+        self._room_fetch_generation += 1
+        if hasattr(self, "poll_timer"):
+            self.poll_timer.stop()
+        super().done(result)

app/src/doctor_workstation/ui/dialogs/prescription_ai.py

@@ -8,7 +8,7 @@ from collections.abc import Callable
 from dataclasses import dataclass, field
 from typing import Any
 
-from PySide6.QtCore import Qt
+from PySide6.QtCore import QCoreApplication, QEvent, Qt
 from PySide6.QtWidgets import (
     QDialog,
     QFrame,
@@ -1086,11 +1086,15 @@ class PrescriptionAiReportDialog(QDialog):
 
     def _clear_host(self) -> None:
         while self.host_layout.count():
-            item = self.host_layout.takeAt(0)
-            widget = item.widget()
-            if widget is not None:
-                widget.setParent(None)
-                widget.deleteLater()
+            item = self.host_layout.takeAt(0)
+            widget = item.widget()
+            if widget is not None:
+                # Keep the parent until Qt processes the deferred deletion.
+                # Detaching a visible child promotes it to a native top-level
+                # window on Windows and causes a small title-bar window to flash.
+                widget.hide()
+                widget.deleteLater()
+                QCoreApplication.sendPostedEvents(widget, QEvent.Type.DeferredDelete)
 
     def _add_label(
         self,

app/src/doctor_workstation/ui/pages/appointments.py

@@ -9,8 +9,8 @@ from html import escape
 from types import MappingProxyType
 from typing import Any
 
-from PySide6.QtCore import QDate, QSize, Qt, QTimer, QUrl, Signal
-from PySide6.QtGui import QAction, QBrush, QColor, QDesktopServices, QPixmap
+from PySide6.QtCore import QDate, Qt, QTimer, QUrl, Signal
+from PySide6.QtGui import QBrush, QColor, QDesktopServices, QPixmap
 from PySide6.QtWidgets import (
     QAbstractItemView,
     QButtonGroup,
@@ -21,10 +21,9 @@ from PySide6.QtWidgets import (
     QDialogButtonBox,
     QFrame,
     QHBoxLayout,
+    QHeaderView,
     QLabel,
     QLineEdit,
-    QListWidget,
-    QListWidgetItem,
     QMenu,
     QMessageBox,
     QPushButton,
@@ -104,8 +103,7 @@ APPOINTMENTS_LIGHT_QSS = """
     border: 1px solid #E2E7F4;
     border-radius: 10px;
 }
-#AppointmentsPage QFrame#AppointmentMainCard,
-#AppointmentsPage QFrame#VideoConsultPanel {
+#AppointmentsPage QFrame#AppointmentMainCard {
     background-color: #FFFFFF;
     border: 1px solid #E2E7F4;
     border-radius: 10px;
@@ -209,6 +207,34 @@ APPOINTMENTS_LIGHT_QSS = """
     border-radius: 4px;
     font-size: 10px;
 }
+#AppointmentsPage QWidget[appointmentImHost="true"] {
+    background-color: transparent;
+}
+#AppointmentsPage QPushButton[appointmentImAction="true"] {
+    min-width: 74px;
+    min-height: 26px;
+    max-height: 26px;
+    padding: 0 9px;
+    color: #5265F6;
+    background-color: #F0F2FF;
+    border: 1px solid #D7DEFF;
+    border-radius: 7px;
+    font-size: 11px;
+    font-weight: 600;
+}
+#AppointmentsPage QPushButton[appointmentImAction="true"]:hover {
+    color: #FFFFFF;
+    background-color: #5265F6;
+    border-color: #5265F6;
+}
+#AppointmentsPage QPushButton[appointmentImAction="true"]:focus {
+    border-color: #8D9BFF;
+}
+#AppointmentsPage QPushButton[appointmentImAction="true"]:disabled {
+    color: #98A3BC;
+    background-color: #F7F8FC;
+    border-color: #E4E8F2;
+}
 #AppointmentsPage QWidget[appointmentInfoHost="true"] {
     background-color: #FFFFFF;
 }
@@ -257,77 +283,6 @@ APPOINTMENTS_LIGHT_QSS = """
     background-color: #EEF1FF;
     border-bottom-color: #5265F6;
 }
-#AppointmentsPage QLabel#VideoConsultTitle {
-    color: #15224A;
-    font-size: 16px;
-    font-weight: 700;
-}
-#AppointmentsPage QListWidget#VideoConsultList {
-    background-color: transparent;
-    border: 0;
-    border-radius: 0;
-    outline: 0;
-}
-#AppointmentsPage QListWidget#VideoConsultList::item {
-    min-height: 80px;
-    margin: 0 0 7px 0;
-    padding: 0;
-    background-color: transparent;
-    border: 0;
-}
-#AppointmentsPage QListWidget#VideoConsultList::item:hover {
-    background-color: transparent;
-}
-#AppointmentsPage QListWidget#VideoConsultList::item:selected {
-    background-color: transparent;
-}
-#AppointmentsPage QFrame[videoPatientCard="true"] {
-    background-color: #FCFDFF;
-    border: 1px solid #E1E6F1;
-    border-radius: 9px;
-}
-#AppointmentsPage QFrame[videoPatientCard="true"]:hover {
-    background-color: #F9FAFF;
-    border-color: #C9D2FF;
-}
-#AppointmentsPage QLabel[videoStatus="true"] {
-    min-height: 20px;
-    max-height: 20px;
-    padding: 0 7px;
-    color: #5265F6;
-    background-color: #EEF1FF;
-    border-radius: 5px;
-    font-size: 10px;
-    font-weight: 600;
-}
-#AppointmentsPage QLabel[videoStatusKind="warning"] {
-    color: #B97715;
-    background-color: #FFF4DF;
-}
-#AppointmentsPage QLabel[videoIdentity="true"] {
-    color: #24335E;
-    font-size: 12px;
-    font-weight: 600;
-}
-#AppointmentsPage QLabel[videoAssistant="true"] {
-    color: #59698E;
-    font-size: 11px;
-}
-#AppointmentsPage QPushButton[videoAction="true"] {
-    min-height: 20px;
-    max-height: 20px;
-    padding: 0 5px;
-    color: #5265F6;
-    background-color: transparent;
-    border: 0;
-    border-radius: 4px;
-    font-size: 10px;
-}
-#AppointmentsPage QPushButton[videoAction="true"]:hover {
-    background-color: #EEF1FF;
-}
-#AppointmentsPage QPushButton[videoActionKind="success"] { color: #159C79; }
-#AppointmentsPage QPushButton[videoActionKind="warning"] { color: #C17A16; }
 #AppointmentsPage QPushButton[filterChoice="true"] {
     min-height: 28px;
     max-height: 28px;
@@ -342,11 +297,6 @@ APPOINTMENTS_LIGHT_QSS = """
     background-color: #F0F1FF;
     border-color: #E0E4FF;
 }
-#AppointmentsPage QPushButton#VideoMoreButton {
-    min-height: 36px;
-    color: #405074;
-    background-color: #FFFFFF;
-}
 """
 
 
@@ -452,14 +402,37 @@ def _status_value(row: Any) -> int:
     return _as_int(first_value(row, "status", default=0))
 
 
+_IM_CONSULT_ACTIVE_STATUSES = frozenset({1, 4})
+
+
+def _im_consult_status_error(row: Any) -> str:
+    """Return why a queue row cannot open the doctor's IM consultation."""
+
+    status = _status_value(row)
+    if status in _IM_CONSULT_ACTIVE_STATUSES:
+        return ""
+    if status == 2:
+        return "已取消的挂号不可进入 IM 问诊"
+    if status == 3:
+        return "已完成的挂号不可再进入 IM 问诊"
+    return "当前挂号状态不可进入 IM 问诊"
+
+
 def prescription_action_label(row: Any) -> str:
     audit = _as_int(first_value(row, "prescription_audit_status", "audit_status"), -1)
     voided = _as_int(first_value(row, "prescription_void_status", "void_status"), 0)
-    explicit = first_value(row, "has_prescription", default=None)
+    explicit = first_value(row, "current_has_prescription", default=None)
+    if explicit is None and _as_int(first_value(row, "current_prescription_id", default=0)) <= 0:
+        explicit = first_value(row, "has_prescription", default=None)
     has_prescription = (
         _as_bool(explicit)
         if explicit is not None
-        else _as_int(first_value(row, "prescription_id", default=0), 0) > 0 or audit in {0, 1, 2}
+        else _as_int(
+            first_value(row, "current_prescription_id", "prescription_id", default=0),
+            0,
+        )
+        > 0
+        or audit in {0, 1, 2}
     )
     if not has_prescription:
         return "开方"
@@ -689,7 +662,6 @@ class AppointmentsPage(QWidget):
         self._dict_labels: dict[str, dict[str, str]] = {}
         self._last_render_signature: tuple[Any, ...] | None = None
         self._responsive_narrow: bool | None = None
-        self._video_panel_user_open = False
         self._can_plain_phone = _canonical_allowed(
             permissions, "tcm.diagnosis/phonePlain", default=False
         )
@@ -889,35 +861,9 @@ class AppointmentsPage(QWidget):
         layout.setSpacing(4)
         self.content_layout = layout
         self.table_card = self._build_table_card()
-        self.video_panel = self._build_video_panel()
-        layout.addWidget(self.table_card, 3)
-        layout.addWidget(self.video_panel, 1)
+        layout.addWidget(self.table_card, 1)
         return host
 
-    def _build_video_panel(self) -> QWidget:
-        panel = QFrame()
-        panel.setObjectName("VideoConsultPanel")
-        panel.setMinimumWidth(0)
-        panel.setMaximumWidth(420)
-        layout = QVBoxLayout(panel)
-        layout.setContentsMargins(14, 12, 14, 8)
-        layout.setSpacing(8)
-        title = QLabel("视频问诊")
-        title.setObjectName("VideoConsultTitle")
-        layout.addWidget(title)
-        self.video_list = QListWidget()
-        self.video_list.setObjectName("VideoConsultList")
-        self.video_list.setSpacing(0)
-        self.video_list.setVerticalScrollMode(QAbstractItemView.ScrollMode.ScrollPerPixel)
-        self.video_list.currentRowChanged.connect(self._video_row_selected)
-        self.video_list.itemDoubleClicked.connect(lambda _item: self._open_detail())
-        layout.addWidget(self.video_list, 1)
-        more = QPushButton("查看更多患者  ﹀")
-        more.setObjectName("VideoMoreButton")
-        more.clicked.connect(lambda: self.pager.next.click())
-        layout.addWidget(more)
-        return panel
-
     def _build_table_card(self) -> QWidget:
         card = QFrame()
         card.setObjectName("AppointmentMainCard")
@@ -1004,12 +950,6 @@ class AppointmentsPage(QWidget):
         self.toolbar_cancel_button.setEnabled(False)
         self.toolbar_cancel_button.clicked.connect(self._cancel_selected)
         actions.addWidget(self.toolbar_cancel_button)
-        self.video_panel_button = QPushButton("视频问诊", card)
-        self.video_panel_button.setCheckable(True)
-        self.video_panel_button.setProperty("variant", "ghost")
-        self.video_panel_button.setProperty("compactAction", True)
-        self.video_panel_button.clicked.connect(self._toggle_video_panel)
-        actions.addWidget(self.video_panel_button)
         actions.addStretch(1)
         refresh = QPushButton("刷新", card)
         refresh.setProperty("variant", "ghost")
@@ -1034,13 +974,23 @@ class AppointmentsPage(QWidget):
                 TableColumn("assistant_name", "助理", 110),
                 TableColumn("has_prescription", "开方", 108, formatter=_prescription_cell),
                 TableColumn("unserved_days", "未服务天数", 112, formatter=_unserved_cell),
+                TableColumn(
+                    "_im_consult",
+                    "IM 问诊",
+                    104,
+                    alignment=Qt.AlignmentFlag.AlignCenter,
+                ),
             ]
         )
         self.table.setObjectName("AppointmentTable")
         self.table.setMinimumHeight(0)
         self.table.setWordWrap(True)
         self.table.setVerticalScrollMode(QAbstractItemView.ScrollMode.ScrollPerPixel)
-        self.table.horizontalHeader().setFixedHeight(34)
+        header = self.table.horizontalHeader()
+        header.setFixedHeight(34)
+        header.setStretchLastSection(False)
+        header.setSectionResizeMode(4, QHeaderView.ResizeMode.Stretch)
+        header.setSectionResizeMode(10, QHeaderView.ResizeMode.Fixed)
         self.table.verticalHeader().setDefaultSectionSize(60)
         self.table.itemSelectionChanged.connect(self._selection_changed)
         self.table.itemDoubleClicked.connect(lambda _item: self._open_detail())
@@ -1051,157 +1001,21 @@ class AppointmentsPage(QWidget):
         layout.addWidget(self.pager)
         return card
 
-    def _toggle_video_panel(self, checked: bool) -> None:
-        self._video_panel_user_open = checked
-        self._apply_responsive_layout()
-
     def _apply_responsive_layout(self) -> None:
-        """Keep the table usable while retaining a video-list entry at low widths."""
+        """Collapse only the date filters when horizontal space is limited."""
 
-        panel = getattr(self, "video_panel", None)
-        button = getattr(self, "video_panel_button", None)
-        if not isinstance(panel, QWidget) or not isinstance(button, QPushButton):
-            return
         narrow = self.width() < 1120
         for preset in ("yesterday", "day_before", "tomorrow", "day_after"):
             self.date_buttons[preset].setVisible(not narrow)
         self.date_overflow_button.setVisible(narrow)
         self.status_filter_label.setVisible(not narrow)
         self.confirm_filter_label.setVisible(not narrow)
-        if narrow:
-            if self._responsive_narrow is not True:
-                self._video_panel_user_open = False
-            button.show()
-            button.setChecked(self._video_panel_user_open)
-            panel.setVisible(self._video_panel_user_open)
-            if self._video_panel_user_open:
-                panel.setFixedWidth(max(250, min(300, round(self.width() * 0.32))))
-        else:
-            button.hide()
-            button.setChecked(False)
-            panel.show()
-            panel.setFixedWidth(max(300, min(420, round(self.width() * 0.30))))
         self._responsive_narrow = narrow
 
     def resizeEvent(self, event: Any) -> None:
         super().resizeEvent(event)
         self._apply_responsive_layout()
 
-    def _sync_video_list(self, rows: Sequence[Any]) -> None:
-        selected_id = (
-            _appointment_id(self.video_list.currentItem().data(Qt.ItemDataRole.UserRole))
-            if self.video_list.currentItem()
-            else 0
-        )
-        self.video_list.clear()
-        row_to_select = -1
-        for index, row in enumerate(rows):
-            status = display_text(first_value(row, "status_desc"), "已预约")
-            name = display_text(first_value(row, "patient_name"), "患者")
-            gender = gender_text(first_value(row, "gender", "gender_desc", default=None))
-            age = first_value(row, "age", default="")
-            identity = " · ".join(
-                part
-                for part in (name, gender, f"{age}岁" if age not in (None, "") else "")
-                if part and part != "—"
-            )
-            assistant = display_text(first_value(row, "assistant_name"), "未分配")
-            item = QListWidgetItem(
-                f"{status}   {identity}      {assistant}\n"
-                "进入视频问诊   查看   诊单   开方   预约   补全身份"
-            )
-            item.setData(Qt.ItemDataRole.UserRole, row)
-            item.setSizeHint(QSize(0, 84))
-            self.video_list.addItem(item)
-            self.video_list.setItemWidget(item, self._build_video_patient_card(row))
-            if selected_id and _appointment_id(row) == selected_id:
-                row_to_select = index
-        if row_to_select >= 0:
-            self.video_list.setCurrentRow(row_to_select)
-        else:
-            self.video_list.setCurrentRow(-1)
-        self.video_panel_button.setText(f"视频问诊 {len(rows)}")
-
-    def _build_video_patient_card(self, row: Any) -> QWidget:
-        card = QFrame()
-        card.setProperty("videoPatientCard", True)
-        layout = QVBoxLayout(card)
-        layout.setContentsMargins(10, 7, 10, 6)
-        layout.setSpacing(5)
-
-        status_text = display_text(first_value(row, "status_desc"), "已预约")
-        name = display_text(first_value(row, "patient_name"), "患者")
-        gender = gender_text(first_value(row, "gender", "gender_desc", default=None))
-        age = first_value(row, "age", default="")
-        identity = " · ".join(
-            part
-            for part in (name, gender, f"{age}岁" if age not in (None, "") else "")
-            if part and part != "—"
-        )
-        assistant = display_text(first_value(row, "assistant_name"), "未分配")
-        heading = QHBoxLayout()
-        heading.setContentsMargins(0, 0, 0, 0)
-        heading.setSpacing(7)
-        status = QLabel(status_text)
-        status.setProperty("videoStatus", True)
-        status.setProperty("videoStatusKind", "warning" if "挂号" in status_text else "primary")
-        heading.addWidget(status)
-        identity_label = QLabel(identity)
-        identity_label.setProperty("videoIdentity", True)
-        heading.addWidget(identity_label)
-        heading.addStretch(1)
-        assistant_label = QLabel(assistant)
-        assistant_label.setProperty("videoAssistant", True)
-        heading.addWidget(assistant_label)
-        layout.addLayout(heading)
-
-        actions = QHBoxLayout()
-        actions.setContentsMargins(0, 0, 0, 0)
-        actions.setSpacing(1)
-
-        def add_action(
-            label: str,
-            callback: Any,
-            permission: str | None = None,
-            kind: str = "",
-        ) -> None:
-            if permission and not _canonical_allowed(self.permissions, permission, default=False):
-                return
-            button = QPushButton(label, card)
-            button.setProperty("videoAction", True)
-            if kind:
-                button.setProperty("videoActionKind", kind)
-            button.clicked.connect(
-                lambda _checked=False, source=row, slot=callback: self._run_video_row_action(
-                    source, slot
-                )
-            )
-            actions.addWidget(button)
-
-        add_action(
-            "进入视频问诊",
-            self._request_video,
-            "doctor.appointment/prescription",
-        )
-        add_action("查看", self._open_detail)
-        add_action("诊单", self._edit_patient, "tcm.diagnosis/edit")
-        if can_open_ai_consult(self.permissions):
-            add_action("AI 分析", self._open_ai_consult)
-        add_action("开方", self._open_prescription, "tcm.diagnosis/kaifang")
-        add_action("二维码", self._request_video_qr, "tcm.diagnosis/videoQr", "success")
-        more = QPushButton("更多", card)
-        more.setProperty("videoAction", True)
-        more.setProperty("videoActionKind", "warning")
-        more.clicked.connect(
-            lambda _checked=False, source=row, anchor=more: self._show_video_more_menu(
-                anchor, source
-            )
-        )
-        actions.addWidget(more)
-        actions.addStretch(1)
-        layout.addLayout(actions)
-        return card
-
     def _run_video_row_action(self, row: Any, callback: Any) -> None:
         appointment_id = _appointment_id(row)
         for row_index in range(self.table.rowCount()):
@@ -1214,47 +1028,6 @@ class AppointmentsPage(QWidget):
                 break
         callback()
 
-    def _show_video_more_menu(self, anchor: QPushButton, row: Any) -> None:
-        menu = QMenu(anchor)
-
-        def add_action(label: str, callback: Any, permission: str | None = None) -> None:
-            if permission and not _canonical_allowed(self.permissions, permission, default=False):
-                return
-            action = QAction(label, menu)
-            action.triggered.connect(
-                lambda _checked=False, source=row, slot=callback: self._run_video_row_action(
-                    source, slot
-                )
-            )
-            menu.addAction(action)
-
-        add_action("完成问诊", self._complete_selected, "doctor.appointment/complete")
-        add_action("查看病历", self._view_case, "tcm.diagnosis/kaifang")
-        if can_open_ai_consult(self.permissions):
-            add_action("AI 分析", self._open_ai_consult)
-        if can_open_diagnosis_ai_report(self.permissions):
-            add_action("AI 报告", self._open_ai_report)
-        add_action("取消挂号", self._cancel_selected, "doctor.appointment/cancel")
-        if menu.actions():
-            menu.exec(anchor.mapToGlobal(anchor.rect().bottomLeft()))
-
-    def _video_row_selected(self, index: int) -> None:
-        if index < 0:
-            return
-        item = self.video_list.item(index)
-        source = item.data(Qt.ItemDataRole.UserRole) if item is not None else None
-        appointment_id = _appointment_id(source)
-        if appointment_id <= 0:
-            return
-        for row_index in range(self.table.rowCount()):
-            cell = self.table.item(row_index, 0)
-            if (
-                cell is not None
-                and _appointment_id(cell.data(Qt.ItemDataRole.UserRole)) == appointment_id
-            ):
-                self.table.selectRow(row_index)
-                break
-
     def _action_button(
         self,
         label: str,
@@ -1484,7 +1257,7 @@ class AppointmentsPage(QWidget):
         self.table.set_rows(rows)
         self._install_table_selectors()
         self._install_appointment_info_cells()
-        self._sync_video_list(rows)
+        self._install_im_consult_actions()
         self._fit_table_rows()
         for row_index in range(self.table.rowCount()):
             source_item = self.table.item(row_index, 0)
@@ -1634,6 +1407,67 @@ class AppointmentsPage(QWidget):
                 font.setBold(True)
                 patient.setFont(font)
 
+    def _install_im_consult_actions(self) -> None:
+        """Render a doctor-initiated IM entry for every appointment row."""
+
+        action_column = 10
+        has_permission = _canonical_allowed(
+            self.permissions,
+            "doctor.appointment/prescription",
+            default=False,
+        )
+        for row_index in range(self.table.rowCount()):
+            source_item = self.table.item(row_index, 0)
+            row = source_item.data(Qt.ItemDataRole.UserRole) if source_item is not None else None
+            host = QWidget(self.table)
+            host.setProperty("appointmentImHost", True)
+            host.setAttribute(Qt.WidgetAttribute.WA_StyledBackground, True)
+            layout = QHBoxLayout(host)
+            layout.setContentsMargins(5, 0, 5, 0)
+            layout.setAlignment(Qt.AlignmentFlag.AlignCenter)
+
+            button = QPushButton("IM 问诊", host)
+            button.setObjectName("AppointmentImConsultButton")
+            button.setProperty("appointmentImAction", True)
+            patient_name = display_text(first_value(row, "patient_name"), "患者")
+            button.setAccessibleName(f"与{patient_name}进行 IM 问诊")
+
+            identifiers_ready = (
+                _appointment_id(row) > 0
+                and _diagnosis_id(row) > 0
+                and _video_patient_id(row) > 0
+            )
+            status_error = _im_consult_status_error(row)
+            enabled = (
+                has_permission
+                and self._native_video_capable
+                and identifiers_ready
+                and not status_error
+            )
+            button.setEnabled(enabled)
+            if not has_permission:
+                tooltip = "当前账号无 IM 问诊权限"
+            elif not self._native_video_capable:
+                tooltip = "当前工作站未配置完整的视频问诊能力"
+            elif not identifiers_ready:
+                tooltip = "患者、诊单或挂号标识不完整"
+            elif status_error:
+                tooltip = status_error
+            else:
+                tooltip = "打开患者 IM，可发送消息并从会话中发起视频"
+            button.setToolTip(tooltip)
+            button.clicked.connect(
+                lambda _checked=False, source=row: self._run_video_row_action(
+                    source,
+                    self._request_video,
+                )
+            )
+            layout.addWidget(button)
+            self.table.setCellWidget(row_index, action_column, host)
+            item = self.table.item(row_index, action_column)
+            if item is not None:
+                item.setText("")
+
     def _fit_table_rows(self) -> None:
         """Give each appointment row enough height for its real line count."""
 
@@ -1685,7 +1519,12 @@ class AppointmentsPage(QWidget):
             and _as_int(first_value(row, "doctor_id", default=0)) > 0
         )
         self.call_button.setEnabled(
-            not_completed and self._native_video_capable and _appointment_id(row) > 0
+            has_row
+            and not _im_consult_status_error(row)
+            and self._native_video_capable
+            and _appointment_id(row) > 0
+            and _diagnosis_id(row) > 0
+            and _video_patient_id(row) > 0
         )
         self.complete_button.setEnabled(not_completed and _appointment_id(row) > 0)
         self.prescription_button.setEnabled(has_row and _diagnosis_id(row) > 0)
@@ -1760,15 +1599,15 @@ class AppointmentsPage(QWidget):
         row = self._current_row()
         if row is None:
             return
-        status = _status_value(row)
-        if status == 3:
-            show_toast(self, "已完成的挂号不可再发起通话。", "warning")
+        status_error = _im_consult_status_error(row)
+        if status_error:
+            show_toast(self, f"{status_error}。", "warning")
             return
         appointment_id = _appointment_id(row)
         diagnosis_id = _diagnosis_id(row)
         patient_id = _video_patient_id(row)
         if appointment_id <= 0 or diagnosis_id <= 0 or patient_id <= 0:
-            show_toast(self, "患者、诊单或挂号标识不完整，无法进入视频问诊。", "warning")
+            show_toast(self, "患者、诊单或挂号标识不完整，无法进入 IM 问诊。", "warning")
             return
         self.video_requested.emit(
             {
@@ -1777,6 +1616,8 @@ class AppointmentsPage(QWidget):
                 "patient_id": patient_id,
                 "diagnosis_id": diagnosis_id,
                 "patient_name": first_value(row, "patient_name", default="患者"),
+                # Open IM first. The doctor explicitly starts video from the
+                # conversation instead of requiring an already-live call.
                 "mode": "im",
                 "record": row,
             }
@@ -2069,7 +1910,8 @@ class AppointmentsPage(QWidget):
         if _diagnosis_id(row) <= 0 or _appointment_id(row) <= 0:
             show_toast(self, "该预约缺少诊单信息，请先编辑患者。", "warning")
             return
-        self._begin_prescription_load(row)
+        mode = "view" if prescription_action_label(row) == "查看" else "open"
+        self._begin_prescription_load(row, mode=mode)
 
     def _view_case(self) -> None:
         if not _canonical_allowed(self.permissions, "tcm.diagnosis/kaifang", default=False):
@@ -2112,7 +1954,7 @@ class AppointmentsPage(QWidget):
         dialog.diagnosis_requested.connect(self._open_diagnosis_id)
         dialog.exec()
 
-    def _begin_prescription_load(self, row: Any) -> None:
+    def _begin_prescription_load(self, row: Any, *, mode: str = "open") -> None:
         snapshot = deepcopy(row)
         self._prescription_generation += 1
         generation = self._prescription_generation
@@ -2126,18 +1968,51 @@ class AppointmentsPage(QWidget):
                 "get_prescription_by_appointment",
                 appointment_id=appointment_id,
             ),
-            on_success=lambda existing: self._prescription_loaded(existing, snapshot, generation),
+            on_success=lambda existing: self._prescription_loaded(
+                existing,
+                snapshot,
+                generation,
+                mode,
+            ),
             on_error=lambda error: self._prescription_error(error, generation),
             on_finished=lambda: self._prescription_finished(generation),
         )
 
-    def _prescription_loaded(self, existing: Any, row: Any, generation: int) -> None:
+    def _prescription_loaded(
+        self,
+        existing: Any,
+        row: Any,
+        generation: int,
+        mode: str = "open",
+    ) -> None:
         if generation != self._prescription_generation:
             return
         self.banner.clear()
         if existing is not None and _as_int(first_value(existing, "id", default=0)) > 0:
             approved = _as_int(first_value(existing, "audit_status", "status"), -1) == 1
             voided = _as_int(first_value(existing, "void_status", "is_void"), 0) == 1
+            actual_id = _as_int(first_value(existing, "id", "prescription_id", default=0))
+            expected_id = _as_int(
+                first_value(row, "current_prescription_id", default=0)
+            )
+            actual_appointment_id = _as_int(
+                first_value(existing, "appointment_id", default=0)
+            )
+            expected_appointment_id = _appointment_id(row)
+            identity_changed = (
+                (expected_id > 0 and actual_id != expected_id)
+                or (
+                    actual_appointment_id > 0
+                    and expected_appointment_id > 0
+                    and actual_appointment_id != expected_appointment_id
+                )
+            )
+            if mode == "view" and (not approved or voided or identity_changed):
+                self.banner.show_message(
+                    "当前挂号的处方状态已变化，请刷新列表后重试。",
+                    "warning",
+                )
+                return
             if not approved or voided:
                 self._open_existing_prescription_editor(existing)
             else:
@@ -2151,6 +2026,12 @@ class AppointmentsPage(QWidget):
                 dialog.diagnosis_requested.connect(self._open_diagnosis_id)
                 dialog.exec()
             return
+        if mode == "view":
+            self.banner.show_message(
+                "当前挂号没有可查看的处方，请刷新列表后重试。",
+                "warning",
+            )
+            return
         self._begin_case_record_load(row)
 
     def _open_existing_prescription_editor(self, prescription: Any) -> None:

app/src/doctor_workstation/ui/pages/consultations.py

@@ -45,6 +45,8 @@ from ..diagnosis_index_widgets import (
     DiagnosisPager,
     DiagnosisTableHost,
     FlowWidget,
+    prescription_action,
+    video_call_is_live,
 )
 from ..dialogs import DiagnosisDialog
 from ..dialogs.ai_consult import can_open_ai_consult, present_ai_consult
@@ -373,6 +375,9 @@ def _video_payload(record: Any) -> dict[str, Any]:
         "patient_id": first_value(record, "patient_id", "source_patient_id"),
         "diagnosis_id": first_value(record, "diagnosis_id", "id"),
         "patient_name": first_value(record, "patient_name", default="患者"),
+        # This page is the assistant/admin receiver.  IM mode logs in and waits
+        # for the doctor's existing invitation; it must never call startCall.
+        "mode": "im",
         "record": record,
     }
 
@@ -389,17 +394,7 @@ def is_diagnosis_confirmed(record: Any) -> bool:
 
 
 def prescription_action_label(record: Any) -> str:
-    audit = _as_int(first_value(record, "prescription_audit_status", "audit_status"), -1)
-    voided = _as_int(first_value(record, "prescription_void_status", "void_status"), 0)
-    explicit = first_value(record, "has_prescription", default=None)
-    has_prescription = (
-        _as_bool(explicit)
-        if explicit is not None
-        else _as_int(first_value(record, "prescription_id", default=0), 0) > 0 or audit in {0, 1, 2}
-    )
-    if not has_prescription:
-        return "开方"
-    return "查看处方" if audit == 1 and voided != 1 else "编辑处方"
+    return prescription_action(record)[0]
 
 
 def can_void_prescription(record: Any) -> bool:
@@ -2931,10 +2926,21 @@ class ConsultationsPage(QWidget):
         self.edit_button.setEnabled(has_record)
         self.delete_button.setEnabled(has_record)
         self.prescription_button.setText(
-            prescription_action_label(record) if record is not None else "开方"
+            prescription_action(
+                record,
+                force_open=self.table_host.force_open_prescription,
+            )[0]
+            if record is not None
+            else "开方"
         )
         self.prescription_button.setEnabled(has_record and not self._prescription_busy)
-        row_has_prescription = _as_bool(first_value(record, "has_prescription", default=False))
+        row_has_prescription = _as_bool(
+            first_value(
+                record,
+                "current_has_prescription",
+                default=first_value(record, "has_prescription", default=False),
+            )
+        )
         self.void_button.setEnabled(
             has_record
             and row_has_prescription
@@ -2946,7 +2952,12 @@ class ConsultationsPage(QWidget):
             _as_int(payload.get(key), 0) > 0
             for key in ("appointment_id", "patient_id", "diagnosis_id")
         )
-        self.video_button.setEnabled(has_record and is_video_available(record) and valid_ids)
+        self.video_button.setEnabled(
+            has_record
+            and is_video_available(record)
+            and video_call_is_live(record)
+            and valid_ids
+        )
 
     @property
     def _diagnosis_dialog(self) -> DiagnosisDialog:
@@ -3076,7 +3087,11 @@ class ConsultationsPage(QWidget):
         record = self.table.current_data()
         if _as_int(first_value(record, "diagnosis_id", "id", default=0)) <= 0:
             return
-        self._begin_prescription_load(record, mode="open")
+        _label, mode = prescription_action(
+            record,
+            force_open=self.table_host.force_open_prescription,
+        )
+        self._begin_prescription_load(record, mode=mode)
 
     def _void_selected_prescription(self) -> None:
         if not _canonical_allowed(self.permissions, "tcm.diagnosis/kaifang"):
@@ -3114,6 +3129,28 @@ class ConsultationsPage(QWidget):
         if existing is not None:
             approved = _as_int(first_value(existing, "audit_status", "status"), -1) == 1
             voided = _as_int(first_value(existing, "void_status", "is_void"), 0) == 1
+            actual_id = _as_int(first_value(existing, "id", "prescription_id", default=0))
+            expected_id = _as_int(
+                first_value(record, "current_prescription_id", default=0)
+            )
+            actual_appointment_id = _as_int(
+                first_value(existing, "appointment_id", default=0)
+            )
+            expected_appointment_id = _appointment_id(record)
+            identity_changed = (
+                (expected_id > 0 and actual_id != expected_id)
+                or (
+                    actual_appointment_id > 0
+                    and expected_appointment_id > 0
+                    and actual_appointment_id != expected_appointment_id
+                )
+            )
+            if mode == "view" and (not approved or voided or identity_changed):
+                self.banner.show_message(
+                    "当前挂号的处方状态已变化，请刷新列表后重试。",
+                    "warning",
+                )
+                return
             if not approved or voided:
                 self._open_existing_prescription_editor(existing)
             else:
@@ -3127,6 +3164,12 @@ class ConsultationsPage(QWidget):
                 detail.diagnosis_requested.connect(self._open_diagnosis_id)
                 detail.exec()
             return
+        if mode == "view":
+            self.banner.show_message(
+                "当前挂号没有可查看的处方，请刷新列表后重试。",
+                "warning",
+            )
+            return
         self._begin_case_record_load(record)
 
     def _open_existing_prescription_editor(self, prescription: Any) -> None:
@@ -3339,6 +3382,9 @@ class ConsultationsPage(QWidget):
         if record is None or not is_video_available(record):
             self.banner.show_message("仅当前“已预约”的挂号可进入视频问诊。", "warning")
             return
+        if not video_call_is_live(record):
+            self.banner.show_message("医生尚未发起视频会话，请等待会话开始。", "warning")
+            return
         payload = _video_payload(record)
         if not all(
             _as_int(payload.get(key), 0) > 0

app/src/doctor_workstation/ui/pages/patients.py

@@ -1317,9 +1317,13 @@ class PatientListWorkspace(QWidget):
         panel.setSpacing(6)
 
         top_row = QHBoxLayout()
+        top_row.setObjectName("PatientFilterTopRow")
         top_row.setContentsMargins(0, 0, 0, 0)
         top_row.setSpacing(6)
+        top_row.setAlignment(Qt.AlignmentFlag.AlignLeft)
         self.keyword_edit = QLineEdit()
+        self.keyword_edit.setObjectName("PatientKeywordInput")
+        self.keyword_edit.setMaximumWidth(620)
         self.keyword_edit.setPlaceholderText("患者姓名 / 手机号 / 助理 / 医生")
         self.keyword_edit.setClearButtonEnabled(True)
         self.keyword_edit.returnPressed.connect(self.search)
@@ -1335,6 +1339,8 @@ class PatientListWorkspace(QWidget):
         self.status_combo.addItem("已过号", "missed")
         self.status_combo.hide()
         self.status_host = QWidget()
+        self.status_host.setObjectName("PatientStatusFilterHost")
+        self.status_host.setMaximumWidth(440)
         status_row = QHBoxLayout(self.status_host)
         status_row.setContentsMargins(0, 0, 0, 0)
         status_row.setSpacing(2)
@@ -1370,21 +1376,27 @@ class PatientListWorkspace(QWidget):
             status_row.addWidget(button, 1)
         self.status_buttons[""].setChecked(True)
         top_row.addWidget(self.status_host, 2)
-        search = QPushButton("查询")
-        search.setProperty("variant", "primary")
-        search.setProperty("patientSearchAction", True)
-        search.clicked.connect(self.search)
-        top_row.addWidget(search)
-        reset = QPushButton("重置")
-        reset.setProperty("variant", "ghost")
-        reset.clicked.connect(self.reset_filters)
-        top_row.addWidget(reset)
+        self.search_button = QPushButton("查询")
+        self.search_button.setObjectName("PatientSearchButton")
+        self.search_button.setProperty("variant", "primary")
+        self.search_button.setProperty("patientSearchAction", True)
+        self.search_button.clicked.connect(self.search)
+        top_row.addWidget(self.search_button)
+        self.reset_button = QPushButton("重置")
+        self.reset_button.setObjectName("PatientResetButton")
+        self.reset_button.setProperty("variant", "ghost")
+        self.reset_button.clicked.connect(self.reset_filters)
+        top_row.addWidget(self.reset_button)
         panel.addLayout(top_row)
 
         bottom_row = QHBoxLayout()
+        bottom_row.setObjectName("PatientFilterDateRow")
         bottom_row.setContentsMargins(0, 0, 0, 0)
         bottom_row.setSpacing(6)
+        bottom_row.setAlignment(Qt.AlignmentFlag.AlignLeft)
         self.quick_host = QWidget()
+        self.quick_host.setObjectName("PatientQuickDateHost")
+        self.quick_host.setMaximumWidth(620)
         quick = QHBoxLayout(self.quick_host)
         quick.setContentsMargins(0, 0, 0, 0)
         quick.setSpacing(2)
@@ -1411,10 +1423,13 @@ class PatientListWorkspace(QWidget):
         bottom_row.addWidget(self.quick_host, 3)
 
         self.date_host = QWidget()
+        self.date_host.setObjectName("PatientDateRangeHost")
+        self.date_host.setMaximumWidth(420)
         dates = QHBoxLayout(self.date_host)
         dates.setContentsMargins(0, 0, 0, 0)
         dates.setSpacing(6)
         self.start_date = QDateEdit(QDate.currentDate())
+        self.start_date.setObjectName("PatientStartDateEdit")
         self.start_date.setCalendarPopup(True)
         self.start_date.setDisplayFormat("yyyy-MM-dd")
         self.start_date.setEnabled(False)
@@ -1425,22 +1440,26 @@ class PatientListWorkspace(QWidget):
         separator.setProperty("role", "muted")
         dates.addWidget(separator)
         self.end_date = QDateEdit(QDate.currentDate())
+        self.end_date.setObjectName("PatientEndDateEdit")
         self.end_date.setCalendarPopup(True)
         self.end_date.setDisplayFormat("yyyy-MM-dd")
         self.end_date.setEnabled(False)
         self.end_date.editingFinished.connect(self._custom_date_changed)
         dates.addWidget(self.end_date, 1)
         bottom_row.addWidget(self.date_host, 2)
-        custom = QPushButton("自定义")
-        custom.setProperty("variant", "ghost")
-        custom.clicked.connect(lambda: self.set_date_mode("custom"))
-        bottom_row.addWidget(custom)
+        self.custom_date_button = QPushButton("自定义")
+        self.custom_date_button.setObjectName("PatientCustomDateButton")
+        self.custom_date_button.setProperty("variant", "ghost")
+        self.custom_date_button.clicked.connect(lambda: self.set_date_mode("custom"))
+        bottom_row.addWidget(self.custom_date_button)
         panel.addLayout(bottom_row)
         return card
 
     def _build_summary(self) -> QHBoxLayout:
         layout = QHBoxLayout()
+        layout.setObjectName("PatientSummaryRow")
         layout.setSpacing(8)
+        layout.setAlignment(Qt.AlignmentFlag.AlignLeft)
         self.summary_buttons: dict[str, QPushButton] = {}
         for key, label, mode in (
             ("today", "今日预约", "today"),
@@ -1448,8 +1467,16 @@ class PatientListWorkspace(QWidget):
             ("day_after", "后天预约", "day_after"),
         ):
             button = QPushButton(f"{label}\n0 人")
+            button.setObjectName(
+                {
+                    "today": "PatientSummaryToday",
+                    "tomorrow": "PatientSummaryTomorrow",
+                    "day_after": "PatientSummaryDayAfter",
+                }[key]
+            )
             button.setProperty("summaryCard", True)
             button.setFixedHeight(42)
+            button.setMaximumWidth(420)
             button.setIcon(_summary_calendar_icon())
             button.setIconSize(QSize(34, 34))
             button.clicked.connect(lambda _checked=False, value=mode: self.set_date_mode(value))

app/src/doctor_workstation/ui/shell.py

@@ -2,6 +2,7 @@
 
 from __future__ import annotations
 
+import sqlite3
 from collections.abc import Mapping, Sequence
 from dataclasses import dataclass
 from functools import wraps
@@ -22,6 +23,7 @@ from PySide6.QtGui import (
     QShortcut,
 )
 from PySide6.QtWidgets import (
+    QApplication,
     QButtonGroup,
     QFrame,
     QHBoxLayout,
@@ -38,6 +40,7 @@ from PySide6.QtWidgets import (
     QWidget,
 )
 
+from .dialogs.local_audio_queue import LocalAudioQueueDialog
 from .pages import (
     AppointmentsPage,
     ConsultationsPage,
@@ -61,6 +64,25 @@ _SHELL_TOPBAR_HEIGHT = 62
 _SHELL_TABS_HEIGHT = 0
 _SHELL_OUTER_GUTTER = 13
 _SHELL_PANEL_GAP = 0
+_SHELL_DESIGN_SIZE = QSize(1710, 920)
+_SHELL_MINIMUM_SIZE = QSize(1024, 640)
+
+
+def _bounded_initial_window_size(available_size: QSize | None) -> QSize:
+    """Fit the design viewport inside the screen's logical available geometry."""
+
+    if available_size is None or not available_size.isValid():
+        return QSize(_SHELL_DESIGN_SIZE.width(), _SHELL_DESIGN_SIZE.height())
+    return QSize(
+        max(
+            _SHELL_MINIMUM_SIZE.width(),
+            min(_SHELL_DESIGN_SIZE.width(), available_size.width()),
+        ),
+        max(
+            _SHELL_MINIMUM_SIZE.height(),
+            min(_SHELL_DESIGN_SIZE.height(), available_size.height()),
+        ),
+    )
 
 # The references place the workspace at page-specific global x anchors while
 # keeping a 13 px outer gutter.  These are the actual rail widths inside that
@@ -660,24 +682,29 @@ class _PaintedIconButton(QToolButton):
         self.setFixedSize(size, size)
         self.setIcon(_painted_shell_icon(kind, icon_size))
         self.setIconSize(QSize(icon_size, icon_size))
+        content_size = max(0, size - 2)
         self.setStyleSheet(
-            """
-            QToolButton#ShellPaintedIconButton {
+            f"""
+            QToolButton#ShellPaintedIconButton {{
+                min-width: {content_size}px;
+                max-width: {content_size}px;
+                min-height: {content_size}px;
+                max-height: {content_size}px;
                 background: transparent;
                 border: 1px solid transparent;
                 border-radius: 9px;
-            }
-            QToolButton#ShellPaintedIconButton:hover {
+            }}
+            QToolButton#ShellPaintedIconButton:hover {{
                 background: #F0F3FC;
                 border-color: #E2E7F4;
-            }
-            QToolButton#ShellPaintedIconButton:pressed { background: #EEF1FF; }
-            QToolButton#ShellPaintedIconButton:focus { border-color: #8D9BFF; }
-            QToolButton#ShellPaintedIconButton[windowControl="close"]:hover {
+            }}
+            QToolButton#ShellPaintedIconButton:pressed {{ background: #EEF1FF; }}
+            QToolButton#ShellPaintedIconButton:focus {{ border-color: #8D9BFF; }}
+            QToolButton#ShellPaintedIconButton[windowControl="close"]:hover {{
                 background: #FFF0F2;
                 border-color: #F4C4CC;
-            }
-            QToolButton#ShellPaintedIconButton::menu-indicator { image: none; width: 0; }
+            }}
+            QToolButton#ShellPaintedIconButton::menu-indicator {{ image: none; width: 0; }}
             """
         )
 
@@ -868,9 +895,12 @@ class ShellWindow(QMainWindow):
         self._activation_page: QWidget | None = None
         self._activation_generation = 0
         self._activation_refreshed = False
+        self._local_audio_settings_dialog: LocalAudioQueueDialog | None = None
 
-        self.setMinimumSize(1024, 640)
-        self.resize(1710, 920)
+        self.setMinimumSize(_SHELL_MINIMUM_SIZE)
+        screen = self.screen() or QApplication.primaryScreen()
+        available_size = screen.availableGeometry().size() if screen is not None else None
+        self.resize(_bounded_initial_window_size(available_size))
 
         canvas = _ShellCanvas(self)
         canvas.setObjectName("AppCanvas")
@@ -1002,7 +1032,20 @@ class ShellWindow(QMainWindow):
                 font-weight: 700;
             }
             QPushButton#ShellAssistantButton:hover { background-color: #4658E8; }
-            QLabel#ShellModelLabel { color: #8A95AF; font-size: 10px; }
+            QPushButton#ShellSettingsButton {
+                min-height: 42px;
+                color: #6E7C9F;
+                font-size: 11px;
+                font-weight: 600;
+                background-color: transparent;
+                border: 1px solid transparent;
+                border-radius: 10px;
+            }
+            QPushButton#ShellSettingsButton:hover {
+                color: #5265F6;
+                background-color: #EEF1FF;
+            }
+            QPushButton#ShellSettingsButton:focus { border-color: #8D9BFF; }
             """
         )
         layout = QVBoxLayout(sidebar)
@@ -1074,11 +1117,17 @@ class ShellWindow(QMainWindow):
         outer_assistant.addWidget(self.assistant_card)
         layout.addLayout(outer_assistant)
 
-        self.model_label = QLabel("模型：GPT-4o 医疗版  ›", sidebar)
-        self.model_label.setObjectName("ShellModelLabel")
-        self.model_label.setAlignment(Qt.AlignmentFlag.AlignCenter)
-        self.model_label.setFixedHeight(76)
-        layout.addWidget(self.model_label)
+        self.upload_settings_button = QPushButton("设置  ›", sidebar)
+        self.upload_settings_button.setObjectName("ShellSettingsButton")
+        self.upload_settings_button.setAccessibleName("本机录音上传设置")
+        self.upload_settings_button.setToolTip("查看本机录音上传记录")
+        self.upload_settings_button.setCursor(Qt.CursorShape.PointingHandCursor)
+        self.upload_settings_button.setFixedHeight(76)
+        self.upload_settings_button.clicked.connect(self._open_local_audio_settings)
+        # Keep the former attribute as a compatibility alias for integrations
+        # that inspect the bottom sidebar control.
+        self.model_label = self.upload_settings_button
+        layout.addWidget(self.upload_settings_button)
         return sidebar
 
     def _build_topbar(self) -> QWidget:
@@ -1095,10 +1144,6 @@ class ShellWindow(QMainWindow):
                 border-top-right-radius: 16px;
             }
             QFrame#ShellGlobalSearch {
-                min-width: 265px;
-                max-width: 265px;
-                min-height: 36px;
-                max-height: 36px;
                 background-color: #F8FAFF;
                 border: 1px solid #E2E7F4;
                 border-radius: 10px;
@@ -1112,6 +1157,23 @@ class ShellWindow(QMainWindow):
                 border: 0;
                 border-radius: 9px;
             }
+            QLineEdit#ShellGlobalSearchInput QToolButton {
+                min-width: 22px;
+                max-width: 22px;
+                min-height: 18px;
+                max-height: 18px;
+                margin: 0;
+                padding: 0;
+                background-color: transparent;
+                border: 0;
+                border-radius: 0;
+            }
+            QLineEdit#ShellGlobalSearchInput QToolButton:hover,
+            QLineEdit#ShellGlobalSearchInput QToolButton:pressed,
+            QLineEdit#ShellGlobalSearchInput QToolButton:focus {
+                background-color: transparent;
+                border: 0;
+            }
             QLabel#ShellShortcutHint {
                 color: #8A95AF;
                 background-color: #F0F3FC;
@@ -1207,7 +1269,9 @@ class ShellWindow(QMainWindow):
         search_layout.addWidget(self.global_search, 1)
         shortcut_hint = QLabel("Ctrl K", search_host)
         shortcut_hint.setObjectName("ShellShortcutHint")
-        search_layout.addWidget(shortcut_hint)
+        shortcut_hint.setAlignment(Qt.AlignmentFlag.AlignCenter)
+        shortcut_hint.setSizePolicy(QSizePolicy.Policy.Fixed, QSizePolicy.Policy.Fixed)
+        search_layout.addWidget(shortcut_hint, 0, Qt.AlignmentFlag.AlignVCenter)
         layout.addWidget(search_host)
 
         self.context_label = QLabel("工作台", topbar)
@@ -1393,7 +1457,7 @@ class ShellWindow(QMainWindow):
         )
         self.brand_copy.setVisible(not self._sidebar_collapsed)
         self.assistant_card.setVisible(not self._sidebar_collapsed)
-        self.model_label.setVisible(not self._sidebar_collapsed)
+        self.upload_settings_button.setVisible(not self._sidebar_collapsed)
         margins = (7, 14, 7, 0) if self._sidebar_collapsed else (12, 19, 12, 0)
         self.nav_layout.setContentsMargins(*margins)
         self.fold_button.kind = "expand" if self._sidebar_collapsed else "fold"
@@ -1486,6 +1550,26 @@ class ShellWindow(QMainWindow):
             3600,
         )
 
+    def _open_local_audio_settings(self) -> None:
+        current = self._local_audio_settings_dialog
+        if current is not None and current.isVisible():
+            current.raise_()
+            current.activateWindow()
+            return
+        try:
+            dialog = LocalAudioQueueDialog(self.repository, None, self)
+        except (OSError, RuntimeError, ValueError, sqlite3.Error) as error:
+            show_toast(self, f"无法打开本机录音上传设置：{error}", "error")
+            return
+        self._local_audio_settings_dialog = dialog
+
+        def clear_dialog(_result: int) -> None:
+            if self._local_audio_settings_dialog is dialog:
+                self._local_audio_settings_dialog = None
+
+        dialog.finished.connect(clear_dialog)
+        dialog.open()
+
     def _tab_index_for_key(self, key: str) -> int:
         for index in range(self.tab_bar.count()):
             if self.tab_bar.tabData(index) == key:

app/src/doctor_workstation/ui/widgets.py

@@ -312,9 +312,14 @@ def run_async(
     on_error: Callable[[Exception], None] | None = None,
     on_finished: Callable[[], None] | None = None,
     pool: QThreadPool | None = None,
+    priority: int = 0,
     **kwargs: Any,
 ) -> Worker:
-    """Run ``function`` off the GUI thread and return its Worker handle."""
+    """Run ``function`` off the GUI thread and return its Worker handle.
+
+    Higher-priority queued work starts first when a pool thread becomes free.
+    Running work is never interrupted.
+    """
 
     worker = Worker(function, *args, **kwargs)
     _RUNNING_WORKERS.add(worker)
@@ -324,7 +329,7 @@ def run_async(
     if on_finished is not None:
         worker.signals.finished.connect(on_finished)
     worker.signals.finished.connect(lambda: _RUNNING_WORKERS.discard(worker))
-    (pool or QThreadPool.globalInstance()).start(worker)
+    (pool or QThreadPool.globalInstance()).start(worker, priority)
     return worker
 
 

app/src/doctor_workstation/video/lifecycle.py

@@ -15,6 +15,7 @@ import threading
 from collections.abc import Callable, Mapping
 from concurrent.futures import Future
 from dataclasses import dataclass
+from pathlib import Path
 from typing import Any, TypeVar
 
 from .launcher import VideoCallRequest
@@ -110,6 +111,29 @@ def _extract_call_record_id(result: Any) -> int | str | None:
     return None
 
 
+def _extract_cloud_recording_outcome(result: Any) -> tuple[bool, str] | None:
+    """Read the cloud mixed-video recording outcome returned by room binding."""
+
+    pending = [result]
+    visited: set[int] = set()
+    while pending:
+        candidate = pending.pop(0)
+        mapping = _mapping_candidate(candidate)
+        if mapping is None or id(mapping) in visited:
+            continue
+        visited.add(id(mapping))
+        recording = mapping.get("cloud_recording", mapping.get("cloudRecording"))
+        if isinstance(recording, Mapping):
+            started = bool(recording.get("started"))
+            message = str(recording.get("message") or "").strip()[:200]
+            return started, message
+        for key in ("data", "result"):
+            nested = mapping.get(key)
+            if isinstance(nested, Mapping):
+                pending.append(nested)
+    return None
+
+
 def _clean_transcript_segment(segment: Mapping[str, Any], session_id: str) -> dict[str, Any]:
     segment_id = str(segment.get("segment_id", segment.get("segmentId", ""))).strip()
     text = str(segment.get("text", segment.get("sourceText", ""))).strip()
@@ -239,6 +263,7 @@ class OrderedCallLifecycle:
         self._claimed_room_id: str | None = None
         self._start_future: Future[bool] | None = None
         self._bind_future: Future[bool] | None = None
+        self._local_recording_future: Future[bool] | None = None
         self._end_future: Future[bool] | None = None
         self._transcription_start_future: Future[bool] | None = None
         self._transcription_finish_future: Future[bool] | None = None
@@ -256,6 +281,13 @@ class OrderedCallLifecycle:
     def transcription_session_id(self) -> str | None:
         return self._transcription_session_id
 
+    @property
+    def current_room_id(self) -> str | None:
+        """Return the room observed for this call cycle, including an active bind."""
+
+        with self._lock:
+            return self.bound_room_id or self._claimed_room_id
+
     def start(self) -> Future[bool]:
         with self._lock:
             if self._start_future is not None:
@@ -318,18 +350,31 @@ class OrderedCallLifecycle:
             def operation() -> bool:
                 with self._lock:
                     started = self.started
+                    record_id = self.call_record_id
                 if not started:
                     return False
+                if record_id is None:
+                    raise ValueError("server did not return the current call_record_id")
                 if not callable(method):
                     self.logger.warning(
                         "video repository does not implement bind_call_room",
                         extra={"video_call": self.request.safe_log_context()},
                     )
                     return False
-                _call_repository_method(
+                result = _call_repository_method(
                     method,
-                    {"diagnosis_id": self.request.diagnosis_id, "room_id": cleaned},
+                    {
+                        "diagnosis_id": self.request.diagnosis_id,
+                        "room_id": cleaned,
+                        "call_record_id": record_id,
+                    },
                 )
+                recording_outcome = _extract_cloud_recording_outcome(result)
+                if recording_outcome is not None and not recording_outcome[0]:
+                    raise RuntimeError(
+                        recording_outcome[1]
+                        or "automatic Tencent cloud mixed-video recording did not start"
+                    )
                 with self._lock:
                     self.bound_room_id = cleaned
                 self.logger.info(
@@ -338,8 +383,85 @@ class OrderedCallLifecycle:
                 )
                 return True
 
-            self._bind_future = self._worker.submit("bind", operation)
-            return self._bind_future
+            future = self._worker.submit("bind", operation)
+            self._bind_future = future
+
+            def release_failed_claim(completed: Future[bool]) -> None:
+                try:
+                    succeeded = bool(completed.result())
+                except Exception:
+                    succeeded = False
+                if succeeded:
+                    return
+                # A transient bridge/API failure must not permanently pin the
+                # room to a failed Future.  The companion retries the exact
+                # same room after the host acknowledgement, so release only
+                # this failed claim while preserving successful bindings.
+                with self._lock:
+                    if self._bind_future is completed and self.bound_room_id is None:
+                        self._bind_future = None
+                        self._claimed_room_id = None
+
+            future.add_done_callback(release_failed_claim)
+            return future
+
+    def save_local_audio_recording(
+        self,
+        path: str | Path,
+        *,
+        mime_type: str = "audio/webm",
+    ) -> Future[bool]:
+        """Upload one locally mixed audio file to this exact call record.
+
+        The operation shares the lifecycle FIFO, so a caller that queues this
+        before :meth:`end` is guaranteed to attach the COS object before the
+        call record is marked ended.
+        """
+
+        recording_path = Path(path).expanduser().resolve()
+        clean_mime = str(mime_type or "audio/webm").strip()[:120] or "audio/webm"
+        if not recording_path.is_file() or recording_path.stat().st_size <= 0:
+            raise ValueError("local audio recording is empty or missing")
+        with self._lock:
+            if self._end_future is not None:
+                raise RuntimeError("video call has already ended")
+            if self._local_recording_future is not None:
+                return self._local_recording_future
+            if self._start_future is None:
+                self.start()
+            method = getattr(self.repository, "upload_call_recording", None)
+            if not callable(method):
+                raise ValueError("video repository does not implement local recording upload")
+
+            def operation() -> bool:
+                with self._lock:
+                    started = self.started
+                    record_id = self.call_record_id
+                if not started:
+                    return False
+                if record_id is None:
+                    raise ValueError("server did not return the current call_record_id")
+                result = _call_repository_method(
+                    method,
+                    {
+                        "path": recording_path,
+                        "diagnosis_id": self.request.diagnosis_id,
+                        "call_record_id": record_id,
+                        "mime_type": clean_mime,
+                    },
+                )
+                if result is False:
+                    raise RuntimeError("local audio recording upload failed")
+                self.logger.info(
+                    "local call audio uploaded and attached",
+                    extra={"video_call": self.request.safe_log_context()},
+                )
+                return True
+
+            self._local_recording_future = self._worker.submit(
+                "local-audio-upload", operation
+            )
+            return self._local_recording_future
 
     def save_screenshot(self, content: bytes, filename: str) -> Future[str]:
         """Upload one video frame and append it to the diagnosis doctor notes."""
@@ -554,15 +676,21 @@ class OrderedCallLifecycle:
             def operation() -> bool:
                 with self._lock:
                     started = self.started
+                    record_id = self.call_record_id
                 if not started:
                     with self._lock:
                         self.ended = True
                     return False
                 if not callable(method):
                     raise ValueError("video repository does not implement end_call")
+                if record_id is None:
+                    raise ValueError("server did not return the current call_record_id")
                 _call_repository_method(
                     method,
-                    {"diagnosis_id": self.request.diagnosis_id},
+                    {
+                        "diagnosis_id": self.request.diagnosis_id,
+                        "call_record_id": record_id,
+                    },
                 )
                 with self._lock:
                     self.ended = True

app/src/doctor_workstation/video/window.py

@@ -11,6 +11,9 @@ import base64
 import binascii
 import json
 import logging
+import os
+import re
+import sqlite3
 import sys
 from collections.abc import Callable, Mapping
 from concurrent.futures import Future
@@ -20,6 +23,11 @@ from pathlib import Path
 from typing import Any
 from urllib.parse import parse_qsl, urlsplit
 
+from ..services.local_audio_queue import (
+    LocalAudioQueueStore,
+    LocalAudioUploadManager,
+    get_local_audio_upload_manager,
+)
 from .launcher import (
     VideoCallRequest,
     VideoTicketError,
@@ -29,7 +37,7 @@ from .lifecycle import OrderedCallLifecycle
 from .security import TrustedDocumentError, TrustedDocumentPolicy
 
 try:  # Optional by design: core-only builds must still import this module.
-    from PySide6.QtCore import QObject, Qt, QUrl, Signal, Slot
+    from PySide6.QtCore import QObject, Qt, QTimer, QUrl, Signal, Slot
     from PySide6.QtWebChannel import QWebChannel
     from PySide6.QtWebEngineCore import (
         QWebEnginePage,
@@ -39,7 +47,7 @@ try:  # Optional by design: core-only builds must still import this module.
     from PySide6.QtWebEngineWidgets import QWebEngineView
     from PySide6.QtWidgets import QApplication, QMainWindow
 except (ImportError, OSError) as _qt_import_error:  # pragma: no cover - no Qt runtime.
-    QObject = Qt = QUrl = Signal = Slot = None  # type: ignore[assignment]
+    QObject = QTimer = Qt = QUrl = Signal = Slot = None  # type: ignore[assignment]
     QWebChannel = QWebEnginePage = QWebEngineProfile = None  # type: ignore[assignment]
     QWebEngineSettings = QWebEngineView = None  # type: ignore[assignment]
     QApplication = QMainWindow = None  # type: ignore[assignment]
@@ -63,6 +71,18 @@ class CompanionLocation:
     is_local: bool
 
 
+@dataclass(slots=True)
+class _LocalAudioCapture:
+    record_id: int
+    session_id: str
+    mime_type: str
+    path: Path
+    handle: Any
+    lifecycle: OrderedCallLifecycle
+    next_sequence: int = 0
+    bytes_written: int = 0
+
+
 def _validate_remote_url(value: str) -> str:
     parsed = urlsplit(value)
     if parsed.scheme.lower() != "https" or not parsed.hostname:
@@ -204,13 +224,67 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
                 }
             )
 
+        @Slot(str, str)  # type: ignore[misc]
+        def startLocalAudioRecording(  # noqa: N802 - Qt bridge API
+            self, session_id: str, mime_type: str
+        ) -> None:
+            self._callback(
+                {
+                    "source": "doctor-call",
+                    "event": "local-audio-start",
+                    "sessionId": session_id,
+                    "mimeType": mime_type,
+                }
+            )
+
+        @Slot(str, int, str)  # type: ignore[misc]
+        def appendLocalAudioChunk(  # noqa: N802 - Qt bridge API
+            self, session_id: str, sequence: int, encoded: str
+        ) -> None:
+            self._callback(
+                {
+                    "source": "doctor-call",
+                    "event": "local-audio-chunk",
+                    "sessionId": session_id,
+                    "sequence": sequence,
+                    "data": encoded,
+                }
+            )
+
+        @Slot(str, int)  # type: ignore[misc]
+        def finishLocalAudioRecording(  # noqa: N802 - Qt bridge API
+            self, session_id: str, total_bytes: int
+        ) -> None:
+            self._callback(
+                {
+                    "source": "doctor-call",
+                    "event": "local-audio-finish",
+                    "sessionId": session_id,
+                    "totalBytes": total_bytes,
+                }
+            )
+
+        @Slot(str)  # type: ignore[misc]
+        def abortLocalAudioRecording(self, session_id: str) -> None:  # noqa: N802
+            self._callback(
+                {
+                    "source": "doctor-call",
+                    "event": "local-audio-abort",
+                    "sessionId": session_id,
+                }
+            )
+
     class _EmbeddedVideoWindow(QMainWindow):  # type: ignore[misc, valid-type]
         status_changed = Signal(str)  # type: ignore[misc]
         call_ended = Signal(str)  # type: ignore[misc]
         call_error = Signal(str)  # type: ignore[misc]
         _start_completed = Signal(bool)  # type: ignore[misc]
+        _room_completed = Signal(str, bool, str)  # type: ignore[misc]
         _screenshot_completed = Signal(bool, str)  # type: ignore[misc]
         _transcription_completed = Signal(str, str, str, bool, str)  # type: ignore[misc]
+        _local_recording_completed = Signal(  # type: ignore[misc]
+            str, str, int, bool, str
+        )
 
         def __init__(
             self,
@@ -247,8 +321,15 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
             self._close_reason = "window-closed"
             self._call_cycle_closed = False
             self._start_requested = False
+            self._shutdown_requested = False
+            self._local_audio_capture: _LocalAudioCapture | None = None
+            self._local_audio_store: LocalAudioQueueStore | None = None
+            self._local_audio_uploads: LocalAudioUploadManager | None = None
             self._legacy_grants: list[tuple[Any, Any]] = []
             self._permission_grants: list[Any] = []
+            self._shutdown_timer = QTimer(self)
+            self._shutdown_timer.setSingleShot(True)
+            self._shutdown_timer.timeout.connect(self._force_requested_shutdown)
 
             self.setWindowTitle(
                 f"与 {self.patient_name} IM 问诊" if self.open_im else "视频面诊"
@@ -284,8 +365,10 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
             self._connect_permissions()
 
             self._start_completed.connect(self._on_lifecycle_started)
+            self._room_completed.connect(self._on_room_completed)
             self._screenshot_completed.connect(self._on_screenshot_completed)
             self._transcription_completed.connect(self._on_transcription_completed)
+            self._local_recording_completed.connect(self._on_local_recording_completed)
             self.web_view.loadFinished.connect(self._on_load_finished)
             self.web_view.setUrl(QUrl(self.location.url))
 
@@ -428,6 +511,28 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
                     str(message.get("message") or "截屏图片无效。")[:200],
                 )
                 return
+            if event == "local-audio-start":
+                self._start_local_audio_recording(
+                    str(message.get("sessionId") or ""),
+                    str(message.get("mimeType") or "audio/webm"),
+                )
+                return
+            if event == "local-audio-chunk":
+                self._append_local_audio_chunk(
+                    str(message.get("sessionId") or ""),
+                    message.get("sequence"),
+                    str(message.get("data") or ""),
+                )
+                return
+            if event == "local-audio-finish":
+                self._finish_local_audio_recording(
+                    str(message.get("sessionId") or ""),
+                    message.get("totalBytes"),
+                )
+                return
+            if event == "local-audio-abort":
+                self._abort_local_audio_recording(str(message.get("sessionId") or ""))
+                return
             if event == "transcription-start-request":
                 self._start_transcription(
                     str(message.get("sessionId") or ""),
@@ -445,7 +550,13 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
                 return
             room_id = message.get("roomId", message.get("room_id"))
             if room_id not in (None, ""):
-                self.lifecycle.bind_room(room_id)
+                clean_room_id = str(room_id).strip()
+                future = self.lifecycle.bind_room(clean_room_id)
+                future.add_done_callback(
+                    lambda completed, current_room_id=clean_room_id: (
+                        self._notify_room_completed(current_room_id, completed)
+                    )
+                )
             if event == "room":
                 return
             if event == "status":
@@ -457,7 +568,7 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
                 self.lifecycle.end(f"companion-{status}")
                 self._call_cycle_closed = True
                 self._start_requested = False
-                if not self.open_im:
+                if not self.open_im or self._shutdown_requested:
                     self._close_from_companion("companion-hangup")
             elif event == "error":
                 message_text = str(message.get("message", "视频通话错误"))[:400]
@@ -466,9 +577,343 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
                     self.lifecycle.end("companion-error")
                     self._call_cycle_closed = True
                     self._start_requested = False
-                if not self.open_im:
+                if not self.open_im or self._shutdown_requested:
                     self._close_from_companion("companion-error")
 
+        def _notify_room_completed(self, room_id: str, future: Future[bool]) -> None:
+            try:
+                succeeded = bool(future.result())
+            except Exception as error:
+                succeeded = False
+                message = str(error)[:200] or "腾讯云混流视频录制未启动。"
+            else:
+                message = (
+                    "腾讯云混流视频已启动；本机录音将在结束后另行上传 COS。"
+                    if succeeded
+                    else "通话房间尚未绑定，云端视频和本机录音无法关联通话记录。"
+                )
+            with suppress(RuntimeError):
+                self._room_completed.emit(room_id, succeeded, message)
+
+        def _on_room_completed(
+            self,
+            room_id: str,
+            succeeded: bool,
+            message: str,
+        ) -> None:
+            if self._closing:
+                return
+            room_payload = json.dumps(str(room_id)[:160], ensure_ascii=True)
+            payload = json.dumps(str(message)[:200], ensure_ascii=True)
+            state = "true" if succeeded else "false"
+            self._page.runJavaScript(
+                "window.doctorConsultation?.roomBindingResult?.("
+                f"{room_payload}, {state}, {payload});"
+            )
+
+        def _emit_local_recording_result(
+            self,
+            operation: str,
+            session_id: str,
+            sequence: int,
+            succeeded: bool,
+            message: str,
+        ) -> None:
+            with suppress(RuntimeError):
+                self._local_recording_completed.emit(
+                    operation,
+                    session_id,
+                    sequence,
+                    succeeded,
+                    str(message)[:200],
+                )
+
+        def _on_local_recording_completed(
+            self,
+            operation: str,
+            session_id: str,
+            sequence: int,
+            succeeded: bool,
+            message: str,
+        ) -> None:
+            if self._closing or self._released:
+                return
+            self._page.runJavaScript(
+                "window.doctorConsultation?.localRecordingResult?.("
+                f"{json.dumps(operation)}, {json.dumps(session_id)}, {sequence}, "
+                f"{'true' if succeeded else 'false'}, "
+                f"{json.dumps(str(message)[:200], ensure_ascii=True)});"
+            )
+
+        def _start_local_audio_recording(self, session_id: str, mime_type: str) -> None:
+            cleaned = str(session_id or "").strip()
+            clean_mime = str(mime_type or "audio/webm").strip().lower()[:120]
+            if not re.fullmatch(r"[A-Za-z0-9_-]{12,64}", cleaned):
+                self._emit_local_recording_result(
+                    "start", cleaned, -1, False, "本地录音会话标识无效。"
+                )
+                return
+            if not clean_mime.startswith(("audio/webm", "audio/ogg")):
+                self._emit_local_recording_result(
+                    "start", cleaned, -1, False, "当前浏览器录音格式不受支持。"
+                )
+                return
+            if self._local_audio_capture is not None:
+                existing = self._local_audio_capture.session_id == cleaned
+                self._emit_local_recording_result(
+                    "start",
+                    cleaned,
+                    -1,
+                    existing,
+                    "本地录音已启动。" if existing else "已有另一条本地录音正在进行。",
+                )
+                return
+            try:
+                lifecycle = self.lifecycle
+                raw_call_record_id = lifecycle.call_record_id
+                call_record_id = (
+                    int(raw_call_record_id) if raw_call_record_id not in (None, "") else None
+                )
+                store, uploads = get_local_audio_upload_manager(
+                    lifecycle.repository,
+                    self._local_audio_store,
+                )
+                self._local_audio_store = store
+                self._local_audio_uploads = uploads
+                record = store.begin_recording(
+                    session_id=cleaned,
+                    diagnosis_id=self.request.diagnosis_id,
+                    mime_type=clean_mime,
+                    call_record_id=call_record_id,
+                    room_id=lifecycle.current_room_id or "",
+                )
+                # The handle intentionally remains open across WebChannel chunks.
+                handle = record.file_path.open("w+b")
+            except (OSError, RuntimeError, sqlite3.Error) as error:
+                self._emit_local_recording_result(
+                    "start", cleaned, -1, False, str(error)[:200]
+                )
+                return
+            self._local_audio_capture = _LocalAudioCapture(
+                record_id=record.id,
+                session_id=cleaned,
+                mime_type=clean_mime,
+                path=record.file_path,
+                handle=handle,
+                lifecycle=lifecycle,
+            )
+            self._emit_local_recording_result(
+                "start", cleaned, -1, True, "本机语音录音已启动。"
+            )
+
+        def _append_local_audio_chunk(
+            self,
+            session_id: str,
+            sequence_value: Any,
+            encoded: str,
+        ) -> None:
+            capture = self._local_audio_capture
+            try:
+                sequence = int(sequence_value)
+            except (TypeError, ValueError):
+                sequence = -1
+            if capture is None or session_id != capture.session_id:
+                self._emit_local_recording_result(
+                    "chunk", session_id, sequence, False, "本地录音会话标识不匹配。"
+                )
+                return
+            if sequence != capture.next_sequence:
+                self._emit_local_recording_result(
+                    "chunk", session_id, sequence, False, "本地录音分片顺序不连续。"
+                )
+                return
+            if not encoded or len(encoded) > 16_384:
+                self._emit_local_recording_result(
+                    "chunk", session_id, sequence, False, "本地录音分片过大或为空。"
+                )
+                return
+            try:
+                content = base64.b64decode(encoded, validate=True)
+            except (ValueError, binascii.Error):
+                self._emit_local_recording_result(
+                    "chunk", session_id, sequence, False, "本地录音分片解析失败。"
+                )
+                return
+            if not content or len(content) > 12 * 1024:
+                self._emit_local_recording_result(
+                    "chunk", session_id, sequence, False, "本地录音分片大小无效。"
+                )
+                return
+            if capture.bytes_written + len(content) > 512 * 1024 * 1024:
+                self._emit_local_recording_result(
+                    "chunk", session_id, sequence, False, "本地录音超过 512 MB 限制。"
+                )
+                self._abort_local_audio_recording(session_id)
+                return
+            try:
+                capture.handle.write(content)
+            except OSError as error:
+                self._emit_local_recording_result(
+                    "chunk", session_id, sequence, False, str(error)[:200]
+                )
+                self._abort_local_audio_recording(session_id)
+                return
+            capture.bytes_written += len(content)
+            capture.next_sequence += 1
+
+        def _finish_local_audio_recording(
+            self, session_id: str, total_bytes_value: Any
+        ) -> None:
+            capture = self._local_audio_capture
+            try:
+                total_bytes = int(total_bytes_value)
+            except (TypeError, ValueError):
+                total_bytes = -1
+            if capture is None or session_id != capture.session_id:
+                self._emit_local_recording_result(
+                    "finish", session_id, -1, False, "本地录音会话标识不匹配。"
+                )
+                return
+            self._local_audio_capture = None
+            try:
+                capture.handle.flush()
+                os.fsync(capture.handle.fileno())
+                capture.handle.close()
+            except OSError as error:
+                self._mark_local_audio_invalid(capture.record_id, str(error))
+                self._emit_local_recording_result(
+                    "finish", session_id, -1, False, str(error)[:200]
+                )
+                return
+            if total_bytes != capture.bytes_written or total_bytes <= 0:
+                self._mark_local_audio_invalid(
+                    capture.record_id, "本地录音文件不完整。"
+                )
+                self._emit_local_recording_result(
+                    "finish", session_id, -1, False, "本地录音文件不完整。"
+                )
+                return
+            if capture.bytes_written < 1024:
+                self._mark_local_audio_invalid(
+                    capture.record_id, "本地录音文件为空或只有容器信息。"
+                )
+                self._emit_local_recording_result(
+                    "finish",
+                    session_id,
+                    -1,
+                    False,
+                    "本地录音文件为空或只有容器信息，已阻止上传。",
+                )
+                return
+            try:
+                with capture.path.open("rb") as recording:
+                    signature = recording.read(4)
+            except OSError as error:
+                self._mark_local_audio_invalid(capture.record_id, str(error))
+                self._emit_local_recording_result(
+                    "finish", session_id, -1, False, str(error)[:200]
+                )
+                return
+            valid_signature = (
+                capture.mime_type.startswith("audio/webm")
+                and signature == b"\x1aE\xdf\xa3"
+            ) or (
+                capture.mime_type.startswith("audio/ogg") and signature == b"OggS"
+            )
+            if not valid_signature:
+                self._mark_local_audio_invalid(
+                    capture.record_id, "本地录音格式校验失败。"
+                )
+                self._emit_local_recording_result(
+                    "finish",
+                    session_id,
+                    -1,
+                    False,
+                    "本地录音格式校验失败，已阻止上传无效文件。",
+                )
+                return
+            store = self._local_audio_store
+            uploads = self._local_audio_uploads
+            if store is None or uploads is None:
+                self._emit_local_recording_result(
+                    "finish", session_id, -1, False, "本机录音队列尚未初始化。"
+                )
+                return
+            try:
+                store.finalize_recording(
+                    capture.record_id,
+                    size_bytes=capture.bytes_written,
+                )
+            except (OSError, RuntimeError, sqlite3.Error) as error:
+                self._mark_local_audio_invalid(capture.record_id, str(error))
+                self._emit_local_recording_result(
+                    "finish", session_id, -1, False, str(error)[:200]
+                )
+                return
+
+            lifecycle = capture.lifecycle
+
+            def enqueue_upload(start_result: Future[bool] | None = None) -> None:
+                try:
+                    if start_result is not None and not bool(start_result.result()):
+                        raise RuntimeError("通话记录创建失败，录音已保存在本机，可稍后重试。")
+                    raw_call_record_id = lifecycle.call_record_id
+                    call_record_id = int(raw_call_record_id or 0)
+                    if call_record_id <= 0:
+                        raise RuntimeError("未取得通话记录编号，录音已保存在本机，可稍后重试。")
+                    store.bind_identity(
+                        capture.record_id,
+                        call_record_id=call_record_id,
+                        room_id=lifecycle.current_room_id or "",
+                    )
+                    uploads.submit(capture.record_id)
+                except Exception as error:
+                    with suppress(Exception):
+                        store.update_status(
+                            capture.record_id,
+                            "failed",
+                            str(error)[:1000],
+                        )
+
+            if lifecycle.call_record_id:
+                enqueue_upload()
+            else:
+                try:
+                    lifecycle.start().add_done_callback(enqueue_upload)
+                except Exception as error:
+                    store.update_status(
+                        capture.record_id,
+                        "failed",
+                        str(error)[:1000] or "通话记录创建失败。",
+                    )
+            self._emit_local_recording_result(
+                "finish",
+                session_id,
+                -1,
+                True,
+                "本地录音已保存，正在后台上传 COS。",
+            )
+
+        def _mark_local_audio_invalid(self, record_id: int, message: str) -> None:
+            store = self._local_audio_store
+            if store is None:
+                return
+            with suppress(Exception):
+                store.mark_invalid(record_id, message)
+
+        def _abort_local_audio_recording(self, session_id: str) -> None:
+            capture = self._local_audio_capture
+            if capture is None or (session_id and capture.session_id != session_id):
+                return
+            self._local_audio_capture = None
+            with suppress(OSError):
+                capture.handle.flush()
+                capture.handle.close()
+            self._mark_local_audio_invalid(
+                capture.record_id,
+                "本次本地录音未正常结束，文件已保留以便排查。",
+            )
+
         def _start_call_cycle(self) -> None:
             if self._closing or self._start_requested:
                 return
@@ -633,7 +1078,49 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
             self.close()
 
         def hangup(self) -> None:
-            self._close_reason = "desktop-hangup"
+            self._request_companion_shutdown("desktop-hangup")
+
+        def _request_companion_shutdown(self, reason: str) -> None:
+            """Let MediaRecorder finish and upload before WebEngine is destroyed."""
+
+            self._close_reason = reason
+            if self._closing or self._released:
+                return
+            should_wait_for_companion = (
+                self._injected
+                and self._start_requested
+                and not self._call_cycle_closed
+                and not self._companion_ended
+            )
+            if not should_wait_for_companion:
+                self.close()
+                return
+            if self._shutdown_requested:
+                return
+            self._shutdown_requested = True
+            # doctorConsultation.close() stops MediaRecorder, drains every queued
+            # WebChannel chunk, waits for the Qt/COS finish acknowledgement, and
+            # only then emits hangup.  Keeping _closing false here is essential:
+            # bridge callbacks are deliberately rejected once final destruction
+            # begins.
+            self._page.runJavaScript(
+                "void window.doctorConsultation?.close?.().catch(() => undefined)"
+            )
+            self._shutdown_timer.start(190_000)
+
+        def _force_requested_shutdown(self) -> None:
+            """Bound a failed companion shutdown without racing queued uploads."""
+
+            if not self._shutdown_requested or self._closing or self._released:
+                return
+            if self._start_requested and not self._call_cycle_closed:
+                # OrderedCallLifecycle places end after any upload that already
+                # reached the Qt bridge.
+                self.lifecycle.end(f"{self._close_reason}-timeout")
+                self._call_cycle_closed = True
+                self._start_requested = False
+            self._abort_local_audio_recording("")
+            self._companion_ended = True
             self.close()
 
         def _begin_shutdown(self) -> None:
@@ -641,12 +1128,10 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
                 return
             self._closing = True
             self._media_active = False
-            if self._injected and not self._companion_ended and not self._released:
-                self._page.runJavaScript(
-                    "void window.doctorConsultation?.close?.().catch(() => undefined)"
-                )
+            self._shutdown_timer.stop()
             if self._start_requested and not self._call_cycle_closed:
                 self.lifecycle.end(self._close_reason)
+            self._abort_local_audio_recording("")
             self._release_webengine()
 
         def wait_for_lifecycles(self, timeout: float) -> bool:
@@ -698,6 +1183,15 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
             self._profile.deleteLater()
 
         def closeEvent(self, event: Any) -> None:
+            if (
+                self._injected
+                and self._start_requested
+                and not self._call_cycle_closed
+                and not self._companion_ended
+            ):
+                event.ignore()
+                self._request_companion_shutdown(self._close_reason)
+                return
             self._begin_shutdown()
             event.accept()
 

app/tests/test_api_client.py

@@ -3,7 +3,10 @@
 from __future__ import annotations
 
 import json
+from concurrent.futures import ThreadPoolExecutor
 from pathlib import Path
+from threading import Barrier, get_ident
+from typing import Any
 
 import httpx
 import pytest
@@ -17,6 +20,7 @@ from doctor_workstation.core.errors import (
     OpenPageRequiredError,
     WorkWechatBindingRequiredError,
 )
+from doctor_workstation.services import api_client as api_client_module
 from doctor_workstation.services.api_client import ApiClient
 from doctor_workstation.services.token_store import TokenStore
 
@@ -48,6 +52,41 @@ def test_get_normalises_adminapi_and_sends_contract_headers() -> None:
     )
 
 
+def test_default_client_allows_parallel_requests_with_independent_transports(
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    """Production workers must not queue behind one process-wide HTTP lock."""
+
+    rendezvous = Barrier(2, timeout=2)
+    created: list[Any] = []
+    request_threads: set[int] = set()
+
+    class PooledClient:
+        def __init__(self, **_options: Any) -> None:
+            self.closed = False
+            created.append(self)
+
+        def request(self, _method: str, url: str, **_options: Any) -> httpx.Response:
+            request_threads.add(get_ident())
+            rendezvous.wait()
+            return httpx.Response(200, json={"code": 1, "data": url.rsplit("/", 1)[-1]})
+
+        def close(self) -> None:
+            self.closed = True
+
+    monkeypatch.setattr(api_client_module.httpx, "Client", PooledClient)
+    client = ApiClient("https://example.test", max_retries=0)
+    with ThreadPoolExecutor(max_workers=2) as executor:
+        first = executor.submit(client.get, "patient/first")
+        second = executor.submit(client.get, "patient/second")
+        assert {first.result(timeout=3), second.result(timeout=3)} == {"first", "second"}
+    client.close()
+
+    assert len(created) == 2
+    assert len(request_threads) == 2
+    assert all(item.closed for item in created)
+
+
 def test_post_uses_json_and_never_retries_timeout() -> None:
     """Writes use JSON and a timeout never causes an automatic duplicate POST."""
 

app/tests/test_appointments_parity_ui.py

@@ -10,7 +10,14 @@ from typing import Any
 os.environ.setdefault("QT_QPA_PLATFORM", "offscreen")
 
 import pytest
-from PySide6.QtWidgets import QAbstractItemView, QApplication, QDialog, QDialogButtonBox, QLabel
+from PySide6.QtWidgets import (
+    QAbstractItemView,
+    QApplication,
+    QDialog,
+    QDialogButtonBox,
+    QLabel,
+    QPushButton,
+)
 
 from doctor_workstation.core.errors import ApiProtocolError
 from doctor_workstation.core.models import Appointment, PageResult
@@ -188,6 +195,106 @@ def test_diagnosis_and_patient_ids_stay_distinct_for_video() -> None:
     )
     assert prescription_action_label(pending) == "编辑处方"
 
+    historical_only = Appointment.from_dict(
+        {
+            "id": 104,
+            "prescription_audit_status": 1,
+            "prescription_void_status": 0,
+            "has_prescription": 1,
+            "current_has_prescription": 0,
+            "current_prescription_id": 0,
+        }
+    )
+    assert prescription_action_label(historical_only) == "开方"
+
+
+def test_appointment_view_intent_never_degrades_to_edit(
+    application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    row = {
+        "id": 101,
+        "appointment_id": 101,
+        "diagnosis_id": 501,
+        "current_has_prescription": 1,
+        "current_prescription_id": 81,
+        "prescription_audit_status": 1,
+        "prescription_void_status": 0,
+    }
+    page = AppointmentsPage(SimpleNamespace(), permissions=PermissionSet(["*"]))
+    monkeypatch.setattr(page, "_current_row", lambda: row)
+    requested: list[tuple[Any, str]] = []
+    monkeypatch.setattr(
+        page,
+        "_begin_prescription_load",
+        lambda source, *, mode="open": requested.append((source, mode)),
+    )
+    page._open_prescription()
+    assert requested == [(row, "view")]
+
+    monkeypatch.setattr(
+        page,
+        "_open_existing_prescription_editor",
+        lambda _existing: pytest.fail("view intent must never open the editor"),
+    )
+    page._prescription_loaded(
+        {
+            "id": 81,
+            "appointment_id": 101,
+            "audit_status": 2,
+            "void_status": 0,
+        },
+        row,
+        page._prescription_generation,
+        "view",
+    )
+    assert "状态已变化" in page.banner.label.text()
+    page.close()
+    application.processEvents()
+
+
+def test_appointment_im_action_opens_chat_without_an_existing_live_call(
+    application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    page = AppointmentsPage(
+        DemoDoctorRepository(),
+        permissions=PermissionSet(["doctor.appointment/prescription"]),
+    )
+    row = {
+        "id": 101,
+        "appointment_id": 101,
+        "diagnosis_id": 501,
+        "patient_id": 501,
+        "source_patient_id": 301,
+        "patient_name": "测试患者",
+        "status": 1,
+    }
+    emitted: list[dict[str, Any]] = []
+    monkeypatch.setattr(page, "_current_row", lambda: row)
+    page.video_requested.connect(emitted.append)
+
+    page._request_video()
+
+    assert len(emitted) == 1
+    assert emitted[0]["mode"] == "im"
+    assert emitted[0]["appointment_id"] == 101
+    assert emitted[0]["diagnosis_id"] == 501
+    assert emitted[0]["patient_id"] == 301
+
+    warnings: list[str] = []
+    monkeypatch.setattr(
+        appointments_module,
+        "show_toast",
+        lambda _parent, message, _kind: warnings.append(message),
+    )
+    row["status"] = 2
+    page._request_video()
+    assert len(emitted) == 1
+    assert warnings == ["已取消的挂号不可进入 IM 问诊。"]
+    page.close()
+    application.processEvents()
+
 
 def test_appointment_pending_prescription_uses_full_edit_contract(
     application: QApplication,
@@ -508,15 +615,20 @@ def test_appointment_ai_report_button_visible_with_reception_permission(
     application.processEvents()
 
 
-def test_appointments_reference_split_layout_and_video_list(
+def test_appointments_use_full_width_table_with_per_row_im_consult(
     application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
 ) -> None:
+    monkeypatch.setattr(appointments_module, "run_async", lambda *_args, **_kwargs: object())
     page = AppointmentsPage(
         DemoDoctorRepository(),
-        permissions=PermissionSet(["doctor.appointment/lists"]),
+        permissions=PermissionSet(
+            ["doctor.appointment/lists", "doctor.appointment/prescription"]
+        ),
         current_user={"id": 1001, "role_id": 1},
     )
     page.resize(1460, 820)
+    page.show()
     page._apply_responsive_layout()
     page._loaded(
         {
@@ -524,6 +636,7 @@ def test_appointments_reference_split_layout_and_video_list(
                 {
                     "id": 101,
                     "diagnosis_id": 501,
+                    "source_patient_id": 301,
                     "patient_name": "赵俊霞",
                     "gender": 0,
                     "age": 53,
@@ -532,6 +645,7 @@ def test_appointments_reference_split_layout_and_video_list(
                     "appointment_time": "09:50",
                     "status": 1,
                     "status_desc": "已挂号",
+                    "video_call_hint": {"state": "live", "label": "视频通话进行中"},
                 }
             ],
             "count": 1,
@@ -541,32 +655,143 @@ def test_appointments_reference_split_layout_and_video_list(
     )
     application.processEvents()
 
-    assert page.video_list.count() == 1
-    assert "赵俊霞" in page.video_list.item(0).text()
-    assert 300 <= page.video_panel.width() <= 420
+    assert page.content_layout.count() == 1
+    assert not hasattr(page, "video_panel")
+    assert not hasattr(page, "video_list")
+    assert page.table_card.width() == page.content_host.width()
     assert page.table.objectName() == "AppointmentTable"
     assert (
         page.table.verticalScrollMode()
         == QAbstractItemView.ScrollMode.ScrollPerPixel
     )
-    assert (
-        page.video_list.verticalScrollMode()
-        == QAbstractItemView.ScrollMode.ScrollPerPixel
-    )
+    assert page.table.horizontalHeaderItem(10).text() == "IM 问诊"
+    im_host = page.table.cellWidget(0, 10)
+    assert im_host is not None
+    im_button = im_host.findChild(QPushButton, "AppointmentImConsultButton")
+    assert im_button is not None
+    assert im_button.text() == "IM 问诊"
+    assert im_button.isEnabled()
+    assert im_button.accessibleName() == "与赵俊霞进行 IM 问诊"
+    emitted: list[dict[str, Any]] = []
+    page.video_requested.connect(emitted.append)
+    im_button.click()
+    assert emitted and emitted[0]["mode"] == "im"
+    assert emitted[0]["appointment_id"] == 101
     assert page.date_buttons["today"].isChecked()
 
     page.resize(1024, 640)
     page._apply_responsive_layout()
-    assert page.video_panel.isHidden()
-    assert not page.video_panel_button.isHidden()
+    application.processEvents()
+    assert page.table_card.width() == page.content_host.width()
     assert not page.date_overflow_button.isHidden()
     assert page.date_buttons["yesterday"].isHidden()
     assert not page.date_buttons["today"].isHidden()
-    page.video_panel_button.click()
-    assert not page.video_panel.isHidden()
-    assert 250 <= page.video_panel.width() <= 300
-    page.video_panel_button.click()
-    assert page.video_panel.isHidden()
+    page.close()
+    application.processEvents()
+
+
+def test_im_entry_does_not_require_a_live_video_hint(
+    application: QApplication,
+) -> None:
+    page = AppointmentsPage(
+        DemoDoctorRepository(),
+        permissions=PermissionSet(["doctor.appointment/prescription"]),
+    )
+    rows = [
+        {
+            "id": 101,
+            "diagnosis_id": 501,
+            "source_patient_id": 301,
+            "patient_name": "已接通患者",
+            "status": 1,
+            "video_call_hint": {"state": "ended", "label": "视频通话已结束"},
+        },
+        {
+            "id": 102,
+            "diagnosis_id": 502,
+            "source_patient_id": 302,
+            "patient_name": "等待患者",
+            "status": 1,
+        },
+    ]
+    page._loaded({"lists": rows, "count": 2}, page._generation, False)
+    application.processEvents()
+
+    buttons = [
+        page.table.cellWidget(index, 10).findChild(
+            QPushButton,
+            "AppointmentImConsultButton",
+        )
+        for index in range(page.table.rowCount())
+    ]
+    buttons_by_name = {
+        button.accessibleName(): button for button in buttons if button is not None
+    }
+    assert set(buttons_by_name) == {
+        "与已接通患者进行 IM 问诊",
+        "与等待患者进行 IM 问诊",
+    }
+    assert buttons_by_name["与已接通患者进行 IM 问诊"].isEnabled()
+    waiting = buttons_by_name["与等待患者进行 IM 问诊"]
+    assert waiting.isEnabled()
+    assert waiting.toolTip() == "打开患者 IM，可发送消息并从会话中发起视频"
+    page.close()
+    application.processEvents()
+
+
+def test_im_entry_allows_fulfillable_statuses_and_rejects_terminal_or_unknown_statuses(
+    application: QApplication,
+) -> None:
+    page = AppointmentsPage(
+        DemoDoctorRepository(),
+        permissions=PermissionSet(["doctor.appointment/prescription"]),
+    )
+    rows = [
+        {
+            "id": index + 100,
+            "diagnosis_id": index + 500,
+            "source_patient_id": index + 300,
+            "patient_name": name,
+            "status": status,
+        }
+        for index, (name, status) in enumerate(
+            (
+                ("已预约患者", 1),
+                ("已过号患者", 4),
+                ("已取消患者", 2),
+                ("已完成患者", 3),
+                ("未知状态患者", 0),
+            )
+        )
+    ]
+    page._loaded({"lists": rows, "count": len(rows)}, page._generation, False)
+    application.processEvents()
+
+    buttons = {
+        button.accessibleName(): button
+        for row_index in range(page.table.rowCount())
+        if (
+            button := page.table.cellWidget(row_index, 10).findChild(
+                QPushButton,
+                "AppointmentImConsultButton",
+            )
+        )
+        is not None
+    }
+    assert buttons["与已预约患者进行 IM 问诊"].isEnabled()
+    assert buttons["与已过号患者进行 IM 问诊"].isEnabled()
+    assert not buttons["与已取消患者进行 IM 问诊"].isEnabled()
+    assert buttons["与已取消患者进行 IM 问诊"].toolTip() == (
+        "已取消的挂号不可进入 IM 问诊"
+    )
+    assert not buttons["与已完成患者进行 IM 问诊"].isEnabled()
+    assert buttons["与已完成患者进行 IM 问诊"].toolTip() == (
+        "已完成的挂号不可再进入 IM 问诊"
+    )
+    assert not buttons["与未知状态患者进行 IM 问诊"].isEnabled()
+    assert buttons["与未知状态患者进行 IM 问诊"].toolTip() == (
+        "当前挂号状态不可进入 IM 问诊"
+    )
     page.close()
     application.processEvents()
 
@@ -601,19 +826,20 @@ def test_identical_appointment_poll_keeps_existing_cell_widgets(
     page._loaded(result, page._generation, True)
     selector = page.table.cellWidget(0, 0)
     appointment_info = page.table.cellWidget(0, 4)
-    video_card = page.video_list.itemWidget(page.video_list.item(0))
+    im_action = page.table.cellWidget(0, 10)
 
     page._loaded(deepcopy(result), page._generation, True)
 
     assert page.table.cellWidget(0, 0) is selector
     assert page.table.cellWidget(0, 4) is appointment_info
-    assert page.video_list.itemWidget(page.video_list.item(0)) is video_card
+    assert page.table.cellWidget(0, 10) is im_action
 
     changed = deepcopy(result)
     changed["lists"][0]["assistant_name"] = "新医助"
     page._loaded(changed, page._generation, True)
     assert page.table.cellWidget(0, 0) is not selector
     assert page.table.cellWidget(0, 4) is not appointment_info
+    assert page.table.cellWidget(0, 10) is not im_action
     page.close()
     application.processEvents()
 
@@ -665,11 +891,11 @@ def test_appointments_density_fits_four_rows_in_1366_shell_viewport(
     assert all(60 <= height <= 66 for height in heights)
     assert page.table.viewport().height() // max(heights) >= 4
     assert page.pager.isVisibleTo(page)
-    assert 300 <= page.video_panel.width() < 420
+    assert page.content_layout.count() == 1
+    assert page.table_card.width() == page.content_host.width()
 
     page.resize(1024, 640)
     application.processEvents()
-    assert page.video_panel.isHidden()
-    assert not page.video_panel_button.isHidden()
+    assert page.table_card.width() == page.content_host.width()
     page.close()
     application.processEvents()

app/tests/test_consultations_parity_ui.py

@@ -169,7 +169,7 @@ def test_video_condition_never_uses_diagnosis_status_or_missed_status() -> None:
     assert payload["patient_id"] == 301
 
 
-def test_nested_appointments_confirmation_and_prescription_labels() -> None:
+def test_nested_appointments_confirmation_and_prescription_labels() -> None:
     row = _row(
         appointment_id=None,
         appointment_status=None,
@@ -195,6 +195,62 @@ def test_nested_appointments_confirmation_and_prescription_labels() -> None:
         )
         == "编辑处方"
     )
+    assert (
+        prescription_action_label(
+            {
+                "has_prescription": 1,
+                "current_has_prescription": 0,
+                "prescription_audit_status": 1,
+                "prescription_void_status": 0,
+            }
+        )
+        == "开方"
+    )
+
+
+def test_view_prescription_intent_is_readonly_and_fails_closed_on_state_change(
+    application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    row = _row(
+        has_prescription=1,
+        current_has_prescription=1,
+        current_prescription_id=701,
+        prescription_audit_status=1,
+        prescription_void_status=0,
+    )
+    page = ConsultationsPage(SimpleNamespace(), permissions=PermissionSet(["*"]))
+    page.table_host.set_rows([row])
+    page.table.selectRow(0)
+
+    requested: list[tuple[Any, str]] = []
+    monkeypatch.setattr(
+        page,
+        "_begin_prescription_load",
+        lambda record, *, mode: requested.append((record, mode)),
+    )
+    page._open_prescription()
+    assert requested == [(row, "view")]
+
+    monkeypatch.setattr(
+        page,
+        "_open_existing_prescription_editor",
+        lambda _existing: pytest.fail("view intent must never open the editor"),
+    )
+    page._prescription_loaded(
+        {
+            "id": 701,
+            "appointment_id": 101,
+            "audit_status": 0,
+            "void_status": 0,
+        },
+        row,
+        "view",
+        page._prescription_generation,
+    )
+    assert "状态已变化" in page.banner.label.text()
+    page.close()
+    application.processEvents()
 
 
 def test_default_query_matches_admin_today_and_page_size_contract(
@@ -611,7 +667,7 @@ def test_switching_rows_invalidates_prescription_worker_and_clears_busy(
     application.processEvents()
 
 
-def test_native_call_does_not_reuse_video_qr_permission(
+def test_native_call_does_not_reuse_video_qr_permission(
     application: QApplication,
 ) -> None:
     class VideoRepository:
@@ -627,10 +683,17 @@ def test_native_call_does_not_reuse_video_qr_permission(
         def end_call(self, diagnosis_id: int) -> None:
             pass
 
-    page = ConsultationsPage(VideoRepository(), permissions=PermissionSet([]))
-    emitted: list[dict[str, Any]] = []
-    page.video_requested.connect(emitted.append)
-    page.table.set_rows([_row()])
+    live_row = _row(
+        video_call_hint={
+            "state": "live",
+            "label": "视频通话进行中",
+            "start_time": 1787102100,
+        }
+    )
+    page = ConsultationsPage(VideoRepository(), permissions=PermissionSet([]))
+    emitted: list[dict[str, Any]] = []
+    page.video_requested.connect(emitted.append)
+    page.table.set_rows([live_row])
     page.table.selectRow(0)
     application.processEvents()
 
@@ -638,12 +701,55 @@ def test_native_call_does_not_reuse_video_qr_permission(
     assert page.video_button.isEnabled()
     video_cell = page.table_host.fixed.indexWidget(page.table_host.model.index(0, 10))
     video_action = next(button for button in video_cell.findChildren(QToolButton))
-    assert video_action.text() == "进入视频问诊"
-    assert "摄像头和麦克风" in video_action.toolTip()
-    page._request_video()
-    assert emitted == [_video_payload(_row())]
-    page.close()
-    application.processEvents()
+    assert video_action.text() == "进入视频问诊"
+    assert emitted == []
+    assert "摄像头和麦克风" in video_action.toolTip()
+    page._request_video()
+    assert emitted == [_video_payload(live_row)]
+    assert emitted[0]["mode"] == "im"
+    page.close()
+    application.processEvents()
+
+
+@pytest.mark.parametrize(
+    ("hint", "status_text"),
+    [
+        ({"state": "none", "label": ""}, "暂无通话"),
+        ({"state": "pending_room", "label": "通话发起中，待同步房间"}, "等待接通"),
+    ],
+)
+def test_video_join_action_is_hidden_until_doctor_session_is_live(
+    application: QApplication,
+    hint: dict[str, Any],
+    status_text: str,
+) -> None:
+    class VideoRepository:
+        def get_call_ticket(self, patient_id: int, diagnosis_id: int) -> None:
+            pass
+
+        def start_call(self, diagnosis_id: int, patient_id: int, *, call_type: int = 2) -> None:
+            pass
+
+        def bind_call_room(self, diagnosis_id: int, room_id: str) -> None:
+            pass
+
+        def end_call(self, diagnosis_id: int) -> None:
+            pass
+
+    page = ConsultationsPage(VideoRepository(), permissions=PermissionSet([]))
+    emitted: list[dict[str, Any]] = []
+    page.video_requested.connect(emitted.append)
+    page.table.set_rows([_row(video_call_hint=hint)])
+    page.table.selectRow(0)
+    application.processEvents()
+
+    video_cell = page.table_host.fixed.indexWidget(page.table_host.model.index(0, 10))
+    assert video_cell.findChildren(QToolButton) == []
+    assert status_text in " ".join(label.text() for label in video_cell.findChildren(QLabel))
+    page._request_video()
+    assert emitted == []
+    page.close()
+    application.processEvents()
 
 
 @pytest.mark.parametrize(

app/tests/test_diagnosis_index_visual.py

@@ -146,6 +146,8 @@ def _row(identifier: int, **changes: Any) -> dict[str, Any]:
         "assistant_name": "赵医助",
         "assign_read_at": None,
         "has_prescription": 1,
+        "current_has_prescription": 0,
+        "current_prescription_id": 0,
         "followup_time_text": "2026-08-17 09:00",
         "followup_doctor_name": "陈医生",
         "unserved_days": 2,

app/tests/test_diagnosis_order_video_visual.py

@@ -1,12 +1,14 @@
 from __future__ import annotations
 
 import os
+import threading
+from types import SimpleNamespace
 from typing import Any
 
 os.environ.setdefault("QT_QPA_PLATFORM", "offscreen")
 
 import pytest
-from PySide6.QtWidgets import QApplication, QFrame, QLabel, QPushButton, QVBoxLayout
+from PySide6.QtWidgets import QApplication, QDialog, QFrame, QLabel, QPushButton, QVBoxLayout
 
 from doctor_workstation.ui import diagnosis_media
 from doctor_workstation.ui.diagnosis_drawer import RecordTable
@@ -378,6 +380,7 @@ def test_video_table_embeds_player_and_preserves_row_bound_upload(
         [
             {
                 "id": 48,
+                "room_id": "doctor-501-20260819-143247",
                 "recording_urls_list": [
                     "https://media.example.invalid/replay.mp4",
                     "https://media.example.invalid/replay-backup.m3u8",
@@ -407,6 +410,12 @@ def test_video_table_embeds_player_and_preserves_row_bound_upload(
     application.processEvents()
 
     table = dialog._table_registry["video"][1]
+    assert table.horizontalHeaderItem(1).text() == "房间号"
+    assert table.item(0, 1).text() == "doctor-501-20260819-143247"
+    assert table.item(1, 1).text() == "历史记录未保存"
+    room_rect = table.visualItemRect(table.item(0, 1))
+    assert room_rect.left() >= 0
+    assert room_rect.right() < table.viewport().width()
     playback = table.cellWidget(0, 0)
     assert isinstance(playback, RecordingPlaybackCell)
     assert playback.property("callRecordId") == 48
@@ -465,6 +474,132 @@ def test_video_table_embeds_player_and_preserves_row_bound_upload(
     application.processEvents()
 
 
+def test_video_table_exposes_local_audio_separately_from_cloud_video_and_text(
+    application: QApplication,
+) -> None:
+    dialog = DiagnosisDialog(_Repository(), permissions=["*"])
+    dialog._editable = False
+    dialog._can_video_upload = False
+    dialog._diagnosis_id = 501
+    opened: list[str] = []
+    dialog._open_recording_player = lambda target: opened.append(target)  # type: ignore[method-assign]
+    audio_url = "https://cos.example.invalid/calls/local-audio.webm"
+    dialog._fill_video(
+        [
+            {
+                "id": 49,
+                "recording_urls_list": [
+                    "https://cos.example.invalid/calls/cloud-mixed-video.mp4"
+                ],
+                "local_audio_urls_list": [audio_url],
+                "local_audio_status_text": "已保存",
+                "transcript_text": "医生：请描述症状。\n患者：最近口渴。",
+                "transcription_status_text": "已完成",
+                "call_type": 2,
+                "status": 2,
+                "recording_status_text": "已生成",
+            }
+        ]
+    )
+    table = dialog._table_registry["video"][1]
+    action_host = table.cellWidget(0, 8)
+    assert action_host is not None
+    audio = action_host.findChild(QPushButton, "DiagnosisLocalAudioPlayback")
+    transcript = action_host.findChild(QPushButton, "DiagnosisVideoTranscriptView")
+    assert audio is not None and audio.property("callRecordId") == 49
+    assert transcript is not None and transcript.property("callRecordId") == 49
+    status = table.item(0, 7).text()
+    assert "云端视频：已生成" in status
+    assert "本机录音：已保存" in status
+    assert "转写文字：已完成" in status
+
+    audio.click()
+    assert opened == [audio_url]
+    dialog.close()
+    application.processEvents()
+
+
+def test_local_audio_upload_and_queue_close_refresh_server_backed_video_rows(
+    application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    created: list[QDialog] = []
+
+    class _UploadManager:
+        def __init__(self) -> None:
+            self.listeners: set[Any] = set()
+
+        def add_upload_listener(self, listener: Any) -> None:
+            self.listeners.add(listener)
+
+        def remove_upload_listener(self, listener: Any) -> None:
+            self.listeners.discard(listener)
+
+        def complete(self, diagnosis_id: int, call_record_id: int) -> None:
+            record = SimpleNamespace(
+                diagnosis_id=diagnosis_id,
+                call_record_id=call_record_id,
+            )
+            for listener in tuple(self.listeners):
+                listener(record)
+
+    manager = _UploadManager()
+
+    class _QueueDialog(QDialog):
+        def __init__(
+            self,
+            _repository: Any,
+            _diagnosis_id: int,
+            parent: QDialog,
+        ) -> None:
+            super().__init__(parent)
+            self.manager = manager
+            created.append(self)
+
+    monkeypatch.setattr(diagnosis_module, "LocalAudioQueueDialog", _QueueDialog)
+    dialog = DiagnosisDialog(_Repository(), permissions=["*"])
+    dialog._diagnosis_id = 501
+    dialog._can_video_upload = True
+    reloads: list[tuple[str, bool]] = []
+    dialog._ensure_tab_loaded = (  # type: ignore[method-assign]
+        lambda key, force=False: reloads.append((key, force))
+    )
+
+    dialog._open_local_audio_queue()
+    assert len(created) == 1
+    queue_dialog = created[0]
+    assert reloads == [("video", True)]
+
+    dialog._loading_tabs.add("video")
+    manager.complete(501, 49)
+    manager.complete(501, 50)
+    manager.complete(999, 51)
+    application.processEvents()
+    assert reloads == [("video", True)]
+    assert dialog._video_reload_pending is True
+
+    dialog._loading_tabs.discard("video")
+    dialog._flush_video_reload_if_pending(501)
+    application.processEvents()
+    assert reloads == [("video", True), ("video", True)]
+
+    queue_dialog.accept()
+    application.processEvents()
+    assert reloads == [("video", True), ("video", True)]
+    assert manager.listeners
+
+    worker = threading.Thread(target=lambda: manager.complete(501, 52))
+    worker.start()
+    worker.join(timeout=5)
+    assert worker.is_alive() is False
+    application.processEvents()
+    assert reloads == [("video", True), ("video", True), ("video", True)]
+
+    dialog.reject()
+    application.processEvents()
+    assert manager.listeners == set()
+
+
 def test_inline_player_rejects_stale_owner_generation(application: QApplication) -> None:
     class _Owner:
         _tab_generations = {"video": 4}

app/tests/test_local_audio_queue.py

@@ -0,0 +1,482 @@
+from __future__ import annotations
+
+import sqlite3
+import threading
+from pathlib import Path
+from typing import Any
+
+import pytest
+from PySide6.QtTest import QTest
+from PySide6.QtWidgets import QApplication
+
+from doctor_workstation.services.local_audio_queue import (
+    LocalAudioQueueStore,
+    LocalAudioUploadManager,
+)
+from doctor_workstation.ui.dialogs.local_audio_queue import (
+    LocalAudioQueueDialog,
+    _display_time,
+)
+
+
+def _application() -> QApplication:
+    return QApplication.instance() or QApplication([])
+
+
+def _ready_record(
+    store: LocalAudioQueueStore,
+    *,
+    diagnosis_id: int,
+    call_record_id: int,
+    session_id: str,
+    room_id: str = "",
+) -> int:
+    record = store.begin_recording(
+        session_id=session_id,
+        diagnosis_id=diagnosis_id,
+        mime_type="audio/webm",
+        call_record_id=call_record_id,
+        room_id=room_id,
+    )
+    payload = b"\x1aE\xdf\xa3" + (b"local-call-audio" * 128)
+    record.file_path.write_bytes(payload)
+    finalized = store.finalize_recording(record.id, size_bytes=len(payload))
+    return finalized.id
+
+
+class _ConcurrentRepository:
+    def __init__(self, expected: int) -> None:
+        self.expected = expected
+        self.lock = threading.Lock()
+        self.release = threading.Event()
+        self.all_started = threading.Event()
+        self.active = 0
+        self.maximum_active = 0
+        self.calls: list[dict[str, Any]] = []
+
+    def upload_call_recording(self, **payload: Any) -> dict[str, str]:
+        path = Path(payload["path"])
+        assert path.is_file()
+        with self.lock:
+            self.active += 1
+            self.maximum_active = max(self.maximum_active, self.active)
+            self.calls.append(payload)
+            if self.active >= self.expected:
+                self.all_started.set()
+        try:
+            assert self.release.wait(5), "concurrent uploads did not receive release"
+            return {"file_url": f"cos://recordings/{path.name}"}
+        finally:
+            with self.lock:
+                self.active -= 1
+
+
+class _RetryRepository:
+    def __init__(self) -> None:
+        self.calls = 0
+        self.call_records: dict[int, list[dict[str, Any]]] = {}
+        self.list_calls: list[int] = []
+
+    def upload_call_recording(self, **payload: Any) -> dict[str, str]:
+        self.calls += 1
+        if self.calls == 1:
+            raise RuntimeError("COS 暂时不可用")
+        return {"file_url": f"cos://recordings/{Path(payload['path']).name}"}
+
+    def list_call_records(self, diagnosis_id: int) -> list[dict[str, Any]]:
+        self.list_calls.append(int(diagnosis_id))
+        return list(self.call_records.get(int(diagnosis_id), []))
+
+
+def test_existing_queue_schema_adds_room_id_without_losing_rows(
+    tmp_path: Path,
+) -> None:
+    root = tmp_path / "old-audio-queue"
+    root.mkdir()
+    database = root / "queue.sqlite3"
+    with sqlite3.connect(database) as connection:
+        connection.execute(
+            """
+            CREATE TABLE local_audio_uploads (
+                id INTEGER PRIMARY KEY AUTOINCREMENT,
+                session_id TEXT NOT NULL UNIQUE,
+                diagnosis_id INTEGER NOT NULL,
+                call_record_id INTEGER,
+                mime_type TEXT NOT NULL,
+                file_path TEXT NOT NULL,
+                size_bytes INTEGER NOT NULL DEFAULT 0,
+                status TEXT NOT NULL,
+                error_text TEXT NOT NULL DEFAULT '',
+                uploaded_url TEXT NOT NULL DEFAULT '',
+                attempts INTEGER NOT NULL DEFAULT 0,
+                created_at TEXT NOT NULL,
+                updated_at TEXT NOT NULL,
+                uploaded_at TEXT NOT NULL DEFAULT ''
+            )
+            """
+        )
+        connection.execute(
+            """
+            INSERT INTO local_audio_uploads (
+                session_id, diagnosis_id, call_record_id, mime_type, file_path,
+                size_bytes, status, error_text, uploaded_url, attempts,
+                created_at, updated_at, uploaded_at
+            ) VALUES (?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?)
+            """,
+            (
+                "legacy-uploaded-session",
+                8169,
+                901,
+                "audio/webm",
+                str(root / "legacy.webm"),
+                2048,
+                "uploaded",
+                "",
+                "cos://recordings/legacy.webm",
+                2,
+                "2026-08-20T01:00:00+00:00",
+                "2026-08-20T01:02:00+00:00",
+                "2026-08-20T01:02:00+00:00",
+            ),
+        )
+
+    store = LocalAudioQueueStore(root)
+    record = store.list_records()[0]
+    with sqlite3.connect(database) as connection:
+        columns = {
+            str(row[1])
+            for row in connection.execute(
+                "PRAGMA table_info(local_audio_uploads)"
+            ).fetchall()
+        }
+
+    assert "room_id" in columns
+    assert record.room_id == ""
+    assert record.status == "uploaded"
+    assert record.uploaded_url == "cos://recordings/legacy.webm"
+    assert record.attempts == 2
+    assert LocalAudioQueueStore(root).require(record.id).room_id == ""
+
+
+def test_local_audio_identity_binding_is_idempotent_and_rejects_conflicts(
+    tmp_path: Path,
+) -> None:
+    store = LocalAudioQueueStore(tmp_path / "audio-queue")
+    record = store.begin_recording(
+        session_id="identity-binding-session",
+        diagnosis_id=8169,
+        mime_type="audio/webm",
+        call_record_id=901,
+        room_id="00123456",
+    )
+
+    assert record.call_record_id == 901
+    assert record.room_id == "00123456"
+    assert store.bind_identity(
+        record.id,
+        call_record_id=901,
+        room_id="00123456",
+    ).room_id == "00123456"
+    assert store.bind_identity(record.id, call_record_id=901).room_id == "00123456"
+
+    with pytest.raises(RuntimeError, match="房间号发生冲突"):
+        store.bind_identity(record.id, call_record_id=901, room_id="99887766")
+    with pytest.raises(RuntimeError, match="通话记录 ID 或房间号发生冲突"):
+        store.bind_identity(record.id, call_record_id=902, room_id="00123456")
+    assert store.require(record.id).call_record_id == 901
+    assert store.require(record.id).room_id == "00123456"
+
+
+def test_local_audio_queue_uploads_three_files_concurrently(tmp_path: Path) -> None:
+    store = LocalAudioQueueStore(tmp_path / "audio-queue")
+    record_ids = [
+        _ready_record(
+            store,
+            diagnosis_id=8169,
+            call_record_id=900 + index,
+            session_id=f"session-{index}",
+        )
+        for index in range(3)
+    ]
+    repository = _ConcurrentRepository(expected=3)
+    manager = LocalAudioUploadManager(repository, store, max_workers=3)
+    futures = [manager.submit(record_id) for record_id in record_ids]
+
+    try:
+        assert repository.all_started.wait(5)
+        assert repository.maximum_active == 3
+    finally:
+        repository.release.set()
+
+    assert [future.result(timeout=5) for future in futures] == [True, True, True]
+    records = [store.require(record_id) for record_id in record_ids]
+    assert all(record.status == "uploaded" for record in records)
+    assert all(record.exists for record in records)
+    assert all(record.uploaded_url.startswith("cos://recordings/") for record in records)
+    assert {call["call_record_id"] for call in repository.calls} == {900, 901, 902}
+
+
+def test_failed_local_audio_is_kept_and_can_be_retried(tmp_path: Path) -> None:
+    store = LocalAudioQueueStore(tmp_path / "audio-queue")
+    record_id = _ready_record(
+        store,
+        diagnosis_id=8169,
+        call_record_id=901,
+        session_id="retry-session",
+    )
+    repository = _RetryRepository()
+    manager = LocalAudioUploadManager(repository, store, max_workers=1)
+
+    assert manager.submit(record_id).result(timeout=5) is False
+    failed = store.require(record_id)
+    assert failed.status == "failed"
+    assert failed.exists
+    assert failed.attempts == 1
+    assert "COS 暂时不可用" in failed.error_text
+
+    store.retry(record_id)
+    assert manager.submit(record_id).result(timeout=5) is True
+    uploaded = store.require(record_id)
+    assert uploaded.status == "uploaded"
+    assert uploaded.exists
+    assert uploaded.attempts == 2
+    assert uploaded.uploaded_url.startswith("cos://recordings/")
+
+
+def test_local_audio_manager_notifies_when_an_upload_reaches_uploaded(
+    tmp_path: Path,
+) -> None:
+    store = LocalAudioQueueStore(tmp_path / "audio-queue")
+    repository = _RetryRepository()
+    repository.calls = 1
+    manager = LocalAudioUploadManager(repository, store, max_workers=1)
+    record_id = _ready_record(
+        store,
+        diagnosis_id=8169,
+        call_record_id=901,
+        session_id="upload-notification-session",
+    )
+    uploads: list[tuple[int, int, str]] = []
+
+    def record_upload(record: Any) -> None:
+        uploads.append(
+            (record.diagnosis_id, int(record.call_record_id or 0), record.uploaded_url)
+        )
+
+    manager.add_upload_listener(record_upload)
+    assert manager.submit(record_id).result(timeout=5) is True
+    assert manager.submit(record_id).result(timeout=5) is True
+    manager.remove_upload_listener(record_upload)
+
+    assert uploads == [
+        (
+            8169,
+            901,
+            store.require(record_id).uploaded_url,
+        )
+    ]
+
+
+def test_local_audio_manager_does_not_report_success_without_uploaded_url(
+    tmp_path: Path,
+) -> None:
+    class _IncompleteRepository:
+        @staticmethod
+        def upload_call_recording(**_payload: Any) -> dict[str, bool]:
+            return {"completed": True}
+
+    store = LocalAudioQueueStore(tmp_path / "audio-queue")
+    record_id = _ready_record(
+        store,
+        diagnosis_id=8169,
+        call_record_id=901,
+        session_id="missing-url-session",
+    )
+    manager = LocalAudioUploadManager(_IncompleteRepository(), store, max_workers=1)
+    uploads: list[Any] = []
+    manager.add_upload_listener(uploads.append)
+
+    assert manager.submit(record_id).result(timeout=5) is False
+    record = store.require(record_id)
+    assert record.status == "failed"
+    assert "文件地址" in record.error_text
+    assert uploads == []
+
+
+def test_local_audio_dialog_displays_utc_recording_time_in_business_timezone() -> None:
+    assert _display_time("2026-08-20T01:51:00+00:00") == (
+        "2026-08-20 09:51:00"
+    )
+
+
+def test_local_audio_dialog_lists_status_and_retry_controls(tmp_path: Path) -> None:
+    application = _application()
+    store = LocalAudioQueueStore(tmp_path / "audio-queue")
+    repository = _RetryRepository()
+    manager = LocalAudioUploadManager(repository, store, max_workers=1)
+
+    failed_id = _ready_record(
+        store,
+        diagnosis_id=8169,
+        call_record_id=901,
+        session_id="failed-session",
+        room_id="67534825",
+    )
+    store.update_status(failed_id, "failed", "等待医生重试")
+    uploaded_id = _ready_record(
+        store,
+        diagnosis_id=8169,
+        call_record_id=902,
+        session_id="uploaded-session",
+        room_id="1692231119",
+    )
+    store.mark_uploaded(uploaded_id, "cos://recordings/uploaded.webm")
+
+    dialog = LocalAudioQueueDialog(
+        repository,
+        8169,
+        store=store,
+        manager=manager,
+    )
+    dialog.show()
+    application.processEvents()
+    try:
+        assert dialog.objectName() == "LocalAudioQueueDialog"
+        assert dialog.table.columnCount() == 8
+        assert dialog.table.rowCount() == 2
+        assert dialog.summary_failed.text() == "失败 1"
+        assert dialog.summary_uploaded.text() == "已上传 1"
+        assert dialog.retry_failed_button.isEnabled()
+        assert dialog.table.horizontalHeaderItem(1).text() == "通话记录 ID"
+        assert dialog.table.horizontalHeaderItem(2).text() == "房间号"
+        assert dialog.table.horizontalHeaderItem(5).text() == "上传状态"
+        assert dialog.table.horizontalHeaderItem(6).text() == "失败原因"
+        assert dialog.table.columnWidth(dialog._room_column) == 180
+        rooms = {
+            dialog.table.item(row, 2).text() for row in range(dialog.table.rowCount())
+        }
+        assert rooms == {"67534825", "1692231119"}
+        statuses = {
+            dialog.table.item(row, 5).text() for row in range(dialog.table.rowCount())
+        }
+        assert statuses == {"上传失败", "已上传"}
+    finally:
+        dialog.close()
+        application.processEvents()
+
+
+def test_global_local_audio_dialog_lists_all_diagnoses_and_outcomes(
+    tmp_path: Path,
+) -> None:
+    application = _application()
+    store = LocalAudioQueueStore(tmp_path / "audio-queue")
+    repository = _RetryRepository()
+    manager = LocalAudioUploadManager(repository, store, max_workers=1)
+
+    failed_id = _ready_record(
+        store,
+        diagnosis_id=8169,
+        call_record_id=901,
+        session_id="global-failed-session",
+        room_id="67534825",
+    )
+    store.update_status(failed_id, "failed", "等待医生重试")
+    uploaded_id = _ready_record(
+        store,
+        diagnosis_id=9001,
+        call_record_id=902,
+        session_id="global-uploaded-session",
+        room_id="407179477",
+    )
+    store.mark_uploaded(uploaded_id, "cos://recordings/global-uploaded.webm")
+
+    dialog = LocalAudioQueueDialog(
+        repository,
+        None,
+        store=store,
+        manager=manager,
+    )
+    dialog.show()
+    application.processEvents()
+    try:
+        assert dialog.title_label.text() == "本机录音上传管理"
+        assert dialog.table.columnCount() == 9
+        assert dialog.table.rowCount() == 2
+        assert dialog.table.horizontalHeaderItem(1).text() == "诊单 ID"
+        assert dialog.table.horizontalHeaderItem(2).text() == "通话记录 ID"
+        assert dialog.table.horizontalHeaderItem(3).text() == "房间号"
+        assert dialog.table.horizontalHeaderItem(6).text() == "上传状态"
+        diagnosis_ids = {
+            dialog.table.item(row, 1).text()
+            for row in range(dialog.table.rowCount())
+        }
+        assert diagnosis_ids == {"8169", "9001"}
+        statuses = {
+            dialog.table.item(row, 6).text()
+            for row in range(dialog.table.rowCount())
+        }
+        assert statuses == {"上传失败", "已上传"}
+        rooms = {
+            dialog.table.item(row, 3).text()
+            for row in range(dialog.table.rowCount())
+        }
+        assert rooms == {"67534825", "407179477"}
+        assert dialog.summary_failed.text() == "失败 1"
+        assert dialog.summary_uploaded.text() == "已上传 1"
+    finally:
+        dialog.close()
+        application.processEvents()
+
+
+def test_dialog_fetches_and_persists_historical_room_ids_once_per_diagnosis(
+    tmp_path: Path,
+) -> None:
+    application = _application()
+    store = LocalAudioQueueStore(tmp_path / "audio-queue")
+    repository = _RetryRepository()
+    repository.call_records[8169] = [
+        {"id": 902, "room_id": "1692231119"},
+        {"id": 901, "room_id": "67534825"},
+    ]
+    manager = LocalAudioUploadManager(repository, store, max_workers=1)
+    first_id = _ready_record(
+        store,
+        diagnosis_id=8169,
+        call_record_id=901,
+        session_id="legacy-room-first",
+    )
+    second_id = _ready_record(
+        store,
+        diagnosis_id=8169,
+        call_record_id=902,
+        session_id="legacy-room-second",
+    )
+
+    dialog = LocalAudioQueueDialog(
+        repository,
+        8169,
+        store=store,
+        manager=manager,
+    )
+    dialog.show()
+    try:
+        for _ in range(200):
+            application.processEvents()
+            if store.require(first_id).room_id and store.require(second_id).room_id:
+                break
+            QTest.qWait(10)
+
+        assert store.require(first_id).room_id == "67534825"
+        assert store.require(second_id).room_id == "1692231119"
+        assert repository.list_calls == [8169]
+        for _ in range(3):
+            dialog.refresh_records()
+            application.processEvents()
+        assert repository.list_calls == [8169]
+        assert {
+            dialog.table.item(row, 2).text()
+            for row in range(dialog.table.rowCount())
+        } == {"67534825", "1692231119"}
+    finally:
+        dialog.close()
+        application.processEvents()

app/tests/test_mock_repository.py

@@ -295,6 +295,34 @@ def test_demo_transcript_upsert_and_finish_round_trip_in_call_records(
     assert "final words" in record["transcript_text"]
 
 
+def test_demo_local_audio_is_preserved_separately_from_cloud_video_and_text(
+    repository: DemoDoctorRepository,
+    tmp_path: Path,
+) -> None:
+    started = repository.start_call(501, 301)
+    call_record_id = int(started["id"])
+    audio = tmp_path / "local-call.webm"
+    audio.write_bytes(b"webm-opus-audio")
+
+    result = repository.upload_call_recording(
+        audio,
+        501,
+        call_record_id=call_record_id,
+        mime_type="audio/webm;codecs=opus",
+    )
+    record = next(
+        row for row in repository.list_call_records(501) if row["id"] == call_record_id
+    )
+
+    assert result["media_kind"] == "local_audio"
+    assert result["call_record_id"] == call_record_id
+    assert record["local_audio_status"] == 2
+    assert record["local_audio_status_text"] == "已保存"
+    assert record["local_audio_urls_list"] == [result["file_url"]]
+    assert record["recording_urls_list"] == []
+    assert record["transcript_text"] == ""
+
+
 def test_tolerant_page_parsing_accepts_aliases_and_bad_rows() -> None:
     """List parsing handles nullable fields, aliases and non-object rows safely."""
 

app/tests/test_patient_ai_report_desktop.py

@@ -3,6 +3,7 @@
 from __future__ import annotations
 
 import os
+from concurrent.futures import ThreadPoolExecutor
 from copy import deepcopy
 from datetime import date
 from typing import Any
@@ -40,8 +41,11 @@ def immediate_async(monkeypatch: pytest.MonkeyPatch) -> None:
         on_success: Any = None,
         on_error: Any = None,
         on_finished: Any = None,
+        pool: Any = None,
+        priority: int = 0,
         **kwargs: Any,
     ) -> object:
+        del pool, priority
         try:
             result = function(*args, **kwargs)
         except Exception as error:
@@ -305,6 +309,64 @@ def test_openai_failure_keeps_new_qwen_snapshot(
     page.close()
 
 
+def test_finished_only_cached_regeneration_unlocks_retry_and_keeps_snapshot(
+    application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    detail = _detail(109, 301, 509)
+    saved = _snapshot("qwen", 1, "2026-08-14 10:45:00")
+    jobs: list[dict[str, Any]] = []
+
+    def queue(function: Any, *args: Any, **options: Any) -> object:
+        jobs.append({"function": function, "args": args, **options})
+        return object()
+
+    monkeypatch.setattr(reception_module, "run_async", queue)
+
+    class Repository:
+        def list_patient_ai_reports(self, patient_id: int) -> dict[str, Any]:
+            return {"patient_id": patient_id, "reports": [saved]}
+
+        def generate_patient_ai_report(
+            self,
+            patient_id: int,
+            *,
+            model: str,
+        ) -> dict[str, Any]:
+            raise AssertionError(f"queued worker must not run inline: {patient_id}/{model}")
+
+    page = ReceptionPage(
+        Repository(),
+        PermissionSet(
+            [
+                "tcm.diagnosis/patientAiReports",
+                "tcm.diagnosis/generatePatientAiReport",
+            ]
+        ),
+    )
+    page._select_record(detail["appointment"])
+    jobs[0]["on_success"]({"detail": detail, "warnings": []})
+    jobs[1]["on_success"]({"patient_id": 301, "reports": [saved]})
+    jobs[1]["on_finished"]()
+    assert page._ai_analysis_model_states["qwen"] == "success"
+    assert page.ai_analysis_regenerate_button.isEnabled()
+
+    page.ai_analysis_regenerate_button.click()
+    assert len(jobs) == 3
+    assert page._ai_analysis_regenerating
+    assert not page.ai_analysis_regenerate_button.isEnabled()
+
+    jobs[2]["on_finished"]()
+
+    assert not page._ai_analysis_regenerating
+    assert page._ai_analysis_regeneration_model is None
+    assert page._ai_analysis_model_states["qwen"] == "success"
+    assert page.ai_summary_label.text() == "千问第 1 版诊断建议"
+    assert page.ai_analysis_regenerate_button.isEnabled()
+    assert "未返回有效结果" in page.ai_analysis_secondary_status.text()
+    page.close()
+
+
 def test_late_patient_history_response_is_discarded_after_switch(
     application: QApplication,
     monkeypatch: pytest.MonkeyPatch,
@@ -353,6 +415,7 @@ def test_late_patient_history_response_is_discarded_after_switch(
     first_history_job = jobs[1]
 
     page._select_record(second["appointment"])
+    assert first_history_job["function"]() is reception_module._ASYNC_REQUEST_CANCELLED
     finish(jobs[2])
     second_history_job = jobs[3]
     finish(second_history_job)
@@ -364,6 +427,563 @@ def test_late_patient_history_response_is_discarded_after_switch(
     page.close()
 
 
+def test_aba_switch_attaches_to_inflight_patient_generation_without_duplicate_post(
+    application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    first = _detail(110, 301, 510)
+    second = _detail(111, 302, 511)
+    jobs: list[dict[str, Any]] = []
+
+    def queue(function: Any, *args: Any, **options: Any) -> object:
+        jobs.append({"function": function, "args": args, **options})
+        return object()
+
+    monkeypatch.setattr(reception_module, "run_async", queue)
+
+    class Repository:
+        def __init__(self) -> None:
+            self.generate_calls: list[tuple[int, str]] = []
+
+        def list_patient_ai_reports(self, patient_id: int) -> dict[str, Any]:
+            return {"patient_id": patient_id, "reports": []}
+
+        def generate_patient_ai_report(
+            self,
+            patient_id: int,
+            *,
+            model: str,
+        ) -> dict[str, Any]:
+            self.generate_calls.append((patient_id, model))
+            generated = _snapshot(model, 1, "2026-08-14 12:00:00")
+            generated["patient_id"] = patient_id
+            return {
+                "patient_id": patient_id,
+                "generated_report": generated,
+                "report": generated,
+            }
+
+    repository = Repository()
+    page = ReceptionPage(
+        repository,
+        PermissionSet(
+            [
+                "tcm.diagnosis/patientAiReports",
+                "tcm.diagnosis/generatePatientAiReport",
+            ]
+        ),
+    )
+    page._select_record(first["appointment"])
+    jobs[0]["on_success"]({"detail": first, "warnings": []})
+    jobs[1]["on_success"]({"patient_id": 301, "reports": []})
+    first_qwen_job = jobs[2]
+    qwen_result = first_qwen_job["function"]()
+
+    page._select_record(second["appointment"])
+    page._select_record(first["appointment"])
+    jobs[4]["on_success"]({"detail": first, "warnings": []})
+
+    assert len(jobs) == 5
+    first_qwen_job["on_success"](qwen_result)
+    first_qwen_job["on_finished"]()
+
+    assert repository.generate_calls == [(301, "qwen")]
+    assert len(jobs) == 6
+    assert page._ai_analysis_model_states["qwen"] == "success"
+    assert page.ai_summary_label.text() == "千问第 1 版诊断建议"
+    page.close()
+    application.processEvents()
+
+
+def test_patient_history_get_is_singleflight_across_aba_switch(
+    application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    first = _detail(112, 301, 512)
+    second = _detail(113, 302, 513)
+    saved = _snapshot("qwen", 1, "2026-08-14 12:10:00")
+    jobs: list[dict[str, Any]] = []
+
+    def queue(function: Any, *args: Any, **options: Any) -> object:
+        jobs.append({"function": function, "args": args, **options})
+        return object()
+
+    monkeypatch.setattr(reception_module, "run_async", queue)
+
+    class Repository:
+        def __init__(self) -> None:
+            self.list_calls: list[int] = []
+
+        def list_patient_ai_reports(self, patient_id: int) -> dict[str, Any]:
+            self.list_calls.append(patient_id)
+            return {"patient_id": patient_id, "reports": [saved]}
+
+        def generate_patient_ai_report(self, patient_id: int, *, model: str) -> Any:
+            raise AssertionError(f"history exists: {patient_id}/{model}")
+
+    repository = Repository()
+    page = ReceptionPage(
+        repository,
+        PermissionSet(
+            [
+                "tcm.diagnosis/patientAiReports",
+                "tcm.diagnosis/generatePatientAiReport",
+            ]
+        ),
+    )
+    page._select_record(first["appointment"])
+    jobs[0]["on_success"]({"detail": first, "warnings": []})
+    first_list_job = jobs[1]
+    list_result = first_list_job["function"]()
+
+    page._select_record(second["appointment"])
+    page._select_record(first["appointment"])
+    jobs[3]["on_success"]({"detail": first, "warnings": []})
+
+    assert len(jobs) == 4
+    assert repository.list_calls == [301]
+
+    first_list_job["on_success"](list_result)
+    first_list_job["on_finished"]()
+
+    assert page._ai_analysis_model_states["qwen"] == "success"
+    assert page.ai_summary_label.text() == "千问第 1 版诊断建议"
+    page.close()
+    application.processEvents()
+
+
+def test_patient_ai_finished_only_tracks_qwen_workers_not_unrelated_openai(
+    application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    detail = _detail(114, 301, 514)
+    jobs: list[dict[str, Any]] = []
+
+    def queue(function: Any, *args: Any, **options: Any) -> object:
+        jobs.append({"function": function, "args": args, **options})
+        return object()
+
+    monkeypatch.setattr(reception_module, "run_async", queue)
+
+    class Repository:
+        def list_patient_ai_reports(self, patient_id: int) -> dict[str, Any]:
+            return {"patient_id": patient_id, "reports": []}
+
+        def generate_patient_ai_report(self, patient_id: int, *, model: str) -> Any:
+            raise AssertionError(f"worker must remain queued: {patient_id}/{model}")
+
+    page = ReceptionPage(
+        Repository(),
+        PermissionSet(
+            [
+                "tcm.diagnosis/patientAiReports",
+                "tcm.diagnosis/generatePatientAiReport",
+            ]
+        ),
+    )
+    page._select_record(detail["appointment"])
+    jobs[0]["on_success"]({"detail": detail, "warnings": []})
+    current_list_job = jobs[1]
+    stale_qwen = (page._ai_analysis_generation - 2, 114, 301, "qwen")
+    stale_openai = (page._ai_analysis_generation - 1, 114, 301, "openai")
+
+    page._patient_ai_generation_requests.add(stale_qwen)
+    page._patient_ai_generation_finished(*stale_qwen)
+    assert page._ai_analysis_model_states["qwen"] == "loading"
+
+    page._patient_ai_generation_requests.add(stale_openai)
+    current_list_job["on_finished"]()
+    page._patient_ai_generation_finished(*stale_openai)
+
+    assert not page._patient_ai_list_requests
+    assert not page._patient_ai_generation_requests
+    assert page._ai_analysis_model_states["qwen"] == "error"
+    assert not page._ai_analysis_loading
+    assert "未返回有效结果" in page.ai_analysis_state_label.text()
+    page.close()
+    application.processEvents()
+
+
+def test_aba_cancelled_generation_is_replaced_instead_of_becoming_false_error(
+    application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    first = _detail(115, 301, 515)
+    second = _detail(116, 302, 516)
+    jobs: list[dict[str, Any]] = []
+
+    def queue(function: Any, *args: Any, **options: Any) -> object:
+        jobs.append({"function": function, "args": args, **options})
+        return object()
+
+    monkeypatch.setattr(reception_module, "run_async", queue)
+    monkeypatch.setattr(
+        reception_module,
+        "_AI_AUTOMATIC_GENERATION_SETTLE_SECONDS",
+        5.0,
+    )
+
+    class Repository:
+        def __init__(self) -> None:
+            self.generate_calls: list[tuple[int, str]] = []
+
+        def list_patient_ai_reports(self, patient_id: int) -> dict[str, Any]:
+            return {"patient_id": patient_id, "reports": []}
+
+        def generate_patient_ai_report(
+            self,
+            patient_id: int,
+            *,
+            model: str,
+        ) -> dict[str, Any]:
+            self.generate_calls.append((patient_id, model))
+            generated = _snapshot(model, 1, "2026-08-14 12:20:00")
+            generated["patient_id"] = patient_id
+            return {
+                "patient_id": patient_id,
+                "generated_report": generated,
+                "report": generated,
+            }
+
+    repository = Repository()
+    page = ReceptionPage(
+        repository,
+        PermissionSet(
+            [
+                "tcm.diagnosis/patientAiReports",
+                "tcm.diagnosis/generatePatientAiReport",
+            ]
+        ),
+    )
+    page._select_record(first["appointment"])
+    jobs[0]["on_success"]({"detail": first, "warnings": []})
+    jobs[1]["on_success"]({"patient_id": 301, "reports": []})
+    old_qwen_job = jobs[2]
+
+    with ThreadPoolExecutor(max_workers=1) as executor:
+        cancelled_future = executor.submit(old_qwen_job["function"])
+        page._select_record(second["appointment"])
+        cancelled = cancelled_future.result(timeout=1.0)
+    monkeypatch.setattr(
+        reception_module,
+        "_AI_AUTOMATIC_GENERATION_SETTLE_SECONDS",
+        0.0,
+    )
+    assert cancelled is reception_module._ASYNC_REQUEST_CANCELLED
+    assert repository.generate_calls == []
+
+    page._select_record(first["appointment"])
+    jobs[4]["on_success"]({"detail": first, "warnings": []})
+    assert len(jobs) == 6
+    current_list_job = jobs[5]
+    current_list_job["on_success"]({"patient_id": 301, "reports": []})
+    assert len(jobs) == 7
+    replacement_qwen_job = jobs[6]
+
+    current_list_job["on_finished"]()
+    assert len(jobs) == 7
+    qwen_result = replacement_qwen_job["function"]()
+    replacement_qwen_job["on_success"](qwen_result)
+    replacement_qwen_job["on_finished"]()
+    jobs_after_replacement = len(jobs)
+
+    old_qwen_job["on_success"](cancelled)
+    old_qwen_job["on_finished"]()
+
+    assert repository.generate_calls == [(301, "qwen")]
+    assert len(jobs) == jobs_after_replacement
+    assert page._ai_analysis_model_states["qwen"] == "success"
+    assert page.ai_summary_label.text() == "千问第 1 版诊断建议"
+    page.close()
+    application.processEvents()
+
+
+@pytest.mark.parametrize("late_completion", ["cancelled", "error"])
+def test_late_history_completion_cannot_clear_newer_generated_snapshot(
+    application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
+    late_completion: str,
+) -> None:
+    detail = _detail(117, 301, 517)
+    jobs: list[dict[str, Any]] = []
+
+    def queue(function: Any, *args: Any, **options: Any) -> object:
+        jobs.append({"function": function, "args": args, **options})
+        return object()
+
+    monkeypatch.setattr(reception_module, "run_async", queue)
+
+    class Repository:
+        def __init__(self) -> None:
+            self.generate_calls: list[tuple[int, str]] = []
+
+        def list_patient_ai_reports(self, patient_id: int) -> dict[str, Any]:
+            raise AssertionError(f"history worker remains pending: {patient_id}")
+
+        def generate_patient_ai_report(
+            self,
+            patient_id: int,
+            *,
+            model: str,
+        ) -> dict[str, Any]:
+            self.generate_calls.append((patient_id, model))
+            generated = _snapshot(model, 9, "2026-08-14 12:30:00")
+            generated["id"] = 901 if model == "qwen" else 902
+            generated["patient_id"] = patient_id
+            return {
+                "patient_id": patient_id,
+                "generated_report": generated,
+                "report": generated,
+            }
+
+    repository = Repository()
+    page = ReceptionPage(
+        repository,
+        PermissionSet(
+            [
+                "tcm.diagnosis/patientAiReports",
+                "tcm.diagnosis/generatePatientAiReport",
+            ]
+        ),
+    )
+    page._select_record(detail["appointment"])
+    jobs[0]["on_success"]({"detail": detail, "warnings": []})
+    history_job = jobs[1]
+    current_context = page._current_patient_ai_context(301)
+    assert current_context is not None
+    generation, appointment_id, _patient_id = current_context
+    page._request_patient_ai_generation("qwen", generation, appointment_id, 301)
+    qwen_job = jobs[2]
+    qwen_result = qwen_job["function"]()
+    qwen_job["on_success"](qwen_result)
+    qwen_job["on_finished"]()
+    jobs_after_generation = len(jobs)
+
+    if late_completion == "cancelled":
+        history_job["on_success"](reception_module._ASYNC_REQUEST_CANCELLED)
+    else:
+        history_job["on_error"](RuntimeError("late history failure"))
+    history_job["on_finished"]()
+
+    assert repository.generate_calls == [(301, "qwen")]
+    assert len(jobs) == jobs_after_generation
+    assert page._ai_analysis_model_states["qwen"] == "success"
+    assert page._ai_analysis_payloads["qwen"]["id"] == 901
+    assert page.ai_summary_label.text() == "千问第 9 版诊断建议"
+    page.close()
+    application.processEvents()
+
+
+def test_cancelled_queued_generation_does_not_invalidate_valid_history_get(
+    application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    first = _detail(118, 301, 518)
+    second = _detail(119, 302, 519)
+    saved = _snapshot("qwen", 10, "2026-08-14 12:40:00")
+    jobs: list[dict[str, Any]] = []
+
+    def queue(function: Any, *args: Any, **options: Any) -> object:
+        jobs.append({"function": function, "args": args, **options})
+        return object()
+
+    monkeypatch.setattr(reception_module, "run_async", queue)
+
+    class Repository:
+        def __init__(self) -> None:
+            self.list_calls: list[int] = []
+            self.generate_calls: list[tuple[int, str]] = []
+
+        def list_patient_ai_reports(self, patient_id: int) -> dict[str, Any]:
+            self.list_calls.append(patient_id)
+            return {"patient_id": patient_id, "reports": [saved]}
+
+        def generate_patient_ai_report(self, patient_id: int, *, model: str) -> Any:
+            self.generate_calls.append((patient_id, model))
+            raise AssertionError("cancelled queued POST must not enter repository")
+
+    repository = Repository()
+    page = ReceptionPage(
+        repository,
+        PermissionSet(
+            [
+                "tcm.diagnosis/patientAiReports",
+                "tcm.diagnosis/generatePatientAiReport",
+            ]
+        ),
+    )
+    page._select_record(first["appointment"])
+    jobs[0]["on_success"]({"detail": first, "warnings": []})
+    history_job = jobs[1]
+    history_result = history_job["function"]()
+    current_context = page._current_patient_ai_context(301)
+    assert current_context is not None
+    generation, appointment_id, _patient_id = current_context
+    page._request_patient_ai_generation("qwen", generation, appointment_id, 301)
+    queued_qwen_job = jobs[2]
+
+    page._select_record(second["appointment"])
+    cancelled = queued_qwen_job["function"]()
+    page._select_record(first["appointment"])
+    jobs[4]["on_success"]({"detail": first, "warnings": []})
+    queued_qwen_job["on_success"](cancelled)
+    queued_qwen_job["on_finished"]()
+    history_job["on_success"](history_result)
+    history_job["on_finished"]()
+
+    assert repository.list_calls == [301]
+    assert repository.generate_calls == []
+    assert len(jobs) == 5
+    assert page._ai_analysis_model_states["qwen"] == "success"
+    assert page.ai_summary_label.text() == "千问第 10 版诊断建议"
+    page.close()
+    application.processEvents()
+
+
+def test_saturated_automatic_ai_slots_end_in_retryable_state_without_post(
+    application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    detail = _detail(120, 301, 520)
+    jobs: list[dict[str, Any]] = []
+
+    def queue(function: Any, *args: Any, **options: Any) -> object:
+        jobs.append({"function": function, "args": args, **options})
+        return object()
+
+    class BusyAutomaticSlots:
+        @staticmethod
+        def acquire(*, blocking: bool) -> bool:
+            assert not blocking
+            return False
+
+        @staticmethod
+        def release() -> None:
+            raise AssertionError("an unacquired slot must not be released")
+
+    monkeypatch.setattr(reception_module, "run_async", queue)
+    monkeypatch.setattr(
+        reception_module,
+        "_AI_AUTOMATIC_GENERATION_SETTLE_SECONDS",
+        0.0,
+    )
+    monkeypatch.setattr(
+        reception_module,
+        "_AI_AUTOMATIC_REQUEST_SLOTS",
+        BusyAutomaticSlots(),
+    )
+
+    class Repository:
+        def __init__(self) -> None:
+            self.generate_calls: list[tuple[int, str]] = []
+
+        def list_patient_ai_reports(self, patient_id: int) -> dict[str, Any]:
+            return {"patient_id": patient_id, "reports": []}
+
+        def generate_patient_ai_report(self, patient_id: int, *, model: str) -> Any:
+            self.generate_calls.append((patient_id, model))
+            raise AssertionError("busy automatic work must not submit a POST")
+
+    repository = Repository()
+    page = ReceptionPage(
+        repository,
+        PermissionSet(
+            [
+                "tcm.diagnosis/patientAiReports",
+                "tcm.diagnosis/generatePatientAiReport",
+            ]
+        ),
+    )
+    page._select_record(detail["appointment"])
+    jobs[0]["on_success"]({"detail": detail, "warnings": []})
+    jobs[1]["on_success"]({"patient_id": 301, "reports": []})
+    automatic_qwen_job = jobs[2]
+    deferred = automatic_qwen_job["function"]()
+    automatic_qwen_job["on_success"](deferred)
+    automatic_qwen_job["on_finished"]()
+
+    assert deferred is reception_module._ASYNC_REQUEST_DEFERRED
+    assert repository.generate_calls == []
+    assert page._ai_analysis_model_states["qwen"] == "error"
+    assert not page._ai_analysis_loading
+    assert not page._ai_analysis_regenerating
+    assert page.ai_analysis_regenerate_button.isEnabled()
+    assert "后台分析任务较多" in page.ai_analysis_state_label.text()
+    page.close()
+    application.processEvents()
+
+
+def test_saturated_history_slots_end_in_retryable_state_without_get(
+    application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    detail = _detail(121, 301, 521)
+    jobs: list[dict[str, Any]] = []
+
+    def queue(function: Any, *args: Any, **options: Any) -> object:
+        jobs.append({"function": function, "args": args, **options})
+        return object()
+
+    class BusyAutomaticSlots:
+        @staticmethod
+        def acquire(*, blocking: bool) -> bool:
+            assert not blocking
+            return False
+
+        @staticmethod
+        def release() -> None:
+            raise AssertionError("an unacquired slot must not be released")
+
+    monkeypatch.setattr(reception_module, "run_async", queue)
+    monkeypatch.setattr(
+        reception_module,
+        "_AI_AUTOMATIC_GENERATION_SETTLE_SECONDS",
+        0.0,
+    )
+    monkeypatch.setattr(
+        reception_module,
+        "_AI_AUTOMATIC_REQUEST_SLOTS",
+        BusyAutomaticSlots(),
+    )
+
+    class Repository:
+        def __init__(self) -> None:
+            self.list_calls: list[int] = []
+
+        def list_patient_ai_reports(self, patient_id: int) -> dict[str, Any]:
+            self.list_calls.append(patient_id)
+            raise AssertionError("busy automatic read must not enter repository")
+
+        def generate_patient_ai_report(self, patient_id: int, *, model: str) -> Any:
+            raise AssertionError(f"history did not complete: {patient_id}/{model}")
+
+    repository = Repository()
+    page = ReceptionPage(
+        repository,
+        PermissionSet(
+            [
+                "tcm.diagnosis/patientAiReports",
+                "tcm.diagnosis/generatePatientAiReport",
+            ]
+        ),
+    )
+    page._select_record(detail["appointment"])
+    jobs[0]["on_success"]({"detail": detail, "warnings": []})
+    history_job = jobs[1]
+    deferred = history_job["function"]()
+    history_job["on_success"](deferred)
+    history_job["on_finished"]()
+
+    assert deferred is reception_module._ASYNC_REQUEST_DEFERRED
+    assert repository.list_calls == []
+    assert page._ai_analysis_model_states["qwen"] == "error"
+    assert not page._ai_analysis_loading
+    assert page.ai_analysis_retry_button.isEnabled()
+    assert "查询任务较多" in page.ai_analysis_state_label.text()
+    page.close()
+    application.processEvents()
+
+
 def test_get_history_requires_exact_top_level_and_row_patient_ids() -> None:
     row = _snapshot("qwen", 1, "2026-08-14 11:00:00")
     valid = {"patient_id": 301, "reports": [row]}

app/tests/test_patients_ui.py

@@ -7,7 +7,7 @@ from typing import Any
 os.environ.setdefault("QT_QPA_PLATFORM", "offscreen")
 
 import pytest
-from PySide6.QtCore import QDate
+from PySide6.QtCore import QDate, QPoint
 from PySide6.QtWidgets import QApplication, QDialogButtonBox, QInputDialog, QLabel
 
 from doctor_workstation.core import PermissionSet
@@ -636,15 +636,35 @@ def test_patient_list_reference_geometry_and_row_actions(
         button.minimumHeight() == 44 and button.maximumHeight() == 44
         for button in workspace.summary_buttons.values()
     )
-    assert all(
-        widget.minimumWidth() == 0 and widget.maximumWidth() > 1000
+    assert workspace.keyword_edit.objectName() == "PatientKeywordInput"
+    assert workspace.status_host.objectName() == "PatientStatusFilterHost"
+    assert workspace.quick_host.objectName() == "PatientQuickDateHost"
+    assert workspace.date_host.objectName() == "PatientDateRangeHost"
+    assert (
+        workspace.keyword_edit.maximumWidth(),
+        workspace.status_host.maximumWidth(),
+        workspace.quick_host.maximumWidth(),
+        workspace.date_host.maximumWidth(),
+    ) == (620, 440, 620, 420)
+    assert workspace.search_button.objectName() == "PatientSearchButton"
+    assert workspace.reset_button.objectName() == "PatientResetButton"
+    assert workspace.custom_date_button.objectName() == "PatientCustomDateButton"
+    for width in (1170, 1290, 1514):
+        page.resize(width, 680)
+        application.processEvents()
         for widget in (
             workspace.keyword_edit,
             workspace.status_host,
+            workspace.search_button,
+            workspace.reset_button,
             workspace.quick_host,
             workspace.date_host,
-        )
-    )
+            workspace.custom_date_button,
+        ):
+            top_left = widget.mapTo(workspace.filter_card, QPoint(0, 0))
+            assert top_left.x() >= 0
+            assert top_left.x() + widget.width() <= workspace.filter_card.width()
+    assert all(button.maximumWidth() == 420 for button in workspace.summary_buttons.values())
     assert page.tabs.minimumHeight() == 0
     assert workspace.content_stack.minimumHeight() == 0
     assert workspace.table.minimumHeight() == 0

app/tests/test_reception_parity_ui.py

@@ -10,14 +10,32 @@ os.environ.setdefault("QT_QPA_PLATFORM", "offscreen")
 
 import httpx
 import pytest
-from PySide6.QtCore import QDate, QPoint, Qt
+from PySide6.QtCore import (
+    QDate,
+    QEvent,
+    QEventLoop,
+    QObject,
+    QPoint,
+    Qt,
+    QThreadPool,
+    QTimer,
+)
 from PySide6.QtGui import QPalette
-from PySide6.QtWidgets import QApplication, QLabel, QPushButton, QScrollArea, QWidget
+from PySide6.QtWidgets import (
+    QApplication,
+    QLabel,
+    QPushButton,
+    QScrollArea,
+    QVBoxLayout,
+    QWidget,
+)
 
 from doctor_workstation.core import PermissionSet
+from doctor_workstation.services import api_client as api_client_module
 from doctor_workstation.services.api_client import ApiClient
 from doctor_workstation.services.mock_repository import DemoDoctorRepository
 from doctor_workstation.services.repository import RemoteDoctorRepository
+from doctor_workstation.ui import widgets as widgets_module
 from doctor_workstation.ui.pages import reception as reception_module
 from doctor_workstation.ui.pages.reception import (
     NOTE_LIMIT,
@@ -41,8 +59,11 @@ def immediate_async(monkeypatch: pytest.MonkeyPatch) -> None:
         on_success: Any = None,
         on_error: Any = None,
         on_finished: Any = None,
+        pool: Any = None,
+        priority: int = 0,
         **kwargs: Any,
     ) -> object:
+        del pool, priority
         try:
             result = function(*args, **kwargs)
         except Exception as error:
@@ -79,6 +100,135 @@ def queued_async(monkeypatch: pytest.MonkeyPatch) -> list[dict[str, Any]]:
     return jobs
 
 
+def test_api_client_reuses_a_bounded_transport_across_qt_runnables(
+    application: QApplication,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    created: list[Any] = []
+
+    class PooledClient:
+        def __init__(self, **_options: Any) -> None:
+            self.closed = False
+            created.append(self)
+
+        def request(self, _method: str, url: str, **_options: Any) -> httpx.Response:
+            return httpx.Response(200, json={"code": 1, "data": url})
+
+        def close(self) -> None:
+            self.closed = True
+
+    monkeypatch.setattr(api_client_module.httpx, "Client", PooledClient)
+    client = ApiClient("https://example.test", max_parallel_requests=2)
+    pool = QThreadPool()
+    pool.setMaxThreadCount(1)
+    pool.setExpiryTimeout(-1)
+    remaining = 40
+    results: list[str] = []
+    loop = QEventLoop()
+
+    def finished() -> None:
+        nonlocal remaining
+        remaining -= 1
+        if remaining == 0:
+            loop.quit()
+
+    for index in range(remaining):
+        widgets_module.run_async(
+            lambda index=index: client.get(f"patient/{index}"),
+            on_success=results.append,
+            on_finished=finished,
+            pool=pool,
+        )
+    QTimer.singleShot(5_000, loop.quit)
+    loop.exec()
+    assert pool.waitForDone(2_000)
+    client.close()
+
+    assert remaining == 0
+    assert len(results) == 40
+    assert len(created) == 1
+    assert created[0].closed
+    application.processEvents()
+
+
+def test_clearing_ai_layout_does_not_promote_children_to_windows(
+    application: QApplication,
+) -> None:
+    host = QWidget()
+    layout = QVBoxLayout(host)
+    dynamic_label = QLabel("正在加载患者 AI 分析", host)
+    layout.addWidget(dynamic_label)
+    host.show()
+    application.processEvents()
+    destroyed: list[bool] = []
+    dynamic_label.destroyed.connect(lambda: destroyed.append(True))
+
+    reception_module._clear_ai_layout(layout)
+
+    assert layout.count() == 0
+    assert destroyed == [True]
+    assert dynamic_label not in application.topLevelWidgets()
+
+    host.close()
+    host.deleteLater()
+
+
+def test_queue_row_never_shows_loading_fields_as_parentless_windows(
+    application: QApplication,
+) -> None:
+    tracked_names = {
+        "StatusBadge",
+        "ReceptionQueueTime",
+        "ReceptionQueueMetric",
+    }
+
+    class OrphanShowRecorder(QObject):
+        def __init__(self) -> None:
+            super().__init__()
+            self.object_names: list[str] = []
+
+        def eventFilter(self, watched: QObject, event: QEvent) -> bool:  # noqa: N802
+            if (
+                event.type() == QEvent.Type.Show
+                and isinstance(watched, QWidget)
+                and watched.objectName() in tracked_names
+                and watched.parentWidget() is None
+                and watched.isWindow()
+            ):
+                self.object_names.append(watched.objectName())
+            return False
+
+    recorder = OrphanShowRecorder()
+    application.installEventFilter(recorder)
+    try:
+        active_row = QueueRow(
+            {
+                "patient_name": "问诊患者",
+                "status": 2,
+                "status_desc": "问诊中",
+                "fasting_blood_sugar": 8.6,
+            }
+        )
+        waiting_row = QueueRow(
+            {
+                "patient_name": "待接诊患者",
+                "status": 1,
+                "appointment_time": "14:30",
+            }
+        )
+    finally:
+        application.removeEventFilter(recorder)
+
+    assert recorder.object_names == []
+    for row in (active_row, waiting_row):
+        for object_name in tracked_names:
+            widget = row.findChild(QWidget, object_name)
+            assert widget is not None
+            assert widget.parentWidget() is row
+            assert not widget.isWindow()
+        row.deleteLater()
+
+
 @pytest.mark.parametrize(
     ("path", "expected"),
     [
@@ -714,6 +864,101 @@ def test_fast_patient_switch_rejects_late_detail(
     application.processEvents()
 
 
+def test_rapid_aba_switch_prioritizes_current_detail_and_skips_stale_bundles(
+    application: QApplication,
+    queued_async: list[dict[str, Any]],
+) -> None:
+    first = _detail(73, name="甲患者")
+    second = _detail(74, name="乙患者")
+
+    class Repository:
+        def __init__(self) -> None:
+            self.calls: list[int] = []
+
+        def get_reception(self, appointment_id: int) -> dict[str, Any]:
+            self.calls.append(appointment_id)
+            return first if appointment_id == 73 else second
+
+    repository = Repository()
+    page = ReceptionPage(repository, PermissionSet([]))
+
+    page._select_record(first["appointment"])
+    page._select_record(second["appointment"])
+    page._select_record(first["appointment"])
+
+    assert [job["priority"] for job in queued_async] == [1, 2, 3]
+    for stale_job in queued_async[:2]:
+        assert stale_job["function"]() == {"cancelled": True}
+        stale_job["on_finished"]()
+    assert repository.calls == []
+
+    current_job = queued_async[2]
+    current_job["on_success"](current_job["function"]())
+    current_job["on_finished"]()
+
+    assert repository.calls == [73]
+    assert page._selected_appointment_id == 73
+    assert page.patient_name_label.text() == "甲患者"
+    assert not page._detail_loading
+
+    page.close()
+    application.processEvents()
+
+
+def test_switching_patient_resets_stale_daily_panel_loading(
+    application: QApplication,
+) -> None:
+    page = ReceptionPage(object(), PermissionSet([]))
+    page.daily_panel.set_loading(True)
+    assert page.daily_panel._loading
+    assert not page.daily_panel.refresh_button.isEnabled()
+
+    page._reset_detail_content(
+        seed={"id": 75, "patient_name": "新患者", "diagnosis_id": 275}
+    )
+
+    assert not page.daily_panel._loading
+    assert page.daily_panel.refresh_button.isEnabled()
+    assert all(button.isEnabled() for button in page.daily_panel.range_buttons.values())
+    assert page.daily_panel.start_date.isEnabled()
+    assert page.daily_panel.end_date.isEnabled()
+
+    page.close()
+    application.processEvents()
+
+
+def test_stale_daily_worker_skips_repository_after_patient_switch(
+    application: QApplication,
+    queued_async: list[dict[str, Any]],
+) -> None:
+    first = _detail(76, name="日常甲患者")
+    second = _detail(77, name="日常乙患者")
+
+    class Repository:
+        def __init__(self) -> None:
+            self.tracking_calls: list[int] = []
+
+        def get_tracking_window(self, diagnosis_id: int, **_options: Any) -> dict[str, Any]:
+            self.tracking_calls.append(diagnosis_id)
+            return {}
+
+    repository = Repository()
+    page = ReceptionPage(repository, PermissionSet([]))
+    page._select_record(first["appointment"])
+    queued_async[0]["on_success"]({"detail": first, "warnings": []})
+    page._request_daily_range("2026-08-13", "2026-08-19")
+    stale_daily_job = queued_async[1]
+    page._select_record(second["appointment"])
+
+    assert stale_daily_job["function"]() == {"cancelled": True}
+    assert repository.tracking_calls == []
+    assert not page.daily_panel._loading
+    assert page.daily_panel.refresh_button.isEnabled()
+
+    page.close()
+    application.processEvents()
+
+
 def test_medication_case_prioritizes_clinical_information_and_keeps_plain_summary(
     application: QApplication,
 ) -> None:
@@ -1169,6 +1414,28 @@ def test_phone_permission_and_ungated_notify_video_actions(
     application.processEvents()
 
 
+def test_im_consult_is_visible_immediately_after_history(
+    application: QApplication,
+) -> None:
+    page = ReceptionPage(DemoDoctorRepository(), PermissionSet([]))
+    page.resize(1280, 760)
+    page.detail_stack.setCurrentIndex(1)
+    page.show()
+    application.processEvents()
+
+    assert page.video_button.text() == "IM 问诊"
+    assert page.video_button.objectName() == "ReceptionImButton"
+    assert not page.video_button.isHidden()
+    assert page.history_button.geometry().right() < page.video_button.geometry().left()
+    assert page.video_button.geometry().right() < page.more_button.geometry().left()
+    assert "IM 问诊" not in [
+        action.text() for action in page.more_button.menu().actions()
+    ]
+
+    page.close()
+    application.processEvents()
+
+
 def test_reception_ai_report_button_follows_permission(
     application: QApplication,
     immediate_async: None,
@@ -1423,6 +1690,65 @@ def test_reception_dual_ai_queues_openai_only_after_qwen_is_visible(
     application.processEvents()
 
 
+def test_saturated_fallback_ai_slots_do_not_leave_current_analysis_loading(
+    application: QApplication,
+    queued_async: list[dict[str, Any]],
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    detail = _detail(86, name="后台分析繁忙患者")
+    calls: list[tuple[int, str]] = []
+
+    class BusyAutomaticSlots:
+        @staticmethod
+        def acquire(*, blocking: bool) -> bool:
+            assert not blocking
+            return False
+
+        @staticmethod
+        def release() -> None:
+            raise AssertionError("an unacquired slot must not be released")
+
+    monkeypatch.setattr(
+        reception_module,
+        "_AI_AUTOMATIC_GENERATION_SETTLE_SECONDS",
+        0.0,
+    )
+    monkeypatch.setattr(
+        reception_module,
+        "_AI_AUTOMATIC_REQUEST_SLOTS",
+        BusyAutomaticSlots(),
+    )
+
+    class Repository:
+        def get_diagnosis_ai_analysis(
+            self,
+            diagnosis_id: int,
+            model: str,
+        ) -> dict[str, Any]:
+            calls.append((diagnosis_id, model))
+            raise AssertionError("busy automatic work must not enter repository")
+
+    page = ReceptionPage(
+        Repository(),
+        PermissionSet(["tcm.diagnosis/aiAnalysis"]),
+    )
+    page._select_record(detail["appointment"])
+    queued_async[0]["on_success"]({"detail": detail, "warnings": []})
+    automatic_qwen_job = queued_async[1]
+    deferred = automatic_qwen_job["function"](*automatic_qwen_job["args"])
+    automatic_qwen_job["on_success"](deferred)
+    automatic_qwen_job["on_finished"]()
+
+    assert deferred is reception_module._ASYNC_REQUEST_DEFERRED
+    assert calls == []
+    assert page._ai_analysis_model_states["qwen"] == "error"
+    assert not page._ai_analysis_loading
+    assert page.ai_analysis_retry_button.isEnabled()
+    assert "后台分析任务较多" in page.ai_analysis_state_label.text()
+    page.close()
+    application.processEvents()
+
+
 def test_reception_openai_failure_keeps_qwen_success_visible(
     application: QApplication,
     queued_async: list[dict[str, Any]],
@@ -1886,6 +2212,89 @@ def test_detail_failure_stops_ai_loading_and_keeps_retry_available(
 
     jobs[0]["on_finished"]()
     assert not page._detail_loading
+    assert "正在" not in page.patient_meta_label.text()
+    assert "正在" not in page.diagnosis_text.text()
+    assert "正在" not in page.health_summary_label.text()
+    assert "正在" not in page.followup_text.text()
+    assert not page.daily_panel._loading
+    assert page.daily_panel.refresh_button.isEnabled()
+
+    page.close()
+    application.processEvents()
+
+
+def test_finished_only_detail_request_cannot_leave_loading_placeholders(
+    application: QApplication,
+    queued_async: list[dict[str, Any]],
+) -> None:
+    page = ReceptionPage(object(), PermissionSet(["*"]))
+    record = {
+        "id": 86,
+        "patient_id": 186,
+        "diagnosis_id": 286,
+        "patient_name": "无结果患者",
+    }
+
+    page._select_record(record)
+    queued_async[0]["on_finished"]()
+
+    assert not page._detail_loading
+    assert page._selected_detail is None
+    assert page.detail_banner.property("kind") == "danger"
+    assert "正在" not in page.patient_meta_label.text()
+    assert "正在" not in page.diagnosis_text.text()
+    assert "正在" not in page.health_summary_label.text()
+    assert "正在" not in page.followup_text.text()
+    assert not page.daily_panel._loading
+    assert page.daily_panel.refresh_button.isEnabled()
+    assert page._ai_analysis_state == "error"
+
+    page.close()
+    application.processEvents()
+
+
+def test_finished_only_patient_ai_query_becomes_retryable(
+    application: QApplication,
+    queued_async: list[dict[str, Any]],
+) -> None:
+    detail = _detail(87, name="AI 无结果患者")
+
+    class Repository:
+        def list_patient_ai_reports(self, patient_id: int) -> dict[str, Any]:
+            raise AssertionError(f"queued worker must not run inline: {patient_id}")
+
+        def generate_patient_ai_report(
+            self,
+            patient_id: int,
+            *,
+            model: str,
+        ) -> dict[str, Any]:
+            raise AssertionError(f"queued worker must not run inline: {patient_id}/{model}")
+
+    page = ReceptionPage(
+        Repository(),
+        PermissionSet(
+            [
+                "tcm.diagnosis/patientAiReports",
+                "tcm.diagnosis/generatePatientAiReport",
+            ]
+        ),
+    )
+    page._select_record(detail["appointment"])
+    queued_async[0]["on_success"]({"detail": detail, "warnings": []})
+    assert len(queued_async) == 2
+    assert page._ai_analysis_state == "loading"
+
+    queued_async[1]["on_finished"]()
+
+    assert page._ai_analysis_state == "error"
+    assert not page._ai_analysis_loading
+    assert "请重试" in page.ai_analysis_state_label.text()
+    assert not page.ai_analysis_retry_button.isHidden()
+
+    page.ai_analysis_retry_button.click()
+    assert len(queued_async) == 3
+    assert page._ai_analysis_state == "loading"
 
     page.close()
     application.processEvents()
@@ -1960,6 +2369,7 @@ def test_reception_ai_analysis_discards_late_qwen_and_openai_results(
     assert len(queued_async) == 2
 
     page._select_record(second["appointment"])
+    assert queued_async[1]["function"]() is reception_module._ASYNC_REQUEST_CANCELLED
     queued_async[2]["on_success"]({"detail": second, "warnings": []})
     assert len(queued_async) == 4
     second_qwen = _analysis_payload("第二位千问风险")
@@ -1968,6 +2378,7 @@ def test_reception_ai_analysis_discards_late_qwen_and_openai_results(
     assert len(queued_async) == 5
 
     page._select_record(third["appointment"])
+    assert queued_async[4]["function"]() is reception_module._ASYNC_REQUEST_CANCELLED
     queued_async[5]["on_success"]({"detail": third, "warnings": []})
     assert len(queued_async) == 7
     third_qwen = _analysis_payload("第三位千问风险")

app/tests/test_repository_parity.py

@@ -3,6 +3,7 @@
 from __future__ import annotations
 
 from datetime import date
+from pathlib import Path
 from typing import Any
 
 import pytest
@@ -480,6 +481,81 @@ def test_remote_start_call_requires_and_normalizes_current_record_id() -> None:
     ]
 
 
+def test_remote_call_record_identity_is_reused_for_room_recording_and_end() -> None:
+    """Room binding and COS finalization must never select a different latest call."""
+
+    client = RecordingClient()
+    repository = RemoteDoctorRepository(client)  # type: ignore[arg-type]
+
+    repository.bind_call_room(501, " room-901 ", call_record_id=901)
+    repository.end_call(501, call_record_id=901)
+
+    assert client.post_calls == [
+        (
+            "tcm.diagnosis/bindCallRoom",
+            {"diagnosis_id": 501, "room_id": "room-901", "call_record_id": 901},
+        ),
+        (
+            "tcm.diagnosis/endCall",
+            {"diagnosis_id": 501, "call_record_id": 901},
+        ),
+    ]
+
+
+def test_remote_local_audio_upload_keeps_exact_call_identity_and_mime(
+    tmp_path: Path,
+) -> None:
+    class MultipartClient(RecordingClient):
+        def __init__(self) -> None:
+            super().__init__()
+            self.multipart_calls: list[
+                tuple[str, dict[str, tuple[str, bytes, str]], dict[str, Any]]
+            ] = []
+
+        def post_multipart(
+            self,
+            endpoint: str,
+            *,
+            files: dict[str, tuple[str, bytes, str]],
+            data: dict[str, Any],
+        ) -> dict[str, Any]:
+            self.multipart_calls.append((endpoint, files, data))
+            completed = int(data["chunk_index"]) == int(data["chunk_total"]) - 1
+            return {
+                "call_record_id": 901,
+                "completed": completed,
+                "file_url": "https://cos.example.test/calls/local-audio.webm"
+                if completed
+                else "",
+                "media_kind": "local_audio",
+            }
+
+    recording = tmp_path / "local-audio.webm"
+    recording.write_bytes(b"a" * (4 * 1024 * 1024 + 3))
+    client = MultipartClient()
+    repository = RemoteDoctorRepository(client)  # type: ignore[arg-type]
+
+    result = repository.upload_call_recording(
+        recording,
+        501,
+        call_record_id=901,
+        mime_type="audio/webm;codecs=opus",
+    )
+
+    assert result["completed"] is True
+    assert result["call_record_id"] == 901
+    assert result["media_kind"] == "local_audio"
+    assert len(client.multipart_calls) == 2
+    assert all(call[0] == "tcm.diagnosis/uploadCallRecording" for call in client.multipart_calls)
+    for _endpoint, files, data in client.multipart_calls:
+        assert data["diagnosis_id"] == 501
+        assert data["call_record_id"] == 901
+        assert data["mime_type"] == "audio/webm;codecs=opus"
+        assert str(data["upload_id"]).startswith("local_audio_")
+        assert files["file"][0] == "local-audio.webm"
+        assert files["file"][2] == "audio/webm;codecs=opus"
+
+
 @pytest.mark.parametrize(
     "response",
     [None, {}, {"ok": True}, {"call_record_id": 0}, {"callRecordId": -1}, {"id": True}],
@@ -645,6 +721,34 @@ def test_remote_diagnosis_ai_assistant_uses_first_party_endpoint_only() -> None:
     assert client.timeouts == [105.0]
 
 
+def test_ai_post_type_error_after_dispatch_is_never_retried() -> None:
+    class FailingAfterDispatchClient:
+        token = "token"
+
+        def __init__(self) -> None:
+            self.calls = 0
+
+        def post(
+            self,
+            endpoint: str,
+            payload: dict[str, Any] | None = None,
+            *,
+            timeout: float | None = None,
+        ) -> Any:
+            assert endpoint == "tcm.diagnosis/generatePatientAiReport"
+            assert payload == {"patient_id": 301, "model": "qwen"}
+            assert timeout == 105.0
+            self.calls += 1
+            raise TypeError("transport failed after dispatch")
+
+    client = FailingAfterDispatchClient()
+
+    with pytest.raises(TypeError, match="after dispatch"):
+        RemoteDoctorRepository(client).generate_patient_ai_report(301, model="qwen")
+
+    assert client.calls == 1
+
+
 def test_remote_diagnosis_ai_stream_normalises_chunks_in_order() -> None:
     class StreamingClient(RecordingClient):
         def post_event_stream(self, endpoint: str, payload: dict[str, Any], **kwargs: Any):

app/tests/test_shell_contract.py

@@ -6,11 +6,17 @@ from typing import Any
 os.environ.setdefault("QT_QPA_PLATFORM", "offscreen")
 
 import pytest
-from PySide6.QtCore import Qt
-from PySide6.QtWidgets import QApplication, QWidget
+from PySide6.QtCore import QSize, Qt
+from PySide6.QtWidgets import QApplication, QDialog, QFrame, QToolButton, QWidget
 
 from doctor_workstation.ui import shell as shell_module
 from doctor_workstation.ui.shell import NavigationItem, ShellWindow
+from doctor_workstation.ui.theme import apply_theme
+
+
+def _logical_pixel(image: Any, x: int, y: int):
+    device_scale = image.devicePixelRatio()
+    return image.pixelColor(round(x * device_scale), round(y * device_scale))
 
 
 class _ShellPageDouble(QWidget):
@@ -39,7 +45,26 @@ class _ShellPageDouble(QWidget):
 
 @pytest.fixture(scope="module")
 def application() -> QApplication:
-    return QApplication.instance() or QApplication([])
+    app = QApplication.instance() or QApplication([])
+    apply_theme(app)
+    return app
+
+
+@pytest.mark.parametrize(
+    ("available_size", "expected_size"),
+    [
+        (QSize(1920, 1080), QSize(1710, 920)),
+        (QSize(1486, 1000), QSize(1486, 920)),
+        (QSize(1600, 800), QSize(1600, 800)),
+        (QSize(800, 600), QSize(1024, 640)),
+        (None, QSize(1710, 920)),
+    ],
+)
+def test_shell_initial_size_is_bounded_by_logical_available_geometry(
+    available_size: QSize | None,
+    expected_size: QSize,
+) -> None:
+    assert shell_module._bounded_initial_window_size(available_size) == expected_size
 
 
 def test_patients_navigation_keeps_the_product_menu_title() -> None:
@@ -145,14 +170,60 @@ def test_shell_matches_reference_geometry_at_both_acceptance_sizes(
         assert shell_window.stack.geometry().bottom() < shell_window.workspace.height()
 
         image = shell_window.grab().toImage()
-        assert image.pixelColor(20, 300).name().lower() in {
+        assert _logical_pixel(image, 20, 300).name().lower() in {
             "#f2f5fd",
             "#f3f6fd",
             "#f2f6fe",
             "#f3f6fe",
         }
-        assert image.pixelColor(610, 20).name().lower() == "#ffffff"
-        assert image.pixelColor(220, 90).name().lower() == "#fcfdfe"
+        assert _logical_pixel(image, 610, 20).name().lower() == "#ffffff"
+        assert _logical_pixel(image, 220, 90).name().lower() == "#fcfdfe"
+
+
+def test_topbar_search_actions_and_navigation_controls_stay_aligned(
+    application: QApplication,
+    shell_window: ShellWindow,
+) -> None:
+    for width, height in ((1024, 640), (1366, 768)):
+        shell_window.resize(width, height)
+        application.processEvents()
+
+        search_host = shell_window.topbar.findChild(QFrame, "ShellGlobalSearch")
+        shortcut_hint = search_host.findChild(QWidget, "ShellShortcutHint")
+        assert search_host.size().toTuple() == (265, 36)
+        assert shell_window.fold_button.size().toTuple() == (38, 38)
+        assert shortcut_hint.size() == shortcut_hint.sizeHint()
+        assert (
+            abs(search_host.geometry().center().y() - shell_window.fold_button.geometry().center().y())
+            <= 1
+        )
+        assert (
+            abs(
+                shortcut_hint.mapTo(search_host, shortcut_hint.rect().center()).y()
+                - search_host.rect().center().y()
+            )
+            <= 1
+        )
+
+        shell_window.global_search.setText("患者")
+        application.processEvents()
+        action_buttons = shell_window.global_search.findChildren(QToolButton)
+        assert len(action_buttons) == 2
+        for button in action_buttons:
+            assert button.size().toTuple() == (22, 18)
+            assert shell_window.global_search.rect().contains(button.geometry())
+            assert (
+                abs(
+                    button.geometry().center().y()
+                    - shell_window.global_search.rect().center().y()
+                )
+                <= 1
+            )
+
+        clear_button = max(action_buttons, key=lambda button: button.x())
+        clear_right = clear_button.mapTo(search_host, clear_button.rect().topRight()).x()
+        assert clear_right < shortcut_hint.x()
+        shell_window.global_search.clear()
 
 
 def test_registered_pages_are_not_top_level_windows(shell_window: ShellWindow) -> None:
@@ -170,7 +241,11 @@ def test_reference_shell_has_integrated_search_ai_card_and_window_controls(
     )
     assert shell_window.assistant_card.isVisible()
     assert shell_window.assistant_button.text() == "开始对话"
-    assert "GPT-4o 医疗版" in shell_window.model_label.text()
+    assert shell_window.upload_settings_button.text().strip().startswith("设置")
+    assert (
+        shell_window.upload_settings_button.accessibleName() == "本机录音上传设置"
+    )
+    assert shell_window.model_label is shell_window.upload_settings_button
     assert shell_window.minimize_button.text() == ""
     assert shell_window.close_button.text() == ""
 
@@ -180,6 +255,42 @@ def test_reference_shell_has_integrated_search_ai_card_and_window_controls(
     assert "在线" in shell_window.assistant_status.text()
 
 
+def test_shell_settings_opens_global_local_audio_upload_manager(
+    application: QApplication,
+    shell_window: ShellWindow,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    captured: dict[str, Any] = {}
+
+    def dialog_factory(
+        repository: Any,
+        diagnosis_id: int | None,
+        parent: QWidget,
+    ) -> QDialog:
+        dialog = QDialog(parent)
+        dialog.setObjectName("LocalAudioQueueDialog")
+        captured.update(
+            repository=repository,
+            diagnosis_id=diagnosis_id,
+            parent=parent,
+            dialog=dialog,
+        )
+        return dialog
+
+    monkeypatch.setattr(shell_module, "LocalAudioQueueDialog", dialog_factory)
+    shell_window.upload_settings_button.click()
+    application.processEvents()
+
+    assert captured["repository"] is shell_window.repository
+    assert captured["diagnosis_id"] is None
+    assert captured["parent"] is shell_window
+    assert captured["dialog"].isVisible()
+
+    captured["dialog"].reject()
+    application.processEvents()
+    assert shell_window._local_audio_settings_dialog is None
+
+
 def test_every_visible_page_navigates_and_visited_tabs_track_active_page(
     shell_window: ShellWindow,
 ) -> None:

app/tests/test_video_contract.py

@@ -28,6 +28,233 @@ from doctor_workstation.video.security import (  # noqa: E402
 )
 
 
+def test_companion_uses_legacy_safe_transcription_session_identity() -> None:
+    """Generated session IDs stay below 32 chars so upgraded databases cannot truncate."""
+
+    source = (PROJECT_ROOT / "video_companion" / "src" / "main.ts").read_text(
+        encoding="utf-8"
+    )
+    function_source = source.split("function newTranscriptionSessionId", 1)[1].split(
+        "function requestTranscriptionStart", 1
+    )[0]
+
+    assert "replaceAll('-', '')" in function_source
+    assert ".slice(0, 28)" in function_source
+    assert "return `tr-${" in function_source
+
+
+def test_companion_archives_cloud_video_local_mixed_audio_and_transcript() -> None:
+    """A connected call starts three independent artifacts before hangup."""
+
+    source = (PROJECT_ROOT / "video_companion" / "src" / "main.ts").read_text(
+        encoding="utf-8"
+    )
+
+    assert "context.createMediaStreamDestination()" in source
+    assert "cloud.getAudioTrack({ processed: true })" in source
+    assert "userId: activeConfig.targetUserId" in source
+    assert "new MediaRecorder(destination.stream" in source
+    assert "recorder.start(1000)" in source
+    assert "bridge.startLocalAudioRecording(sessionId, mimeType)" in source
+    assert "bridge.appendLocalAudioChunk(" in source
+    assert "bridge.finishLocalAudioRecording(sessionId, totalBytes)" in source
+    assert "operations.push(stopLocalRecording())" in source
+    assert "operations.push(stopTranscription('completed'))" in source
+    assert "Promise.allSettled(operations)" in source
+    assert "腾讯云混流视频、本机语音录音和实时转写均已启动" in source
+
+
+def test_companion_watches_room_id_for_the_entire_call_cycle() -> None:
+    """A slowly-created TRTC room must still bind to the exact call record."""
+
+    source = (PROJECT_ROOT / "video_companion" / "src" / "main.ts").read_text(
+        encoding="utf-8"
+    )
+    room_source = source.split("function readRoomId", 1)[1].split(
+        "function handleStatusChanged", 1
+    )[0]
+
+    assert "TUIStore.watch(StoreName.CALL, roomIdWatchOptions)" in room_source
+    assert "[NAME.ROOM_ID]: handleRoomIdChanged" in room_source
+    assert "cycle === callCycleGeneration" in room_source
+    assert "while (activeConfig && !endNotified" in room_source
+    assert "attempt < 40" not in room_source
+    assert "diagnosisId: activeConfig.diagnosisId" in room_source
+
+
+def test_room_binding_is_acknowledged_and_transcriber_room_is_a_fallback() -> None:
+    companion_source = (
+        PROJECT_ROOT / "video_companion" / "src" / "main.ts"
+    ).read_text(encoding="utf-8")
+    window_source = (
+        PROJECT_ROOT / "src" / "doctor_workstation" / "video" / "window.py"
+    ).read_text(encoding="utf-8")
+
+    assert "observeRoomId(roomId)" in companion_source
+    assert "onRealtimeTranscriberStarted: (roomId)" in companion_source
+    assert "function roomBindingResult(" in companion_source
+    assert "if (boundRoomId) return" in companion_source
+    assert "roomBindingResult?.(" in window_source
+
+
+def test_im_conversation_renders_deduplicated_video_call_status_timeline() -> None:
+    """Video lifecycle feedback belongs in the IM timeline as local status events."""
+
+    companion_root = PROJECT_ROOT / "video_companion" / "src"
+    source = (companion_root / "main.ts").read_text(encoding="utf-8")
+    app_source = (companion_root / "App.vue").read_text(encoding="utf-8")
+    styles = (companion_root / "style.css").read_text(encoding="utf-8")
+
+    timeline_source = source.split("function appendVideoCallStatus", 1)[1].split(
+        "function onMessageReceived", 1
+    )[0]
+    assert "activeConfig.mode !== 'chat'" in timeline_source
+    assert "local-video-call-${callCycleGeneration}-${callStatus}" in timeline_source
+    assert "findIndex((item) => item.id === id)" in timeline_source
+    assert "appendVideoCallStatus('starting', '正在创建安全视频通话')" in source
+    assert "appendVideoCallStatus('dialing', '正在呼叫患者')" in source
+    assert "appendVideoCallStatus('connected', '视频通话已接通')" in source
+    assert "appendVideoCallStatus('ended', '视频通话已结束')" in source
+    assert "appendVideoCallStatus('failed', `视频通话发起失败：${message}`)" in source
+    assert "message.type === 'call-status'" in app_source
+    assert 'class="call-status-event"' in app_source
+    assert 'role="status"' in app_source
+    assert "IM 已连接 · ${props.statusText.value}" in app_source
+    assert ".message-row--call-status" in styles
+    assert ".call-status-event--connected" in styles
+    assert ".call-status-event--failed" in styles
+
+
+def test_companion_local_recording_waits_for_real_audio_and_has_runtime_fallbacks() -> None:
+    source = (PROJECT_ROOT / "video_companion" / "src" / "main.ts").read_text(
+        encoding="utf-8"
+    )
+
+    assert "querySelectorAll<HTMLMediaElement>('video, audio')" in source
+    assert "stream.getAudioTracks()" in source
+    assert "navigator.mediaDevices.getUserMedia" in source
+    assert "await waitForCallAudioTracks(cloud, sessionId)" in source
+    assert "localRecordingAttachedSourceCount <= 0" in source
+    assert "localRecordingBytes < 1024" in source
+    assert "已阻止上传空文件" in source
+
+
+def test_qt_close_waits_for_local_audio_finish_before_destroying_webengine() -> None:
+    """A title-bar/desktop hangup must keep accepting bridge chunks until COS ack."""
+
+    source = (
+        PROJECT_ROOT / "src" / "doctor_workstation" / "video" / "window.py"
+    ).read_text(encoding="utf-8")
+    request_shutdown = source.split(
+        "def _request_companion_shutdown", 1
+    )[1].split("def _force_requested_shutdown", 1)[0]
+    begin_shutdown = source.split("def _begin_shutdown", 1)[1].split(
+        "def wait_for_lifecycles", 1
+    )[0]
+    close_event = source.split("def closeEvent", 1)[1].split(
+        "else:", 1
+    )[0]
+
+    assert "window.doctorConsultation?.close?.()" in request_shutdown
+    assert "self._shutdown_requested = True" in request_shutdown
+    assert "self._closing = True" not in request_shutdown
+    assert "event.ignore()" in close_event
+    assert "self._request_companion_shutdown" in close_event
+    assert "self._shutdown_timer.stop()" in begin_shutdown
+    assert "window.doctorConsultation?.close?.()" not in begin_shutdown
+    assert "if not self.open_im or self._shutdown_requested" in source
+
+
+def test_local_audio_capture_keeps_and_persists_its_own_call_room_identity() -> None:
+    """A later IM call cycle must not relabel an earlier recording."""
+
+    source = (
+        PROJECT_ROOT / "src" / "doctor_workstation" / "video" / "window.py"
+    ).read_text(encoding="utf-8")
+
+    assert "lifecycle: OrderedCallLifecycle" in source
+    assert "lifecycle = capture.lifecycle" in source
+    assert "call_record_id=call_record_id" in source
+    assert 'room_id=lifecycle.current_room_id or ""' in source
+    assert "store.bind_identity(" in source
+
+
+def test_companion_shows_incremental_subtitles_but_only_persists_final_segments() -> None:
+    main_source = (
+        PROJECT_ROOT / "video_companion" / "src" / "main.ts"
+    ).read_text(encoding="utf-8")
+    component_source = (
+        PROJECT_ROOT / "video_companion" / "src" / "App.vue"
+    ).read_text(encoding="utf-8")
+    handler = main_source.split("function handleTranscriberMessage", 1)[1].split(
+        "function subscribeTranscriber", 1
+    )[0]
+
+    assert "showLiveCaption(message)" in handler
+    assert "if (message.isCompleted !== true) return" in handler
+    assert handler.index("showLiveCaption(message)") < handler.index(
+        "if (message.isCompleted !== true) return"
+    )
+    assert 'aria-label="实时语音字幕"' in component_source
+    assert "liveCaptions.value" in component_source
+    assert "caption.speaker" in component_source
+    assert "caption.text" in component_source
+
+
+def test_companion_screenshot_requires_doctor_confirmation_before_upload() -> None:
+    source = (PROJECT_ROOT / "video_companion" / "src" / "App.vue").read_text(
+        encoding="utf-8"
+    )
+    capture = source.split("async function captureScreenshot", 1)[1].split(
+        "function discardScreenshot", 1
+    )[0]
+    confirm = source.split("async function confirmScreenshot", 1)[1].split(
+        "watch(", 1
+    )[0]
+
+    assert "screenshotPreview.value = canvas.toDataURL" in capture
+    assert "onSaveScreenshot" not in capture
+    assert "await props.onSaveScreenshot(screenshotPreview.value)" in confirm
+    assert "确认画面后再保存到患者资料" in source
+    assert "确认并上传" in source
+    assert "取消" in source
+
+
+def test_companion_loads_im_history_without_an_empty_first_page_cursor() -> None:
+    source = (PROJECT_ROOT / "video_companion" / "src" / "main.ts").read_text(
+        encoding="utf-8"
+    )
+    load_messages = source.split("async function loadMessages", 1)[1].split(
+        "async function sendText", 1
+    )[0]
+
+    assert "nextReqMessageID: prepend ? nextReqMessageID : ''" not in load_messages
+    assert "nextReqMessageID?: string" in load_messages
+    assert (
+        "if (prepend && nextReqMessageID) request.nextReqMessageID = nextReqMessageID"
+        in load_messages
+    )
+    assert "chat.getMessageList(request)" in load_messages
+
+
+def test_companion_preserves_im_scroll_position_for_live_and_older_messages() -> None:
+    source = (PROJECT_ROOT / "video_companion" / "src" / "App.vue").read_text(
+        encoding="utf-8"
+    )
+    watcher = source.split("() => props.messages.value.length", 1)[1].split(
+        "watch(", 1
+    )[0]
+    load_earlier = source.split("async function loadEarlierMessages", 1)[1].split(
+        "async function runAction", 1
+    )[0]
+
+    assert "if (!stickToMessageBottom.value) return" in watcher
+    assert "stickToMessageBottom.value = false" in load_earlier
+    assert "container.scrollHeight - previousHeight" in load_earlier
+    assert '@scroll="handleMessageScroll"' in source
+    assert '@click="loadEarlierMessages"' in source
+
+
 def test_normalizes_admin_ticket_aliases_to_companion_contract() -> None:
     request = normalize_backend_ticket(
         {
@@ -196,11 +423,13 @@ def test_call_lifecycle_is_fifo_daemon_and_never_blocks_caller() -> None:
             events.append(("start", diagnosis_id, patient_id, call_type))
             return {"call_record_id": 900}
 
-        def bind_call_room(self, diagnosis_id: int, room_id: str) -> None:
-            events.append(("bind", diagnosis_id, room_id))
+        def bind_call_room(
+            self, diagnosis_id: int, room_id: str, *, call_record_id: int
+        ) -> None:
+            events.append(("bind", diagnosis_id, room_id, call_record_id))
 
-        def end_call(self, diagnosis_id: int) -> None:
-            events.append(("end", diagnosis_id))
+        def end_call(self, diagnosis_id: int, *, call_record_id: int) -> None:
+            events.append(("end", diagnosis_id, call_record_id))
 
     request = VideoCallRequest(
         sdk_app_id=1400123456,
@@ -226,17 +455,19 @@ def test_call_lifecycle_is_fifo_daemon_and_never_blocks_caller() -> None:
     assert lifecycle.wait(0.01) is False
     assert duplicate_bind is bind_future
     assert changed_bind.result(timeout=0) is False
+    assert lifecycle.current_room_id == "456789"
 
     release_start.set()
     assert start_future.result(timeout=2) is True
     assert bind_future.result(timeout=2) is True
     assert end_future.result(timeout=2) is True
     assert lifecycle.wait(1) is True
+    assert lifecycle.current_room_id == "456789"
 
     assert events == [
         ("start", 123, 8, 2),
-        ("bind", 123, "456789"),
-        ("end", 123),
+        ("bind", 123, "456789", 900),
+        ("end", 123, 900),
     ]
 
 
@@ -479,6 +710,155 @@ def test_failed_start_prevents_bind_and_end_writes() -> None:
     assert events == ["start"]
 
 
+def test_explicit_cos_recording_failure_fails_room_binding_without_losing_call_identity() -> None:
+    class Repository:
+        def start_call(
+            self, diagnosis_id: int, patient_id: int, *, call_type: int
+        ) -> dict[str, int]:
+            del diagnosis_id, patient_id, call_type
+            return {"call_record_id": 904}
+
+        def bind_call_room(
+            self, diagnosis_id: int, room_id: str, *, call_record_id: int
+        ) -> dict[str, object]:
+            assert (diagnosis_id, room_id, call_record_id) == (123, "456789", 904)
+            return {
+                "call_record_id": 904,
+                "cloud_recording": {
+                    "started": False,
+                    "message": "COS bucket is unavailable",
+                },
+            }
+
+    request = VideoCallRequest(
+        sdk_app_id=1400123456,
+        user_id="doctor_42",
+        user_sig="short-lived-ticket",
+        target_user_id="patient_8",
+        diagnosis_id=123,
+        patient_id=8,
+    )
+    lifecycle = OrderedCallLifecycle(request, Repository(), logging.getLogger(__name__))
+
+    with pytest.raises(RuntimeError, match="COS bucket is unavailable"):
+        lifecycle.bind_room("456789").result(timeout=2)
+
+    assert lifecycle.call_record_id == 904
+    assert lifecycle.bound_room_id is None
+    assert lifecycle.wait(1) is True
+
+
+def test_failed_room_binding_releases_claim_and_can_retry_same_room() -> None:
+    bind_attempts = 0
+
+    class Repository:
+        def start_call(
+            self, diagnosis_id: int, patient_id: int, *, call_type: int
+        ) -> dict[str, int]:
+            del diagnosis_id, patient_id, call_type
+            return {"call_record_id": 906}
+
+        def bind_call_room(
+            self, diagnosis_id: int, room_id: str, *, call_record_id: int
+        ) -> dict[str, object]:
+            nonlocal bind_attempts
+            assert (diagnosis_id, room_id, call_record_id) == (123, "456789", 906)
+            bind_attempts += 1
+            if bind_attempts == 1:
+                raise RuntimeError("temporary bind failure")
+            return {
+                "call_record_id": 906,
+                "cloud_recording": {"started": True},
+            }
+
+    request = VideoCallRequest(
+        sdk_app_id=1400123456,
+        user_id="doctor_42",
+        user_sig="short-lived-ticket",
+        target_user_id="patient_8",
+        diagnosis_id=123,
+        patient_id=8,
+    )
+    lifecycle = OrderedCallLifecycle(request, Repository(), logging.getLogger(__name__))
+
+    with pytest.raises(RuntimeError, match="temporary bind failure"):
+        lifecycle.bind_room("456789").result(timeout=2)
+
+    assert lifecycle.current_room_id is None
+    assert lifecycle.bind_room("456789").result(timeout=2) is True
+    assert lifecycle.bound_room_id == "456789"
+    assert lifecycle.current_room_id == "456789"
+    assert bind_attempts == 2
+    assert lifecycle.wait(1) is True
+
+
+def test_local_audio_upload_uses_exact_started_record_and_precedes_end(
+    tmp_path: Path,
+) -> None:
+    events: list[tuple[object, ...]] = []
+
+    class Repository:
+        def start_call(
+            self, diagnosis_id: int, patient_id: int, *, call_type: int
+        ) -> dict[str, int]:
+            events.append(("start", diagnosis_id, patient_id, call_type))
+            return {"call_record_id": 905}
+
+        def upload_call_recording(
+            self,
+            path: Path,
+            diagnosis_id: int,
+            *,
+            call_record_id: int,
+            mime_type: str,
+        ) -> dict[str, object]:
+            events.append(
+                (
+                    "local-audio",
+                    path.read_bytes(),
+                    diagnosis_id,
+                    call_record_id,
+                    mime_type,
+                )
+            )
+            return {
+                "completed": True,
+                "call_record_id": call_record_id,
+                "media_kind": "local_audio",
+            }
+
+        def end_call(self, diagnosis_id: int, *, call_record_id: int) -> None:
+            events.append(("end", diagnosis_id, call_record_id))
+
+    recording = tmp_path / "call-audio.webm"
+    recording.write_bytes(b"opus-webm-audio")
+    request = VideoCallRequest(
+        sdk_app_id=1400123456,
+        user_id="doctor_42",
+        user_sig="short-lived-ticket",
+        target_user_id="patient_8",
+        diagnosis_id=123,
+        patient_id=8,
+    )
+    lifecycle = OrderedCallLifecycle(request, Repository(), logging.getLogger(__name__))
+
+    lifecycle.start()
+    uploaded = lifecycle.save_local_audio_recording(
+        recording,
+        mime_type="audio/webm;codecs=opus",
+    )
+    ended = lifecycle.end("doctor-hangup")
+
+    assert uploaded.result(timeout=2) is True
+    assert ended.result(timeout=2) is True
+    assert lifecycle.wait(1) is True
+    assert events == [
+        ("start", 123, 8, 2),
+        ("local-audio", b"opus-webm-audio", 123, 905, "audio/webm;codecs=opus"),
+        ("end", 123, 905),
+    ]
+
+
 def test_video_screenshot_is_uploaded_and_appended_to_patient_tongue_images() -> None:
     events: list[tuple[object, ...]] = []
 

app/video_companion/dist/index.html

@@ -5,8 +5,8 @@
     <meta name="viewport" content="width=device-width, initial-scale=1.0" />
     <meta name="color-scheme" content="light" />
     <title>视频面诊</title>
-    <script type="module" crossorigin src="./assets/index-DXNYj41g.js"></script>
-    <link rel="stylesheet" crossorigin href="./assets/index-sts1UBl3.css">
+    <script type="module" crossorigin src="./assets/index-DhmAWjut.js"></script>
+    <link rel="stylesheet" crossorigin href="./assets/index-BsDbRyxy.css">
   </head>
   <body>
     <div id="app"></div>

app/video_companion/src/App.vue

@@ -6,11 +6,19 @@ import type { Ref } from 'vue'
 interface ChatMessage {
   id: string
   mine: boolean
-  type: 'text' | 'image' | 'file' | 'audio' | 'video' | 'system'
+  type: 'text' | 'image' | 'file' | 'audio' | 'video' | 'system' | 'call-status'
   text: string
   url: string
   name: string
   time: string
+  callStatus?: 'starting' | 'dialing' | 'connected' | 'ended' | 'failed'
+}
+
+interface LiveCaption {
+  id: string
+  speaker: string
+  text: string
+  completed: boolean
 }
 
 const props = defineProps<{
@@ -24,6 +32,8 @@ const props = defineProps<{
   notice: Readonly<Ref<string>>
   hasMoreMessages: Readonly<Ref<boolean>>
   transcriptionState: Readonly<Ref<string>>
+  localRecordingState: Readonly<Ref<string>>
+  liveCaptions: Readonly<Ref<LiveCaption[]>>
   onSendText: (text: string) => Promise<void>
   onSendAttachment: (file: File) => Promise<void>
   onLoadMore: () => Promise<void>
@@ -38,29 +48,81 @@ const actionBusy = ref(false)
 const localError = ref('')
 const messageList = ref<HTMLElement | null>(null)
 const fileInput = ref<HTMLInputElement | null>(null)
+const screenshotPreview = ref('')
+const stickToMessageBottom = ref(true)
 
 const isChat = computed(() => props.mode.value === 'chat')
 const isCalling = computed(() => ['starting', 'dialing', 'connected'].includes(props.phase.value))
 const videoVisible = computed(() => !isChat.value || isCalling.value)
 const canCapture = computed(() => props.phase.value === 'connected')
-const transcriptionActive = computed(() => props.transcriptionState.value === 'recording')
-const transcriptionFailed = computed(() => props.transcriptionState.value === 'error')
+const chatConnectionText = computed(() => {
+  if (!props.chatReady.value) return props.statusText.value
+  if (['starting', 'dialing', 'connected', 'ended', 'error'].includes(props.phase.value)) {
+    return `IM 已连接 · ${props.statusText.value}`
+  }
+  return 'IM 已连接'
+})
+const transcriptionActive = computed(() => (
+  props.transcriptionState.value === 'recording'
+  || props.localRecordingState.value === 'recording'
+))
+const transcriptionFailed = computed(() => (
+  props.transcriptionState.value === 'error'
+  || props.localRecordingState.value === 'error'
+))
 const transcriptionStatusText = computed(() => {
-  if (props.transcriptionState.value === 'starting') return '自动录音启动中…'
-  if (props.transcriptionState.value === 'recording') return '自动录音并转文字中'
-  if (props.transcriptionState.value === 'stopping') return '正在保存录音文字…'
-  if (props.transcriptionState.value === 'error') return '自动录音转文字失败'
-  return '自动录音已结束'
+  const localState = props.localRecordingState.value
+  const textState = props.transcriptionState.value
+  if (localState === 'uploading') return '正在上传本机录音到 COS…'
+  if (localState === 'stopping' || textState === 'stopping') return '正在保存录音与转写文字…'
+  if (localState === 'starting' || textState === 'starting') return '自动录音与转写启动中…'
+  if (localState === 'recording' && textState === 'recording') return '本机录音与实时转写中'
+  if (localState === 'recording') return '本机录音中，实时转写未就绪'
+  if (textState === 'recording') return '实时转写中，本机录音未就绪'
+  if (localState === 'error' && textState === 'error') return '本机录音与实时转写均失败'
+  if (localState === 'error') return '本机录音失败，实时转写仍在运行'
+  if (textState === 'error') return '实时转写失败，本机录音仍在运行'
+  return '录音与转写已结束'
 })
 
 watch(
   () => props.messages.value.length,
   async () => {
+    if (!stickToMessageBottom.value) return
     await nextTick()
     if (messageList.value) messageList.value.scrollTop = messageList.value.scrollHeight
   },
 )
 
+watch(
+  () => [props.patientName.value, props.mode.value],
+  async () => {
+    stickToMessageBottom.value = true
+    await nextTick()
+    if (messageList.value) messageList.value.scrollTop = messageList.value.scrollHeight
+  },
+)
+
+function handleMessageScroll(): void {
+  const container = messageList.value
+  if (!container) return
+  stickToMessageBottom.value = (
+    container.scrollHeight - container.scrollTop - container.clientHeight <= 96
+  )
+}
+
+async function loadEarlierMessages(): Promise<void> {
+  const container = messageList.value
+  if (!container || actionBusy.value) return
+  const previousHeight = container.scrollHeight
+  const previousTop = container.scrollTop
+  stickToMessageBottom.value = false
+  await runAction(props.onLoadMore)
+  await nextTick()
+  container.scrollTop = previousTop + (container.scrollHeight - previousHeight)
+  handleMessageScroll()
+}
+
 async function runAction(action: () => Promise<void>): Promise<void> {
   if (actionBusy.value) return
   actionBusy.value = true
@@ -113,9 +175,35 @@ async function captureScreenshot(): Promise<void> {
     const context = canvas.getContext('2d')
     if (!context) throw new Error('无法创建截图画布')
     context.drawImage(video, 0, 0, canvas.width, canvas.height)
-    await props.onSaveScreenshot(canvas.toDataURL('image/jpeg', 0.9))
+    screenshotPreview.value = canvas.toDataURL('image/jpeg', 0.9)
   })
 }
+
+function discardScreenshot(): void {
+  if (actionBusy.value) return
+  screenshotPreview.value = ''
+}
+
+async function confirmScreenshot(): Promise<void> {
+  if (!screenshotPreview.value || actionBusy.value) return
+  actionBusy.value = true
+  localError.value = ''
+  try {
+    await props.onSaveScreenshot(screenshotPreview.value)
+    screenshotPreview.value = ''
+  } catch (error) {
+    localError.value = error instanceof Error ? error.message : '截图上传失败，请稍后重试'
+  } finally {
+    actionBusy.value = false
+  }
+}
+
+watch(
+  () => props.phase.value,
+  (value) => {
+    if (value !== 'connected') screenshotPreview.value = ''
+  },
+)
 </script>
 
 <template>
@@ -127,7 +215,7 @@ async function captureScreenshot(): Promise<void> {
           <h1>{{ patientName.value }}</h1>
           <p>
             <span class="connection-dot" :class="{ 'connection-dot--online': chatReady.value }" />
-            {{ chatReady.value ? 'IM 已连接' : statusText.value }}
+            {{ chatConnectionText }}
           </p>
         </div>
         <button
@@ -150,13 +238,13 @@ async function captureScreenshot(): Promise<void> {
         </button>
       </header>
 
-      <div ref="messageList" class="message-list" aria-live="polite">
+      <div ref="messageList" class="message-list" aria-live="polite" @scroll="handleMessageScroll">
         <button
           v-if="hasMoreMessages.value"
           class="load-more"
           type="button"
           :disabled="chatBusy.value"
-          @click="runAction(onLoadMore)"
+          @click="loadEarlierMessages"
         >
           {{ chatBusy.value ? '正在读取…' : '查看更早消息' }}
         </button>
@@ -171,10 +259,26 @@ async function captureScreenshot(): Promise<void> {
           v-for="message in messages.value"
           :key="message.id"
           class="message-row"
-          :class="{ 'message-row--mine': message.mine }"
+          :class="{
+            'message-row--mine': message.mine,
+            'message-row--call-status': message.type === 'call-status',
+          }"
         >
-          <div class="message-meta">{{ message.mine ? '我' : patientName.value }} · {{ message.time }}</div>
-          <div class="message-bubble">
+          <template v-if="message.type === 'call-status'">
+            <div
+              class="call-status-event"
+              :class="`call-status-event--${message.callStatus || 'ended'}`"
+              role="status"
+              :aria-label="`${message.text}，${message.time}`"
+            >
+              <span class="call-status-event__icon" aria-hidden="true">▣</span>
+              <strong>{{ message.text }}</strong>
+              <time>{{ message.time }}</time>
+            </div>
+          </template>
+          <template v-else>
+            <div class="message-meta">{{ message.mine ? '我' : patientName.value }} · {{ message.time }}</div>
+            <div class="message-bubble">
             <p v-if="message.type === 'text'">{{ message.text }}</p>
             <img
               v-else-if="message.type === 'image' && message.url"
@@ -193,8 +297,9 @@ async function captureScreenshot(): Promise<void> {
             </a>
             <audio v-else-if="message.type === 'audio' && message.url" :src="message.url" controls />
             <video v-else-if="message.type === 'video' && message.url" class="message-video" :src="message.url" controls />
-            <p v-else>{{ message.text }}</p>
-          </div>
+              <p v-else>{{ message.text }}</p>
+            </div>
+          </template>
         </article>
       </div>
 
@@ -251,6 +356,19 @@ async function captureScreenshot(): Promise<void> {
         {{ statusText.value }}
       </div>
 
+      <div
+        v-if="canCapture && liveCaptions.value.length"
+        class="live-captions"
+        role="log"
+        aria-live="polite"
+        aria-label="实时语音字幕"
+      >
+        <p v-for="caption in liveCaptions.value" :key="caption.id">
+          <strong>{{ caption.speaker }}</strong>
+          <span>{{ caption.text }}</span>
+        </p>
+      </div>
+
       <div v-if="isCalling" class="video-actions">
         <div
           v-if="canCapture"
@@ -271,7 +389,7 @@ async function captureScreenshot(): Promise<void> {
           :disabled="!canCapture || actionBusy"
           @click="captureScreenshot"
         >
-          截屏并保存患者资料
+          截屏预览
         </button>
         <button class="hangup-button" type="button" :disabled="actionBusy" @click="runAction(onHangup)">
           结束视频
@@ -281,6 +399,35 @@ async function captureScreenshot(): Promise<void> {
       <div v-if="localError || notice.value" class="video-notice" :class="{ 'video-notice--error': localError }">
         {{ localError || notice.value }}
       </div>
+
+      <div
+        v-if="screenshotPreview"
+        class="screenshot-dialog-backdrop"
+        role="dialog"
+        aria-modal="true"
+        aria-labelledby="screenshot-preview-title"
+        @click.self="discardScreenshot"
+      >
+        <section class="screenshot-dialog">
+          <header>
+            <div>
+              <p class="eyebrow">视频截图确认</p>
+              <h2 id="screenshot-preview-title">确认画面后再保存到患者资料</h2>
+            </div>
+            <button type="button" aria-label="关闭截图预览" :disabled="actionBusy" @click="discardScreenshot">×</button>
+          </header>
+          <div class="screenshot-preview-frame">
+            <img :src="screenshotPreview" alt="本次视频截图预览">
+          </div>
+          <p class="screenshot-dialog__hint">只有点击“确认并上传”后，截图才会上传并写入患者资料。</p>
+          <footer>
+            <button class="screenshot-cancel" type="button" :disabled="actionBusy" @click="discardScreenshot">取消</button>
+            <button class="screenshot-confirm" type="button" :disabled="actionBusy" @click="confirmScreenshot">
+              {{ actionBusy ? '正在上传…' : '确认并上传' }}
+            </button>
+          </footer>
+        </section>
+      </div>
     </section>
   </main>
 </template>

app/video_companion/src/env.d.ts

@@ -29,6 +29,8 @@ interface DoctorConsultationApi {
   startVideo(): Promise<void>
   hangup(): Promise<void>
   hostCallReady(ok: boolean, message?: string): void
+  recordingResult(ok: boolean, message: string): void
+  roomBindingResult(roomId: string, ok: boolean, message: string): void
   screenshotResult(ok: boolean, message: string): void
   transcriptionResult(
     operation: 'start' | 'segment' | 'stop',
@@ -37,11 +39,22 @@ interface DoctorConsultationApi {
     ok: boolean,
     message: string,
   ): void
+  localRecordingResult(
+    operation: 'start' | 'chunk' | 'finish',
+    sessionId: string,
+    sequence: number,
+    ok: boolean,
+    message: string,
+  ): void
 }
 
 interface QtVideoBridge {
   notify?: (payload: string) => void
   saveScreenshot?: (dataUrl: string) => void
+  startLocalAudioRecording?: (sessionId: string, mimeType: string) => void
+  appendLocalAudioChunk?: (sessionId: string, sequence: number, encoded: string) => void
+  finishLocalAudioRecording?: (sessionId: string, totalBytes: number) => void
+  abortLocalAudioRecording?: (sessionId: string) => void
 }
 
 interface Window {

app/video_companion/src/main.ts

@@ -14,8 +14,10 @@ import './style.css'
 
 type CallPhase = 'ready' | 'starting' | 'dialing' | 'connected' | 'ended' | 'error'
 type CompanionMode = 'chat' | 'video'
-type ChatMessageType = 'text' | 'image' | 'file' | 'audio' | 'video' | 'system'
+type ChatMessageType = 'text' | 'image' | 'file' | 'audio' | 'video' | 'system' | 'call-status'
+type VideoCallStatus = 'starting' | 'dialing' | 'connected' | 'ended' | 'failed'
 type TranscriptionState = 'idle' | 'starting' | 'recording' | 'stopping' | 'error'
+type LocalRecordingState = 'idle' | 'starting' | 'recording' | 'stopping' | 'uploading' | 'error'
 
 interface NormalizedCallConfig {
   SDKAppID: number
@@ -35,6 +37,14 @@ interface UiChatMessage {
   url: string
   name: string
   time: string
+  callStatus?: VideoCallStatus
+}
+
+interface UiLiveCaption {
+  id: string
+  speaker: string
+  text: string
+  completed: boolean
 }
 
 interface BridgeMessage {
@@ -109,6 +119,25 @@ interface PendingSegment {
   attempts: number
 }
 
+interface PendingLocalRecordingReply {
+  resolve: (value: boolean) => void
+  promise: Promise<boolean>
+}
+
+interface TrtcAudioTrackEvent {
+  userId?: string
+  track?: MediaStreamTrack
+}
+
+interface TrtcAudioCloud {
+  getAudioTrack?(configOrUserId?: {
+    userId?: string
+    processed?: boolean
+  } | string): MediaStreamTrack | null
+  on?(event: 'track', handler: (event: TrtcAudioTrackEvent) => void): void
+  off?(event: 'track', handler: (event: TrtcAudioTrackEvent) => void): void
+}
+
 const phase = ref<CallPhase>('ready')
 const statusText = ref('正在连接问诊服务')
 const patientName = ref('患者')
@@ -119,6 +148,8 @@ const chatBusy = ref(false)
 const notice = ref('')
 const hasMoreMessages = ref(false)
 const transcriptionState = ref<TranscriptionState>('idle')
+const localRecordingState = ref<LocalRecordingState>('idle')
+const liveCaptions = ref<UiLiveCaption[]>([])
 
 let activeConfig: NormalizedCallConfig | null = null
 let chat: any = null
@@ -129,6 +160,10 @@ let nextReqMessageID = ''
 let endNotified = true
 let starting = false
 let emittedRoomId = ''
+let pendingRoomId = ''
+let boundRoomId = ''
+let roomBindingSentAt = 0
+let roomBindingAttempts = 0
 let resolveHostCallReady: ((value: boolean) => void) | null = null
 const pendingTranscriptionStarts = new Map<string, PendingTranscriptionReply>()
 const pendingTranscriptionStops = new Map<string, PendingTranscriptionReply>()
@@ -143,10 +178,34 @@ let transcriptionStopPromise: Promise<void> | null = null
 let hangupNotification: Promise<void> | null = null
 let callCycleGeneration = 0
 let autoTranscriptionAttemptedGeneration = -1
+let autoLocalRecordingAttemptedGeneration = -1
 let lastTranscriberMessageAt = 0
 let transcriberStoppedAt = 0
 const acknowledgedSegmentIds = new Set<string>()
 const pendingSegments = new Map<string, PendingSegment>()
+const pendingLocalRecordingStarts = new Map<string, PendingLocalRecordingReply>()
+const pendingLocalRecordingFinishes = new Map<string, PendingLocalRecordingReply>()
+let localRecordingSessionId = ''
+let localRecordingMimeType = ''
+let localRecorder: MediaRecorder | null = null
+let localAudioContext: AudioContext | null = null
+let localAudioDestination: MediaStreamAudioDestinationNode | null = null
+let localAudioCloud: TrtcAudioCloud | null = null
+let localAudioTrackHandler: ((event: TrtcAudioTrackEvent) => void) | null = null
+let localAudioSources: MediaStreamAudioSourceNode[] = []
+let localAudioTrackIds = new Set<string>()
+let localAudioOwnedTracks: MediaStreamTrack[] = []
+let localAudioDiscoveryTimer: number | null = null
+let localAudioHasDoctorSource = false
+let localAudioHasPatientSource = false
+let localRecordingAttachedSourceCount = 0
+let localRecordingChunkSequence = 0
+let localRecordingBytes = 0
+let localRecordingChunkChain: Promise<void> = Promise.resolve()
+let localRecordingStartPromise: Promise<void> | null = null
+let localRecordingStopPromise: Promise<void> | null = null
+let localRecordingFatalError = ''
+let liveCaptionClearTimer: number | null = null
 
 function initializeQtWebChannel(): void {
   const transport = window.qt?.webChannelTransport
@@ -361,6 +420,29 @@ function mergeMessages(rawList: any[], prepend = false): void {
   })
 }
 
+function appendVideoCallStatus(callStatus: VideoCallStatus, text: string): void {
+  if (!activeConfig || activeConfig.mode !== 'chat') return
+  const id = `local-video-call-${callCycleGeneration}-${callStatus}`
+  const message: UiChatMessage = {
+    id,
+    mine: false,
+    type: 'call-status',
+    text,
+    url: '',
+    name: '',
+    time: timeText(undefined),
+    callStatus,
+  }
+  const existingIndex = messages.value.findIndex((item) => item.id === id)
+  if (existingIndex < 0) {
+    messages.value = [...messages.value, message]
+    return
+  }
+  const next = [...messages.value]
+  next[existingIndex] = { ...next[existingIndex], ...message }
+  messages.value = next
+}
+
 function onMessageReceived(event: any): void {
   if (!activeConfig) return
   const expected = `C2C${activeConfig.targetUserId}`
@@ -465,11 +547,19 @@ async function loadMessages(prepend: boolean): Promise<void> {
   if (!chat || !activeConfig || chatBusy.value) return
   chatBusy.value = true
   try {
-    const response = await chat.getMessageList({
+    const request: {
+      conversationID: string
+      count: number
+      nextReqMessageID?: string
+    } = {
       conversationID: `C2C${activeConfig.targetUserId}`,
-      nextReqMessageID: prepend ? nextReqMessageID : '',
       count: 30,
-    })
+    }
+    // Tencent Cloud IM requires the first roaming-history request to omit the
+    // pagination cursor.  Passing an empty string is not equivalent and can
+    // return an empty page even though the C2C conversation has history.
+    if (prepend && nextReqMessageID) request.nextReqMessageID = nextReqMessageID
+    const response = await chat.getMessageList(request)
     const data = response?.data ?? {}
     const list = Array.isArray(data.messageList) ? data.messageList : []
     nextReqMessageID = String(data.nextReqMessageID ?? '')
@@ -539,9 +629,454 @@ async function sendAttachment(file: File): Promise<void> {
   }
 }
 
+function newLocalRecordingSessionId(): string {
+  const random = window.crypto?.randomUUID?.().replaceAll('-', '')
+  const entropy = random || `${Date.now().toString(36)}${Math.random().toString(36).slice(2)}`
+  return `audio-${entropy.replace(/[^a-zA-Z0-9]/g, '').slice(0, 32)}`
+}
+
+function selectLocalRecordingMimeType(): string {
+  if (typeof MediaRecorder === 'undefined') return ''
+  const candidates = [
+    'audio/webm;codecs=opus',
+    'audio/webm',
+    'audio/ogg;codecs=opus',
+    'audio/ogg',
+  ]
+  return candidates.find((candidate) => MediaRecorder.isTypeSupported(candidate)) ?? ''
+}
+
+function requestLocalRecordingStart(sessionId: string, mimeType: string): Promise<boolean> {
+  const bridge = window.qtVideoBridge
+  if (!bridge || typeof bridge.startLocalAudioRecording !== 'function') {
+    return Promise.resolve(false)
+  }
+  const existing = pendingLocalRecordingStarts.get(sessionId)
+  if (existing) return existing.promise
+  const pending = {} as PendingLocalRecordingReply
+  pending.promise = new Promise<boolean>((resolve) => {
+    pending.resolve = resolve
+  })
+  pendingLocalRecordingStarts.set(sessionId, pending)
+  bridge.startLocalAudioRecording(sessionId, mimeType)
+  window.setTimeout(() => {
+    if (pendingLocalRecordingStarts.get(sessionId) !== pending) return
+    pendingLocalRecordingStarts.delete(sessionId)
+    pending.resolve(false)
+  }, 15000)
+  return pending.promise
+}
+
+function requestLocalRecordingFinish(sessionId: string, totalBytes: number): Promise<boolean> {
+  const bridge = window.qtVideoBridge
+  if (!bridge || typeof bridge.finishLocalAudioRecording !== 'function') {
+    return Promise.resolve(false)
+  }
+  const existing = pendingLocalRecordingFinishes.get(sessionId)
+  if (existing) return existing.promise
+  const pending = {} as PendingLocalRecordingReply
+  pending.promise = new Promise<boolean>((resolve) => {
+    pending.resolve = resolve
+  })
+  pendingLocalRecordingFinishes.set(sessionId, pending)
+  bridge.finishLocalAudioRecording(sessionId, totalBytes)
+  window.setTimeout(() => {
+    if (pendingLocalRecordingFinishes.get(sessionId) !== pending) return
+    pendingLocalRecordingFinishes.delete(sessionId)
+    pending.resolve(false)
+  }, 180000)
+  return pending.promise
+}
+
+function bytesToBase64(bytes: Uint8Array): string {
+  let binary = ''
+  for (let index = 0; index < bytes.length; index += 1) {
+    binary += String.fromCharCode(bytes[index])
+  }
+  return window.btoa(binary)
+}
+
+async function sendLocalRecordingBlob(blob: Blob, sessionId: string): Promise<void> {
+  if (!blob.size || sessionId !== localRecordingSessionId) return
+  const bridge = window.qtVideoBridge
+  if (!bridge || typeof bridge.appendLocalAudioChunk !== 'function') {
+    throw new Error('桌面端本地录音分片通道不可用')
+  }
+  const bytes = new Uint8Array(await blob.arrayBuffer())
+  const maxChunkBytes = 8 * 1024
+  for (let offset = 0; offset < bytes.length; offset += maxChunkBytes) {
+    const chunk = bytes.subarray(offset, Math.min(offset + maxChunkBytes, bytes.length))
+    bridge.appendLocalAudioChunk(
+      sessionId,
+      localRecordingChunkSequence,
+      bytesToBase64(chunk),
+    )
+    localRecordingChunkSequence += 1
+    localRecordingBytes += chunk.length
+  }
+}
+
+function getTrtcAudioCloud(): TrtcAudioCloud | null {
+  const engine = TUICallKitAPI.getTUICallEngineInstance?.()
+  const cloud = engine?.getTRTCCloudInstance?.() as Partial<TrtcAudioCloud> | null
+  return cloud ? cloud as TrtcAudioCloud : null
+}
+
+function attachLocalRecordingTrack(
+  track: MediaStreamTrack | null | undefined,
+  sourceKind: 'doctor' | 'patient' | 'unknown' = 'unknown',
+): boolean {
+  const context = localAudioContext
+  const destination = localAudioDestination
+  if (
+    !context
+    || !destination
+    || !track
+    || track.kind !== 'audio'
+    || track.readyState === 'ended'
+  ) return false
+  if (sourceKind === 'doctor') localAudioHasDoctorSource = true
+  if (sourceKind === 'patient') localAudioHasPatientSource = true
+  if (localAudioTrackIds.has(track.id)) return true
+  const source = context.createMediaStreamSource(new MediaStream([track]))
+  source.connect(destination)
+  localAudioSources.push(source)
+  localAudioTrackIds.add(track.id)
+  localRecordingAttachedSourceCount += 1
+  track.addEventListener('ended', () => localAudioTrackIds.delete(track.id), { once: true })
+  return true
+}
+
+function attachCurrentCallAudioTracks(cloud: TrtcAudioCloud | null): void {
+  if (!activeConfig) return
+  if (typeof cloud?.getAudioTrack === 'function') {
+    try {
+      attachLocalRecordingTrack(cloud.getAudioTrack({ processed: true }), 'doctor')
+    } catch {
+      try {
+        attachLocalRecordingTrack(cloud.getAudioTrack(), 'doctor')
+      } catch {
+        // The rendered media elements below remain a supported fallback.
+      }
+    }
+    try {
+      attachLocalRecordingTrack(cloud.getAudioTrack({
+        userId: activeConfig.targetUserId,
+        processed: true,
+      }), 'patient')
+    } catch {
+      try {
+        attachLocalRecordingTrack(cloud.getAudioTrack(activeConfig.targetUserId), 'patient')
+      } catch {
+        // Remote audio can become available a few frames after connected.
+      }
+    }
+  }
+
+  for (const media of document.querySelectorAll<HTMLMediaElement>('video, audio')) {
+    const stream = media.srcObject
+    if (!(stream instanceof MediaStream)) continue
+    const sourceKind = media.muted ? 'doctor' : 'patient'
+    for (const track of stream.getAudioTracks()) {
+      attachLocalRecordingTrack(track, sourceKind)
+    }
+  }
+}
+
+async function attachDoctorMicrophoneFallback(): Promise<void> {
+  if (localAudioHasDoctorSource || !navigator.mediaDevices?.getUserMedia) return
+  const stream = await navigator.mediaDevices.getUserMedia({
+    audio: {
+      echoCancellation: true,
+      noiseSuppression: true,
+      autoGainControl: true,
+    },
+    video: false,
+  })
+  const tracks = stream.getAudioTracks()
+  localAudioOwnedTracks.push(...tracks)
+  for (const track of tracks) attachLocalRecordingTrack(track, 'doctor')
+}
+
+async function waitForCallAudioTracks(
+  cloud: TrtcAudioCloud | null,
+  sessionId: string,
+  timeoutMs = 7000,
+): Promise<void> {
+  const startedAt = Date.now()
+  let microphoneAttempted = false
+  while (Date.now() - startedAt < timeoutMs) {
+    if (sessionId !== localRecordingSessionId || endNotified) {
+      throw new Error('视频已结束，本机录音未启动')
+    }
+    attachCurrentCallAudioTracks(cloud)
+    const elapsed = Date.now() - startedAt
+    if (!localAudioHasDoctorSource && !microphoneAttempted && elapsed >= 800) {
+      microphoneAttempted = true
+      try {
+        await attachDoctorMicrophoneFallback()
+      } catch (error) {
+        console.warn(
+          '[doctor-consultation] 本机麦克风录音兜底不可用',
+          safeErrorMessage(error),
+        )
+      }
+    }
+    if (
+      localAudioTrackIds.size > 0
+      && (localAudioHasDoctorSource && localAudioHasPatientSource || elapsed >= 2200)
+    ) return
+    await new Promise((resolve) => window.setTimeout(resolve, 160))
+  }
+  if (localAudioTrackIds.size <= 0) {
+    throw new Error('未检测到医生或患者的实时语音音轨，请检查麦克风权限')
+  }
+}
+
+function startCallAudioDiscovery(cloud: TrtcAudioCloud | null): void {
+  if (localAudioDiscoveryTimer !== null) window.clearInterval(localAudioDiscoveryTimer)
+  localAudioDiscoveryTimer = window.setInterval(() => {
+    attachCurrentCallAudioTracks(cloud)
+  }, 500)
+}
+
+async function cleanupLocalRecordingGraph(): Promise<void> {
+  if (localAudioDiscoveryTimer !== null) {
+    window.clearInterval(localAudioDiscoveryTimer)
+    localAudioDiscoveryTimer = null
+  }
+  if (localAudioCloud && localAudioTrackHandler && typeof localAudioCloud.off === 'function') {
+    try {
+      localAudioCloud.off('track', localAudioTrackHandler)
+    } catch {
+      // The call engine may already have released its event dispatcher.
+    }
+  }
+  localAudioCloud = null
+  localAudioTrackHandler = null
+  for (const source of localAudioSources) {
+    try {
+      source.disconnect()
+    } catch {
+      // A closed AudioContext has already disconnected its graph.
+    }
+  }
+  localAudioSources = []
+  localAudioTrackIds.clear()
+  for (const track of localAudioOwnedTracks) track.stop()
+  localAudioOwnedTracks = []
+  localAudioHasDoctorSource = false
+  localAudioHasPatientSource = false
+  localRecordingAttachedSourceCount = 0
+  const context = localAudioContext
+  localAudioContext = null
+  localAudioDestination = null
+  if (context && context.state !== 'closed') {
+    try {
+      await context.close()
+    } catch {
+      // Closing the consultation must not be blocked by a released device.
+    }
+  }
+  localRecorder = null
+}
+
+async function performStartLocalRecording(): Promise<void> {
+  if (!activeConfig || phase.value !== 'connected' || endNotified) {
+    throw new Error('视频接通后才能启动本机录音')
+  }
+  if (!window.qtVideoBridge?.startLocalAudioRecording) {
+    throw new Error('桌面端本机录音存储通道不可用')
+  }
+  const mimeType = selectLocalRecordingMimeType()
+  if (!mimeType) throw new Error('当前浏览器不支持 Opus 本机录音')
+
+  localRecordingState.value = 'starting'
+  localRecordingFatalError = ''
+  localRecordingChunkSequence = 0
+  localRecordingBytes = 0
+  localRecordingChunkChain = Promise.resolve()
+  localRecordingAttachedSourceCount = 0
+  localAudioHasDoctorSource = false
+  localAudioHasPatientSource = false
+  const sessionId = newLocalRecordingSessionId()
+  localRecordingSessionId = sessionId
+  localRecordingMimeType = mimeType
+
+  try {
+    const AudioContextConstructor = window.AudioContext
+    const context = new AudioContextConstructor()
+    localAudioContext = context
+    localAudioDestination = context.createMediaStreamDestination()
+    const cloud = getTrtcAudioCloud()
+    localAudioCloud = cloud
+    localAudioTrackHandler = (event) => attachLocalRecordingTrack(
+      event.track,
+      event.userId === activeConfig?.userID
+        ? 'doctor'
+        : event.userId === activeConfig?.targetUserId
+          ? 'patient'
+          : 'unknown',
+    )
+    if (typeof cloud?.on === 'function') cloud.on('track', localAudioTrackHandler)
+    if (context.state === 'suspended') await context.resume()
+    await waitForCallAudioTracks(cloud, sessionId)
+    startCallAudioDiscovery(cloud)
+
+    const storageReady = await requestLocalRecordingStart(sessionId, mimeType)
+    if (!storageReady || sessionId !== localRecordingSessionId || endNotified) {
+      throw new Error(notice.value || '服务端未能创建本机录音临时文件')
+    }
+    const destination = localAudioDestination
+    if (!destination) throw new Error('本机录音混音器未就绪')
+    if (localRecordingAttachedSourceCount <= 0) {
+      throw new Error('本机录音没有连接到医生或患者语音')
+    }
+    const recorder = new MediaRecorder(destination.stream, { mimeType })
+    localRecorder = recorder
+    recorder.addEventListener('dataavailable', (event) => {
+      if (!event.data.size || sessionId !== localRecordingSessionId) return
+      localRecordingChunkChain = localRecordingChunkChain
+        .then(() => sendLocalRecordingBlob(event.data, sessionId))
+        .catch((error) => {
+          localRecordingFatalError = safeErrorMessage(error, '本机录音分片保存失败')
+          localRecordingState.value = 'error'
+          notice.value = localRecordingFatalError
+          window.qtVideoBridge?.abortLocalAudioRecording?.(sessionId)
+          if (recorder.state !== 'inactive') recorder.stop()
+        })
+    })
+    recorder.addEventListener('error', (event) => {
+      localRecordingFatalError = safeErrorMessage(
+        (event as ErrorEvent).error,
+        '浏览器本机录音发生错误',
+      )
+      localRecordingState.value = 'error'
+      notice.value = localRecordingFatalError
+    })
+    recorder.start(1000)
+    localRecordingState.value = 'recording'
+    notice.value = '腾讯云混流视频、本机语音录音和实时转写均已启动'
+  } catch (error) {
+    window.qtVideoBridge?.abortLocalAudioRecording?.(sessionId)
+    await cleanupLocalRecordingGraph()
+    if (sessionId === localRecordingSessionId) {
+      localRecordingSessionId = ''
+      localRecordingMimeType = ''
+      localRecordingState.value = 'error'
+    }
+    throw new Error(safeErrorMessage(error, '本机语音录音启动失败'))
+  }
+}
+
+function startLocalRecording(): Promise<void> {
+  if (localRecordingStartPromise) return localRecordingStartPromise
+  if (localRecordingState.value === 'recording') return Promise.resolve()
+  const operation = performStartLocalRecording()
+  const tracked = operation.finally(() => {
+    if (localRecordingStartPromise === tracked) localRecordingStartPromise = null
+  })
+  localRecordingStartPromise = tracked
+  return tracked
+}
+
+async function performStopLocalRecording(): Promise<void> {
+  const startInFlight = localRecordingStartPromise
+  if (startInFlight) {
+    try {
+      await startInFlight
+    } catch {
+      return
+    }
+  }
+  const sessionId = localRecordingSessionId
+  const recorder = localRecorder
+  if (!sessionId || !recorder) {
+    if (localRecordingState.value !== 'error') localRecordingState.value = 'idle'
+    return
+  }
+  localRecordingState.value = 'stopping'
+  try {
+    if (recorder.state !== 'inactive') {
+      await new Promise<void>((resolve) => {
+        recorder.addEventListener('stop', () => resolve(), { once: true })
+        recorder.stop()
+      })
+    }
+    await localRecordingChunkChain
+    if (localRecordingFatalError) throw new Error(localRecordingFatalError)
+    if (localRecordingAttachedSourceCount <= 0) {
+      throw new Error('本机录音没有连接到有效语音音轨')
+    }
+    if (localRecordingBytes < 1024) {
+      throw new Error('本机录音文件为空或不完整，已阻止上传空文件')
+    }
+    localRecordingState.value = 'uploading'
+    notice.value = '正在把本机语音录音上传到 COS…'
+    const persisted = await requestLocalRecordingFinish(sessionId, localRecordingBytes)
+    if (!persisted) throw new Error(notice.value || '本机语音录音上传 COS 失败')
+    localRecordingState.value = 'idle'
+    notice.value = '混流视频、本机录音和转写文字均已归档到本次通话记录'
+  } catch (error) {
+    window.qtVideoBridge?.abortLocalAudioRecording?.(sessionId)
+    localRecordingState.value = 'error'
+    throw new Error(safeErrorMessage(error, '本机语音录音保存失败'))
+  } finally {
+    await cleanupLocalRecordingGraph()
+    if (sessionId === localRecordingSessionId) {
+      localRecordingSessionId = ''
+      localRecordingMimeType = ''
+    }
+  }
+}
+
+function stopLocalRecording(): Promise<void> {
+  if (localRecordingStopPromise) return localRecordingStopPromise
+  if (localRecordingState.value === 'idle' && !localRecordingSessionId) return Promise.resolve()
+  const operation = performStopLocalRecording()
+  const tracked = operation.finally(() => {
+    if (localRecordingStopPromise === tracked) localRecordingStopPromise = null
+  })
+  localRecordingStopPromise = tracked
+  return tracked
+}
+
+function localRecordingResult(
+  operation: 'start' | 'chunk' | 'finish',
+  sessionId: string,
+  _sequence: number,
+  ok: boolean,
+  message: string,
+): void {
+  if (operation === 'start') {
+    const pending = pendingLocalRecordingStarts.get(sessionId)
+    if (!pending) return
+    pendingLocalRecordingStarts.delete(sessionId)
+    if (message && sessionId === localRecordingSessionId) notice.value = message
+    pending.resolve(Boolean(ok))
+  } else if (operation === 'finish') {
+    const pending = pendingLocalRecordingFinishes.get(sessionId)
+    if (!pending) return
+    pendingLocalRecordingFinishes.delete(sessionId)
+    if (message && sessionId === localRecordingSessionId) notice.value = message
+    pending.resolve(Boolean(ok))
+  } else if (!ok && sessionId === localRecordingSessionId) {
+    localRecordingFatalError = message || '本机录音分片保存失败'
+    localRecordingState.value = 'error'
+    notice.value = localRecordingFatalError
+    window.qtVideoBridge?.abortLocalAudioRecording?.(sessionId)
+    if (localRecorder && localRecorder.state !== 'inactive') localRecorder.stop()
+  }
+}
+
 function newTranscriptionSessionId(): string {
-  const random = window.crypto?.randomUUID?.()
-  return random ? `call-${random}` : `call-${Date.now()}-${Math.random().toString(16).slice(2)}`
+  // Keep this identity within 32 ASCII characters.  Some upgraded deployments
+  // still have the legacy varchar(32) column; a UUID with hyphens was silently
+  // truncated there, so the first transcript segment no longer matched the
+  // session that startCallTranscription had acknowledged.
+  const random = window.crypto?.randomUUID?.().replaceAll('-', '')
+  const entropy = random || `${Date.now().toString(36)}${Math.random().toString(36).slice(2)}`
+  return `tr-${entropy.replace(/[^a-zA-Z0-9]/g, '').slice(0, 28)}`
 }
 
 function requestTranscriptionStart(sessionId: string): Promise<boolean> {
@@ -615,19 +1150,59 @@ function getTranscriberManager(): RealtimeTranscriberManager {
   return manager as RealtimeTranscriberManager
 }
 
+function clearLiveCaptions(): void {
+  if (liveCaptionClearTimer !== null) {
+    window.clearTimeout(liveCaptionClearTimer)
+    liveCaptionClearTimer = null
+  }
+  liveCaptions.value = []
+}
+
+function showLiveCaption(message: RealtimeTranscriberMessage): void {
+  if (!activeConfig) return
+  const text = String(message.sourceText ?? '').trim()
+  if (!text) return
+  const speakerUserId = String(message.speakerUserId ?? '').trim()
+  const segmentId = String(message.segmentId ?? '').trim()
+  const id = segmentId || `speaker-${speakerUserId || 'unknown'}`
+  const speaker = speakerUserId === activeConfig.userID
+    ? '医生'
+    : speakerUserId === activeConfig.targetUserId
+      ? patientName.value || '患者'
+      : '对话'
+  const caption: UiLiveCaption = {
+    id,
+    speaker,
+    text: text.slice(0, 500),
+    completed: message.isCompleted === true,
+  }
+  const previous = liveCaptions.value.filter((item) => item.id !== id)
+  liveCaptions.value = [...previous, caption].slice(-2)
+  if (liveCaptionClearTimer !== null) window.clearTimeout(liveCaptionClearTimer)
+  liveCaptionClearTimer = window.setTimeout(() => {
+    liveCaptions.value = []
+    liveCaptionClearTimer = null
+  }, message.isCompleted === true ? 9000 : 5000)
+}
+
 function handleTranscriberMessage(
-  _roomId: string | number,
+  roomId: string | number,
   message: RealtimeTranscriberMessage,
 ): void {
+  // The realtime transcriber always identifies the active TRTC room.  Use it
+  // as a second authoritative source because some CallKit versions clear the
+  // ROOM_ID store before the desktop host has persisted it.
+  observeRoomId(roomId)
   if (
     !activeConfig
     || !['recording', 'stopping'].includes(transcriptionState.value)
     || !transcriptionSessionId
-    || message.isCompleted !== true
   ) return
   lastTranscriberMessageAt = Date.now()
   const segmentId = String(message.segmentId ?? '').trim()
   const text = String(message.sourceText ?? '').trim()
+  showLiveCaption(message)
+  if (message.isCompleted !== true) return
   if (
     !segmentId
     || acknowledgedSegmentIds.has(segmentId)
@@ -666,8 +1241,11 @@ function subscribeTranscriber(): {
   const manager = getTranscriberManager()
   const listener: RealtimeTranscriberListener = {
     onReceiveTranscriberMessage: handleTranscriberMessage,
-    onRealtimeTranscriberStarted: () => undefined,
-    onRealtimeTranscriberStopped: (_roomId, robotId) => {
+    onRealtimeTranscriberStarted: (roomId) => {
+      observeRoomId(roomId)
+    },
+    onRealtimeTranscriberStopped: (roomId, robotId) => {
+      observeRoomId(roomId)
       if (robotId !== transcriberRobotId) return
       transcriberRunning = false
       transcriberStoppedAt = Date.now()
@@ -675,7 +1253,8 @@ function subscribeTranscriber(): {
         void stopTranscription('partial', true)
       }
     },
-    onRealtimeTranscriberError: (_roomId, robotId, _error, errorMessage) => {
+    onRealtimeTranscriberError: (roomId, robotId, _error, errorMessage) => {
+      observeRoomId(roomId)
       if (robotId !== transcriberRobotId || transcriptionState.value === 'stopping') return
       notice.value = safeErrorMessage(new Error(errorMessage), '实时语音转写发生错误')
       void stopTranscription('partial', true)
@@ -738,6 +1317,7 @@ async function performStartTranscription(): Promise<void> {
   transcriptionSessionId = sessionId
   acknowledgedSegmentIds.clear()
   pendingSegments.clear()
+  clearLiveCaptions()
   lastTranscriberMessageAt = Date.now()
   transcriberStoppedAt = 0
   notice.value = '正在准备录音文字存储…'
@@ -841,6 +1421,7 @@ async function stopTranscription(
     transcriptionSessionId = ''
     acknowledgedSegmentIds.clear()
     pendingSegments.clear()
+    clearLiveCaptions()
   })().finally(() => {
     transcriptionStopPromise = null
   })
@@ -889,46 +1470,83 @@ function notifyHangup(status = 'ended'): Promise<void> {
   endNotified = true
   phase.value = 'ended'
   statusText.value = mode.value === 'chat' ? '视频通话已结束，IM 保持连接' : '视频问诊已结束'
+  appendVideoCallStatus('ended', '视频通话已结束')
   hangupNotification = (async () => {
-    try {
-      if (transcriptionState.value !== 'idle') await stopTranscription('completed')
-    } catch (error) {
-      notice.value = safeErrorMessage(error, '录音文字收尾失败，请稍后检查面诊记录')
-      console.warn('[doctor-consultation] 录音文字收尾失败', notice.value)
-    } finally {
-      emit({
-        source: 'doctor-call',
-        event: 'hangup',
-        diagnosisId: activeConfig?.diagnosisId,
-        status,
-      })
+    const operations: Promise<void>[] = []
+    if (localRecordingState.value !== 'idle' || localRecordingSessionId) {
+      operations.push(stopLocalRecording())
     }
+    if (transcriptionState.value !== 'idle') {
+      operations.push(stopTranscription('completed'))
+    }
+    const results = await Promise.allSettled(operations)
+    const failures = results
+      .filter((result): result is PromiseRejectedResult => result.status === 'rejected')
+      .map((result) => safeErrorMessage(result.reason, '录音资料收尾失败'))
+    if (failures.length) {
+      notice.value = failures.join('；').slice(0, 400)
+      console.warn('[doctor-consultation] 录音资料收尾失败', notice.value)
+    }
+    emit({
+      source: 'doctor-call',
+      event: 'hangup',
+      diagnosisId: activeConfig?.diagnosisId,
+      status,
+    })
   })()
   return hangupNotification
 }
 
-function readRoomId(): string {
-  const raw = TUIStore.getData(StoreName.CALL, NAME.ROOM_ID)
+function normalizeRoomId(raw: unknown): string {
   if (raw === undefined || raw === null) return ''
   const value = String(raw).trim()
   return value && value !== '0' ? value : ''
 }
 
-function emitRoomId(): boolean {
-  const roomId = readRoomId()
-  if (!roomId || roomId === emittedRoomId) return Boolean(roomId)
+function readRoomId(): string {
+  return normalizeRoomId(TUIStore.getData(StoreName.CALL, NAME.ROOM_ID))
+}
+
+function observeRoomId(rawRoomId: unknown): boolean {
+  if (!activeConfig || endNotified) return false
+  const roomId = normalizeRoomId(rawRoomId)
+  if (!roomId) return false
+  if (boundRoomId) return boundRoomId === roomId
+
+  const now = Date.now()
+  const retryDelay = Math.min(10_000, 750 * (2 ** Math.min(roomBindingAttempts, 4)))
+  if (pendingRoomId === roomId && now - roomBindingSentAt < retryDelay) return false
+
   emittedRoomId = roomId
-  emit({ source: 'doctor-call', event: 'room', diagnosisId: activeConfig?.diagnosisId, roomId })
-  return true
+  pendingRoomId = roomId
+  roomBindingSentAt = now
+  roomBindingAttempts += 1
+  emit({ source: 'doctor-call', event: 'room', diagnosisId: activeConfig.diagnosisId, roomId })
+  return false
+}
+
+function emitRoomId(): boolean {
+  return observeRoomId(readRoomId())
 }
 
 async function pollRoomId(): Promise<void> {
-  for (let attempt = 0; attempt < 40 && activeConfig && !endNotified; attempt += 1) {
-    if (emitRoomId()) return
-    await new Promise((resolve) => window.setTimeout(resolve, 50))
+  const cycle = callCycleGeneration
+  while (activeConfig && !endNotified && cycle === callCycleGeneration) {
+    if (boundRoomId) return
+    emitRoomId()
+    await new Promise((resolve) => window.setTimeout(resolve, 250))
   }
 }
 
+function handleRoomIdChanged(): void {
+  emitRoomId()
+}
+
+const roomIdWatchOptions = {
+  [NAME.ROOM_ID]: handleRoomIdChanged,
+}
+TUIStore.watch(StoreName.CALL, roomIdWatchOptions)
+
 function handleStatusChanged(payload: unknown): void {
   const value = payload && typeof payload === 'object'
     ? (payload as { newStatus?: unknown }).newStatus
@@ -939,6 +1557,7 @@ function handleStatusChanged(payload: unknown): void {
     const cycle = callCycleGeneration
     phase.value = 'connected'
     statusText.value = '视频问诊进行中'
+    appendVideoCallStatus('connected', '视频通话已接通')
     void pollRoomId()
     if (autoTranscriptionAttemptedGeneration !== cycle) {
       autoTranscriptionAttemptedGeneration = cycle
@@ -947,10 +1566,18 @@ function handleStatusChanged(payload: unknown): void {
         notice.value = safeErrorMessage(error, '自动录音转文字启动失败')
       })
     }
+    if (autoLocalRecordingAttemptedGeneration !== cycle) {
+      autoLocalRecordingAttemptedGeneration = cycle
+      void startLocalRecording().catch((error) => {
+        if (cycle !== callCycleGeneration || endNotified) return
+        notice.value = safeErrorMessage(error, '本机语音录音启动失败')
+      })
+    }
   } else if (status === 'calling' || status.startsWith('dialing')) {
     if (endNotified || !activeConfig) return
     phase.value = 'dialing'
     statusText.value = '正在等待患者接听'
+    appendVideoCallStatus('dialing', '正在等待患者接听')
   } else if (status === 'idle' && activeConfig && !starting) {
     void notifyHangup(status)
   }
@@ -998,8 +1625,13 @@ async function startVideo(): Promise<void> {
     endNotified = false
     phase.value = 'starting'
     statusText.value = '正在创建安全视频通话'
+    appendVideoCallStatus('starting', '正在创建安全视频通话')
     transcriptionState.value = 'idle'
     transcriptionSessionId = ''
+    clearLiveCaptions()
+    localRecordingState.value = 'idle'
+    localRecordingSessionId = ''
+    localRecordingMimeType = ''
     notice.value = ''
     const allowed = await requestHostCallStart()
     if (!allowed) throw new Error(notice.value || '服务器未能创建视频通话记录')
@@ -1012,7 +1644,12 @@ async function startVideo(): Promise<void> {
     await nextTick()
     phase.value = 'dialing'
     statusText.value = '正在呼叫患者'
+    appendVideoCallStatus('dialing', '正在呼叫患者')
     emittedRoomId = ''
+    pendingRoomId = ''
+    boundRoomId = ''
+    roomBindingSentAt = 0
+    roomBindingAttempts = 0
     await TUICallKitAPI.calls({
       userIDList: [activeConfig.targetUserId],
       type: TUICallType.VIDEO_CALL,
@@ -1023,6 +1660,7 @@ async function startVideo(): Promise<void> {
     const message = safeErrorMessage(error, '无法发起视频通话')
     phase.value = 'error'
     statusText.value = message
+    appendVideoCallStatus('failed', `视频通话发起失败：${message}`)
     endNotified = true
     emit({ source: 'doctor-call', event: 'error', diagnosisId: activeConfig.diagnosisId, message })
     throw new Error(message)
@@ -1058,6 +1696,25 @@ function screenshotResult(ok: boolean, message: string): void {
   notice.value = message || (ok ? '截图已保存到患者舌像资料' : '截图保存失败')
 }
 
+function recordingResult(ok: boolean, message: string): void {
+  notice.value = message || (ok
+    ? '通话已自动录制，结束后将由云端完成 COS 文件收尾。'
+    : '自动云端录制未启动，请结束本次通话并检查 COS 配置。')
+}
+
+function roomBindingResult(roomId: string, ok: boolean, message: string): void {
+  const normalized = normalizeRoomId(roomId)
+  if (!normalized || (emittedRoomId && normalized !== emittedRoomId)) return
+  if (ok) {
+    boundRoomId = normalized
+    pendingRoomId = ''
+  } else if (pendingRoomId === normalized) {
+    // Keep the failed room pending so pollRoomId retries it with exponential
+    // backoff. The desktop lifecycle releases only failed claims.
+  }
+  recordingResult(ok, message)
+}
+
 async function open(config: DoctorCallConfig): Promise<void> {
   if (activeConfig) await close()
   activeConfig = normalizeConfig(config)
@@ -1070,14 +1727,20 @@ async function open(config: DoctorCallConfig): Promise<void> {
   hangupNotification = null
   callCycleGeneration += 1
   autoTranscriptionAttemptedGeneration = -1
+  autoLocalRecordingAttemptedGeneration = -1
   phase.value = 'ready'
   transcriptionState.value = 'idle'
   transcriptionSessionId = ''
+  clearLiveCaptions()
   transcriptionGeneration += 1
   transcriberRunning = false
   transcriberRobotId = ''
   acknowledgedSegmentIds.clear()
   pendingSegments.clear()
+  localRecordingState.value = 'idle'
+  localRecordingSessionId = ''
+  localRecordingMimeType = ''
+  localRecordingFatalError = ''
   notice.value = ''
   if (activeConfig.mode === 'chat') {
     try {
@@ -1103,6 +1766,12 @@ async function close(): Promise<void> {
   for (const pending of pendingTranscriptionStops.values()) pending.resolve(false)
   pendingTranscriptionStarts.clear()
   pendingTranscriptionStops.clear()
+  clearLiveCaptions()
+  for (const pending of pendingLocalRecordingStarts.values()) pending.resolve(false)
+  for (const pending of pendingLocalRecordingFinishes.values()) pending.resolve(false)
+  pendingLocalRecordingStarts.clear()
+  pendingLocalRecordingFinishes.clear()
+  await cleanupLocalRecordingGraph()
   await logoutChat()
   activeConfig = null
   phase.value = 'ended'
@@ -1114,8 +1783,11 @@ window.doctorConsultation = {
   startVideo,
   hangup,
   hostCallReady,
+  recordingResult,
+  roomBindingResult,
   screenshotResult,
   transcriptionResult,
+  localRecordingResult,
 }
 window.doctorCall = { start: open, hangup }
 initializeQtWebChannel()
@@ -1131,6 +1803,8 @@ createApp(App, {
   notice: readonly(notice),
   hasMoreMessages: readonly(hasMoreMessages),
   transcriptionState: readonly(transcriptionState),
+  localRecordingState: readonly(localRecordingState),
+  liveCaptions: readonly(liveCaptions),
   onSendText: sendText,
   onSendAttachment: sendAttachment,
   onLoadMore: () => loadMessages(true),

app/video_companion/src/style.css

@@ -151,6 +151,57 @@ button:disabled { cursor: not-allowed; opacity: .55; }
   margin: 12px 0;
 }
 .message-row--mine { align-items: flex-end; }
+.message-row--call-status {
+  align-items: center;
+  margin: 16px 0;
+}
+.call-status-event {
+  display: inline-flex;
+  align-items: center;
+  gap: 8px;
+  min-height: 32px;
+  padding: 0 12px;
+  border: 1px solid #dce2f2;
+  border-radius: 999px;
+  color: #617092;
+  background: rgba(255, 255, 255, .92);
+  font-size: 12px;
+  box-shadow: 0 4px 14px rgba(17, 31, 70, .04);
+}
+.call-status-event__icon {
+  display: grid;
+  place-items: center;
+  width: 20px;
+  height: 20px;
+  border-radius: 7px;
+  color: #5761f4;
+  background: #eef0ff;
+  font-size: 11px;
+}
+.call-status-event strong {
+  color: #34425f;
+  font-weight: 700;
+}
+.call-status-event time {
+  color: #8b97b2;
+  font-variant-numeric: tabular-nums;
+}
+.call-status-event--connected {
+  border-color: #bdebdc;
+  background: #f2fbf7;
+}
+.call-status-event--connected .call-status-event__icon {
+  color: #11986f;
+  background: #dff7ee;
+}
+.call-status-event--failed {
+  border-color: #f3c8cf;
+  background: #fff5f6;
+}
+.call-status-event--failed .call-status-event__icon {
+  color: #c43f50;
+  background: #ffe6e9;
+}
 .message-meta { margin: 0 8px 5px; color: #8995a9; font-size: 11px; }
 .message-bubble {
   max-width: min(72%, 620px);
@@ -285,6 +336,41 @@ button:disabled { cursor: not-allowed; opacity: .55; }
 }
 .live-status .status-dot { width: 7px; height: 7px; margin: 0; box-shadow: none; }
 
+.live-captions {
+  position: absolute;
+  z-index: 38;
+  left: 50%;
+  bottom: 92px;
+  display: grid;
+  gap: 7px;
+  width: min(820px, calc(100% - 360px));
+  transform: translateX(-50%);
+  pointer-events: none;
+}
+.live-captions p {
+  display: grid;
+  grid-template-columns: auto minmax(0, 1fr);
+  gap: 10px;
+  align-items: start;
+  width: fit-content;
+  max-width: 100%;
+  margin: 0 auto;
+  padding: 8px 14px;
+  border: 1px solid rgba(255, 255, 255, .2);
+  border-radius: 10px;
+  color: #fff;
+  background: rgba(9, 13, 20, .78);
+  box-shadow: 0 6px 24px rgba(0, 0, 0, .2);
+  font-size: 16px;
+  line-height: 1.55;
+  backdrop-filter: blur(8px);
+}
+.live-captions strong {
+  color: #aeb8ff;
+  white-space: nowrap;
+}
+.live-captions span { min-width: 0; word-break: break-word; }
+
 .video-actions {
   position: absolute;
   z-index: 40;
@@ -336,10 +422,80 @@ button:disabled { cursor: not-allowed; opacity: .55; }
 }
 .video-notice--error { border-color: rgba(242, 109, 109, .4); color: #ffe4e7; background: rgba(100, 31, 40, .88); }
 
+.screenshot-dialog-backdrop {
+  position: absolute;
+  z-index: 120;
+  inset: 0;
+  display: grid;
+  place-items: center;
+  padding: 24px;
+  background: rgba(7, 11, 19, .76);
+  backdrop-filter: blur(5px);
+}
+.screenshot-dialog {
+  display: grid;
+  grid-template-rows: auto minmax(0, 1fr) auto auto;
+  gap: 14px;
+  width: min(920px, 92vw);
+  max-height: calc(100vh - 48px);
+  padding: 20px;
+  overflow: hidden;
+  border: 1px solid #e2e7f4;
+  border-radius: 18px;
+  color: #111f46;
+  background: #fff;
+  box-shadow: 0 28px 90px rgba(4, 10, 27, .34);
+}
+.screenshot-dialog > header,
+.screenshot-dialog > footer {
+  display: flex;
+  align-items: center;
+  justify-content: space-between;
+  gap: 16px;
+}
+.screenshot-dialog h2 { margin: 2px 0 0; font-size: 20px; line-height: 1.35; }
+.screenshot-dialog .eyebrow { margin: 0; color: #5761f4; }
+.screenshot-dialog > header > button {
+  width: 36px;
+  height: 36px;
+  border: 0;
+  border-radius: 9px;
+  color: #7886aa;
+  background: #f2f4fb;
+  font-size: 24px;
+}
+.screenshot-preview-frame {
+  display: grid;
+  place-items: center;
+  min-height: 260px;
+  overflow: hidden;
+  border-radius: 12px;
+  background: #0b0f16;
+}
+.screenshot-preview-frame img {
+  display: block;
+  max-width: 100%;
+  max-height: min(62vh, 650px);
+  object-fit: contain;
+}
+.screenshot-dialog__hint { margin: 0; color: #617092; font-size: 13px; }
+.screenshot-dialog > footer { justify-content: flex-end; }
+.screenshot-dialog > footer button {
+  min-width: 112px;
+  padding: 10px 18px;
+  border-radius: 9px;
+  font-weight: 700;
+}
+.screenshot-cancel { border: 1px solid #dfe4f1; color: #3f4e75; background: #fff; }
+.screenshot-confirm { border: 1px solid #5761f4; color: #fff; background: #5761f4; }
+.screenshot-confirm:hover { background: #4c57e9; }
+
 @media (max-width: 820px) {
   .consultation-shell { min-width: 620px; }
   .message-list { padding-inline: 18px; }
   .message-bubble { max-width: 82%; }
+  .live-captions { width: calc(100% - 36px); bottom: 88px; }
+  .live-captions p { font-size: 14px; }
 }
 
 /* Doctor workstation blue-white subwindow contract.  Video pixels remain on

server/app/adminapi/controller/doctor/AppointmentController.php

@@ -172,7 +172,7 @@ class AppointmentController extends BaseAdminController
     public function addDoctorNote()
     {
         $params = (new AppointmentValidate())->post()->goCheck('addDoctorNote');
-        if (!DiagnosisLogic::canViewReadonlyDiagnosis(
+        if (!DiagnosisLogic::canManageDiagnosis(
             (int) $params['diagnosis_id'],
             $this->adminId,
             $this->adminInfo

server/app/adminapi/controller/tcm/DiagnosisController.php

@@ -330,25 +330,15 @@ class DiagnosisController extends BaseAdminController
      * @notes 获取通话签名
      * @return \think\response\Json
      */
-    public function getCallSignature()
-    {
-        $params = $this->request->post();
-
-        if (empty($params['diagnosis_id'])) {
-            return $this->fail('诊单ID不能为空');
-        }
-
-        if (empty($params['patient_id'])) {
-            return $this->fail('患者ID不能为空');
-        }
-
-        // 传递当前管理员ID
-        $params['admin_id'] = $this->adminId;
-
-        $result = DiagnosisLogic::getCallSignature($params);
-        if ($result) {
-            return $this->data($result);
-        }
+    public function getCallSignature()
+    {
+        $params = (new DiagnosisValidate())->post()->goCheck('callIdentity');
+        $params['admin_id'] = (int) $this->adminId;
+
+        $result = DiagnosisLogic::getCallSignature($params, $this->adminInfo);
+        if ($result) {
+            return $this->data($result);
+        }
         return $this->fail(DiagnosisLogic::getError());
     }
 
@@ -525,9 +515,9 @@ class DiagnosisController extends BaseAdminController
      * @notes 接通后发起腾讯云云端混流录制（需配置 CAM 与云点播）
      * @return \think\response\Json
      */
-    public function startCloudRecording()
-    {
-        $params = $this->request->post();
+    public function startCloudRecording()
+    {
+        $params = $this->request->post();
         if (empty($params['diagnosis_id'])) {
             return $this->fail('诊单ID不能为空');
         }
@@ -536,12 +526,32 @@ class DiagnosisController extends BaseAdminController
         if ($result === false) {
             return $this->fail(DiagnosisLogic::getError());
         }
-
-        return $this->data($result);
-    }
-
-    /**
-     * @notes 浏览器本地上传通话录制后，关联到通话记录（合并 recording_urls）
+
+        return $this->data($result);
+    }
+
+    /**
+     * @notes 分片上传本机通话录音或手动视频回放
+     * @return \think\response\Json
+     */
+    public function uploadCallRecording()
+    {
+        $params = $this->request->post();
+        if (empty($params['diagnosis_id'])) {
+            return $this->fail('诊单ID不能为空');
+        }
+
+        $params['admin_id'] = (int)$this->adminId;
+        $result = DiagnosisLogic::uploadCallRecording($params);
+        if ($result === false) {
+            return $this->fail(DiagnosisLogic::getError());
+        }
+
+        return $this->data($result);
+    }
+
+    /**
+     * @notes 浏览器本地上传通话录制后，关联到通话记录（合并 recording_urls）
      * @return \think\response\Json
      */
     public function attachLocalCallRecording()

server/app/adminapi/lists/doctor/AppointmentLists.php

@@ -293,20 +293,32 @@ class AppointmentLists extends BaseAdminDataLists implements ListsSearchInterfac
             $prescribedDiagnosisIds = $rxQ->column('diagnosis_id');
             $prescribedDiagnosisIds = array_flip($prescribedDiagnosisIds ?: []);
         }
-        // 当前页预约关联的处方（按 appointment_id，取最新一条）：用于「开方/查看」与审核状态
+        // 当前页预约关联的处方（按 appointment_id，优先最新未作废，否则最新一条）：
+        // 用于本次挂号的「开方/编辑/查看」与审核状态。
         $appointmentIds = array_filter(array_map('intval', array_column($lists, 'id')));
         $rxByAppointmentId = [];
+        $fallbackRxByAppointmentId = [];
         if (!empty($appointmentIds)) {
             $rxRows = Prescription::whereIn('appointment_id', $appointmentIds)
                 ->whereNull('delete_time')
-                ->where('void_status', 0)
                 ->order('id', 'desc')
                 ->field(['id', 'appointment_id', 'audit_status', 'void_status', 'is_system_auto'])
                 ->select()
                 ->toArray();
             foreach ($rxRows as $rx) {
                 $aid = (int) ($rx['appointment_id'] ?? 0);
-                if ($aid > 0 && !isset($rxByAppointmentId[$aid])) {
+                if ($aid <= 0) {
+                    continue;
+                }
+                if (!isset($fallbackRxByAppointmentId[$aid])) {
+                    $fallbackRxByAppointmentId[$aid] = $rx;
+                }
+                if ((int) ($rx['void_status'] ?? 0) === 0 && !isset($rxByAppointmentId[$aid])) {
+                    $rxByAppointmentId[$aid] = $rx;
+                }
+            }
+            foreach ($fallbackRxByAppointmentId as $aid => $rx) {
+                if (!isset($rxByAppointmentId[$aid])) {
                     $rxByAppointmentId[$aid] = $rx;
                 }
             }
@@ -353,6 +365,8 @@ class AppointmentLists extends BaseAdminDataLists implements ListsSearchInterfac
 
             $apptId = (int) ($item['id'] ?? 0);
             $apptRx = $rxByAppointmentId[$apptId] ?? null;
+            $item['current_has_prescription'] = $apptRx !== null ? 1 : 0;
+            $item['current_prescription_id'] = $apptRx !== null ? (int) ($apptRx['id'] ?? 0) : 0;
             $item['prescription_audit_status'] = $apptRx !== null ? (int) ($apptRx['audit_status'] ?? -1) : -1;
             $item['prescription_void_status'] = $apptRx !== null ? (int) ($apptRx['void_status'] ?? 0) : 0;
             $item['prescription_is_system_auto'] = $apptRx !== null ? (int) ($apptRx['is_system_auto'] ?? 0) : 0;

server/app/adminapi/lists/tcm/DiagnosisLists.php

@@ -282,17 +282,51 @@ class DiagnosisLists extends BaseAdminDataLists implements ListsSearchInterface
 
         // 关联是否开方：诊单是否有处方记录
         $diagnosisIds = array_column($lists, 'id');
-        $prescriptionMap = [];
-        if (!empty($diagnosisIds)) {
-            $prescriptionTbl = (new Prescription())->getTable();
-            $prescribedIds = Prescription::whereIn('diagnosis_id', $diagnosisIds)
-                ->whereNull('delete_time')
-                ->column('diagnosis_id');
-            $prescriptionMap = array_fill_keys($prescribedIds, 1);
-        }
-        foreach ($lists as &$item) {
-            $item['has_prescription'] = isset($prescriptionMap[$item['id']]) ? 1 : 0;
-        }
+        $prescriptionMap = [];
+        if (!empty($diagnosisIds)) {
+            $prescribedIds = Prescription::whereIn('diagnosis_id', $diagnosisIds)
+                ->whereNull('delete_time')
+                ->column('diagnosis_id');
+            $prescriptionMap = array_fill_keys($prescribedIds, 1);
+        }
+        foreach ($lists as &$item) {
+            $item['has_prescription'] = isset($prescriptionMap[$item['id']]) ? 1 : 0;
+        }
+
+        // 当前操作必须只认当前挂号的处方。has_prescription 继续表示诊单历史上曾开方，
+        // 不能再用它驱动本次挂号的“开方/编辑/查看”按钮。
+        $currentRxByAppointment = [];
+        $fallbackRxByAppointment = [];
+        $appointmentIds = array_values(array_filter(array_unique(array_map(
+            'intval',
+            array_column($lists, 'appointment_id')
+        ))));
+        if ($appointmentIds !== []) {
+            $currentRxRows = Prescription::whereIn('appointment_id', $appointmentIds)
+                ->whereNull('delete_time')
+                ->field(['id', 'appointment_id', 'audit_status', 'void_status'])
+                ->order('id', 'desc')
+                ->select()
+                ->toArray();
+            foreach ($currentRxRows as $rx) {
+                $appointmentId = (int) ($rx['appointment_id'] ?? 0);
+                if ($appointmentId <= 0) {
+                    continue;
+                }
+                if (!isset($fallbackRxByAppointment[$appointmentId])) {
+                    $fallbackRxByAppointment[$appointmentId] = $rx;
+                }
+                if ((int) ($rx['void_status'] ?? 0) === 0
+                    && !isset($currentRxByAppointment[$appointmentId])) {
+                    $currentRxByAppointment[$appointmentId] = $rx;
+                }
+            }
+            foreach ($fallbackRxByAppointment as $appointmentId => $rx) {
+                if (!isset($currentRxByAppointment[$appointmentId])) {
+                    $currentRxByAppointment[$appointmentId] = $rx;
+                }
+            }
+        }
 
         // 复诊展示：业务上「已开方」即算有复诊，取该诊单下最新一条处方的时间与医师（优先未作废）
         $followupByDiag = [];
@@ -346,17 +380,21 @@ class DiagnosisLists extends BaseAdminDataLists implements ListsSearchInterface
                 ];
             }
         }
-        foreach ($lists as &$item) {
-            $did = (int) $item['id'];
-            $fu = $followupByDiag[$did] ?? null;
-            $item['followup_time_text'] = ($item['has_prescription'] && $fu) ? ($fu['time_text'] ?? '') : '';
-            $item['followup_doctor_name'] = ($item['has_prescription'] && $fu) ? ($fu['doctor_name'] ?? '—') : '';
-            $item['followup_rx_voided'] = ($item['has_prescription'] && $fu && !empty($fu['voided'])) ? 1 : 0;
-            $item['prescription_audit_status'] = ($item['has_prescription'] && $fu) ? (int) ($fu['audit_status'] ?? -1) : -1;
-            $item['prescription_void_status'] = ($item['has_prescription'] && $fu) ? (int) ($fu['void_status'] ?? 0) : 0;
-            // 开方次数即复诊次数：1 张处方 = 第 1 次复诊，以此类推
-            $item['followup_prescription_count'] = (int) ($rxCountByDiag[$did] ?? 0);
-        }
+        foreach ($lists as &$item) {
+            $did = (int) $item['id'];
+            $fu = $followupByDiag[$did] ?? null;
+            $currentAppointmentId = (int) ($item['appointment_id'] ?? 0);
+            $currentRx = $currentRxByAppointment[$currentAppointmentId] ?? null;
+            $item['followup_time_text'] = ($item['has_prescription'] && $fu) ? ($fu['time_text'] ?? '') : '';
+            $item['followup_doctor_name'] = ($item['has_prescription'] && $fu) ? ($fu['doctor_name'] ?? '—') : '';
+            $item['followup_rx_voided'] = ($item['has_prescription'] && $fu && !empty($fu['voided'])) ? 1 : 0;
+            $item['current_has_prescription'] = $currentRx !== null ? 1 : 0;
+            $item['current_prescription_id'] = $currentRx !== null ? (int) ($currentRx['id'] ?? 0) : 0;
+            $item['prescription_audit_status'] = $currentRx !== null ? (int) ($currentRx['audit_status'] ?? -1) : -1;
+            $item['prescription_void_status'] = $currentRx !== null ? (int) ($currentRx['void_status'] ?? 0) : 0;
+            // 开方次数即复诊次数：1 张处方 = 第 1 次复诊，以此类推
+            $item['followup_prescription_count'] = (int) ($rxCountByDiag[$did] ?? 0);
+        }
 
         // 最近一条通话记录状态（列表行展示：通话中 / 已结束等）
         $latestCallByDiag = [];

server/app/adminapi/logic/stats/ConversionLogic.php

@@ -966,7 +966,8 @@ class ConversionLogic
      * - 统计区间内 add_external_contact，按 (user_id, external_userid) 去重；
      * - 同一员工在区间开始前已加过该客户的重加不计（企微「添加时间」仍是首次跟进时间，
      *   删后再加会再推 add_external_contact，但不能当当天新客，否则会跨日重复计）；
-     * - 加粉之后、统计结束前须有 msg_audit_approved（排除未完成链路的幽灵事件）；
+     * - add_external_contact 是企微确认客户关系已建立后的权威事件；会话存档同意
+     *   msg_audit_approved 属于独立能力，不能作为加粉前置条件，否则未开通会话存档的员工会被整批清零；
      * - 加粉之后、统计结束前若出现 del_external_contact（客户从企微侧删除）则不计。
      *   不扣减 del_follow_user：企微客户列表中改名带「删」的客户往往仍在列表中；
      * - 剔除非投放加粉：跟进人 add_way∈{1 扫一扫, 2 搜索手机号, 3 名片分享}；
@@ -993,7 +994,7 @@ class ConversionLogic
             }
         }
 
-        $baseKey = self::requestRowsCacheKey('fans-effective-v6', [
+        $baseKey = self::requestRowsCacheKey('fans-effective-v7', [
             $startTimestamp,
             $endTimestamp,
             self::mediaChannelCacheKey($mediaChannel),
@@ -1035,20 +1036,11 @@ class ConversionLogic
         $query = Db::name('qywx_external_contact_event')
             ->alias('e')
             ->where('e.change_type', 'add_external_contact')
-            ->where('e.event_time', 'between', [$startTimestamp, $endTimestamp])
-            ->where('e.user_id', '<>', '')
-            ->where('e.external_userid', '<>', '')
-            ->whereRaw(
-                'EXISTS (SELECT 1 FROM `' . $eventTable . '` audit_e'
-                . ' WHERE audit_e.user_id = e.user_id'
-                . ' AND audit_e.external_userid = e.external_userid'
-                . ' AND audit_e.change_type = ?'
-                . ' AND audit_e.event_time >= e.event_time'
-                . ' AND audit_e.event_time <= ?)',
-                ['msg_audit_approved', $endTimestamp]
-            )
-            ->whereRaw(
-                'NOT EXISTS (SELECT 1 FROM `' . $eventTable . '` del_e'
+            ->where('e.event_time', 'between', [$startTimestamp, $endTimestamp])
+            ->where('e.user_id', '<>', '')
+            ->where('e.external_userid', '<>', '')
+            ->whereRaw(
+                'NOT EXISTS (SELECT 1 FROM `' . $eventTable . '` del_e'
                 . ' WHERE del_e.user_id = e.user_id'
                 . ' AND del_e.external_userid = e.external_userid'
                 . ' AND del_e.change_type = ?'

server/app/adminapi/logic/tcm/DiagnosisLogic.php

@@ -855,68 +855,77 @@ class DiagnosisLogic extends BaseLogic
     }
 
     /**
-     * @notes 获取通话签名
-     * @param array $params
-     * @return array|bool
-     */
-    public static function getCallSignature(array $params)
-    {
-        try {
-            // 获取配置
-            $config = self::getTrtcConfig();
-           
-            if (!$config) {
-                self::setError('请先配置腾讯云TRTC参数');
-                return false;
-            }
-            
-            // 获取当前管理员ID（从参数中获取）
-            $adminId = $params['admin_id'] ?? 0;
-            $patientId = $params['patient_id'] ?? 0;
-            
-            if (!$adminId) {
-                self::setError('获取管理员信息失败');
-                return false;
-            }
-            
-            if (!$patientId) {
-                self::setError('获取患者信息失败');
-                return false;
-            }
-            
-            // 医生userId
-            $doctorUserId = 'doctor_' . $adminId;
-            $query = Diagnosis::where('id', $patientId)
-            ->where('delete_time', null)->find();
-            if(!$query){
-                self::setError('患者诊单已被删除');
-               return false;
-           }
-          
-            // 患者userId（必须与小程序端一致）
-            $patientUserId = 'patient_' . $patientId;
-            
-            // 生成医生的 UserSig
-            $userSig = self::generateUserSig($config['sdkAppId'], $config['secretKey'], $doctorUserId);
-            
-            if (!$userSig) {
-                self::setError('生成签名失败');
-                return false;
-            }
-            
-            // 导入医生账号到IM
-            self::importDoctorAccountToIm($adminId, $doctorUserId);
-            
-            // 确保患者账号也已导入IM（用于跨平台通话）
-            self::ensurePatientImAccount($patientId, $patientUserId);
-            
-            return [
-                'sdkAppId' => (int)$config['sdkAppId'],  // 确保返回整数
-                'userId' => $doctorUserId,  // 医生的userId
-                'userSig' => $userSig,
-                'assistant_id'=>$query->assistant_id?'doctor_'.$query->assistant_id:'',
-                'patientUserId' => $patientUserId,  // 患者的userId（用于发起通话）
-                'expireTime' => 86400, // 24小时
+     * @notes 获取通话签名
+     * @param array $params
+     * @param array $adminInfo
+     * @return array|bool
+     */
+    public static function getCallSignature(array $params, array $adminInfo = [])
+    {
+        try {
+            $adminId = (int) ($params['admin_id'] ?? 0);
+            $diagnosisId = (int) ($params['diagnosis_id'] ?? 0);
+            $patientId = (int) ($params['patient_id'] ?? 0);
+
+            if ($adminId <= 0) {
+                self::setError('获取管理员信息失败');
+                return false;
+            }
+
+            if ($diagnosisId <= 0 || $patientId <= 0) {
+                self::setError('诊单或患者信息不完整');
+                return false;
+            }
+
+            // Authorize the diagnosis before reading TRTC configuration or importing IM accounts.
+            if (!self::canManageDiagnosis($diagnosisId, $adminId, $adminInfo)) {
+                self::setError('诊单不存在、患者不匹配或无权访问');
+                return false;
+            }
+
+            $diagnosis = Diagnosis::where('id', $diagnosisId)
+                ->where('patient_id', $patientId)
+                ->whereNull('delete_time')
+                ->where('status', 1)
+                ->find();
+            if (!$diagnosis) {
+                self::setError('诊单不存在、患者不匹配或无权访问');
+                return false;
+            }
+
+            $config = self::getTrtcConfig();
+            if (!$config) {
+                self::setError('请先配置腾讯云TRTC参数');
+                return false;
+            }
+
+            $doctorUserId = 'doctor_' . $adminId;
+            // 患者userId（必须与小程序端一致）
+            $patientUserId = 'patient_' . $patientId;
+
+            // 生成医生的 UserSig
+            $userSig = self::generateUserSig($config['sdkAppId'], $config['secretKey'], $doctorUserId);
+
+            if (!$userSig) {
+                self::setError('生成签名失败');
+                return false;
+            }
+
+            // 导入医生账号到IM
+            self::importDoctorAccountToIm($adminId, $doctorUserId);
+
+            // 确保患者账号也已导入IM（用于跨平台通话）
+            self::ensurePatientImAccount($patientId, $patientUserId);
+
+            return [
+                'sdkAppId' => (int)$config['sdkAppId'],  // 确保返回整数
+                'userId' => $doctorUserId,  // 医生的userId
+                'userSig' => $userSig,
+                'assistant_id' => $diagnosis->assistant_id ? 'doctor_' . $diagnosis->assistant_id : '',
+                'patientUserId' => $patientUserId,  // 患者的userId（用于发起通话）
+                'diagnosis_id' => $diagnosisId,
+                'patient_id' => $patientId,
+                'expireTime' => 86400, // 24小时
                 // 与 .env [trtc] ISLOCHOSTVOD 一致：true 允许浏览器本地录制并上传
                 'isLochostVod' => (bool)config('trtc.is_lochost_vod', false),
             ];
@@ -1645,12 +1654,13 @@ class DiagnosisLogic extends BaseLogic
      * @param array $params
      * @return bool
      */
-    public static function endCall(array $params): bool
-    {
-        try {
-            // 获取当前管理员ID（从参数中获取）
-            $adminId = (int)($params['admin_id'] ?? 0);
-            $diagnosisId = (int)($params['diagnosis_id'] ?? 0);
+    public static function endCall(array $params): bool
+    {
+        try {
+            // 获取当前管理员ID（从参数中获取）
+            $adminId = (int)($params['admin_id'] ?? 0);
+            $diagnosisId = (int)($params['diagnosis_id'] ?? 0);
+            $callRecordId = (int)($params['call_record_id'] ?? 0);
 
             if ($adminId <= 0) {
                 self::setError('获取管理员信息失败');
@@ -1661,26 +1671,47 @@ class DiagnosisLogic extends BaseLogic
                 return false;
             }
 
-            // 优先匹配「当前医生 + 进行中」，与 startCloudRecording / bindCallRoom 一致
-            $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
-                ->where('caller_id', $adminId)
-                ->where('status', 1)
-                ->order('id', 'desc')
-                ->find();
-            if (!$record) {
-                $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
-                    ->where('status', 1)
-                    ->order('id', 'desc')
-                    ->find();
-                if ($record) {
-                    \think\facade\Log::warning('endCall: 未匹配 caller_id，已回退到该诊单最新进行中记录', [
-                        'diagnosis_id' => $diagnosisId,
-                        'admin_id' => $adminId,
-                        'record_caller_id' => $record['caller_id'] ?? null,
-                        'call_record_id' => $record['id'] ?? null,
-                    ]);
-                }
-            }
+            $record = null;
+            if ($callRecordId > 0) {
+                $record = \app\common\model\tcm\CallRecord::where('id', $callRecordId)
+                    ->where('diagnosis_id', $diagnosisId)
+                    ->where('caller_id', $adminId)
+                    ->where('caller_type', 'doctor')
+                    ->find();
+                if (!$record) {
+                    self::setError('通话记录不存在或无权操作');
+                    return false;
+                }
+                if ((int)($record['status'] ?? 0) === 2) {
+                    // afterCalling / Store idle may report the same exact call twice.
+                    return true;
+                }
+                if ((int)($record['status'] ?? 0) !== 1) {
+                    self::setError('通话记录状态不可结束');
+                    return false;
+                }
+            } else {
+                // Legacy web callers may not yet send call_record_id.
+                $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
+                    ->where('caller_id', $adminId)
+                    ->where('status', 1)
+                    ->order('id', 'desc')
+                    ->find();
+                if (!$record) {
+                    $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
+                        ->where('status', 1)
+                        ->order('id', 'desc')
+                        ->find();
+                    if ($record) {
+                        \think\facade\Log::warning('endCall: 未传 call_record_id 且未匹配 caller_id，已回退到该诊单最新进行中记录', [
+                            'diagnosis_id' => $diagnosisId,
+                            'admin_id' => $adminId,
+                            'record_caller_id' => $record['caller_id'] ?? null,
+                            'call_record_id' => $record['id'] ?? null,
+                        ]);
+                    }
+                }
+            }
 
             if (!$record) {
                 // 前端常重复回调 endCall（afterCalling + Store idle），第一条已结束则不再告警
@@ -1861,9 +1892,20 @@ class DiagnosisLogic extends BaseLogic
                     if (is_array($decoded)) {
                         $urls = $decoded;
                     }
-                }
+                }
                 $record['recording_urls_list'] = $urls;
                 $record['recording_status_text'] = self::recordingStatusText((int)($record['recording_status'] ?? 0));
+                $localAudioUrls = [];
+                if (!empty($record['local_audio_urls'])) {
+                    $decodedLocalAudioUrls = json_decode((string)$record['local_audio_urls'], true);
+                    if (is_array($decodedLocalAudioUrls)) {
+                        $localAudioUrls = $decodedLocalAudioUrls;
+                    }
+                }
+                $record['local_audio_urls_list'] = $localAudioUrls;
+                $record['local_audio_status_text'] = self::localAudioStatusText(
+                    (int)($record['local_audio_status'] ?? 0)
+                );
                 $record['transcription_status_text'] = self::transcriptionStatusText(
                     (string)($record['transcription_status'] ?? '')
                 );
@@ -2184,11 +2226,12 @@ class DiagnosisLogic extends BaseLogic
      * @notes 将 TRTC 房间号写入当前诊单通话记录，并尝试 API 合流云端录制
      * @return array{cloud_recording?:array}|false 成功返回 data 数组（供接口带给前端）；失败 false
      */
-    public static function bindCallRoom(array $params)
-    {
-        try {
-            $diagnosisId = (int)($params['diagnosis_id'] ?? 0);
-            $roomId = trim((string)($params['room_id'] ?? ''));
+    public static function bindCallRoom(array $params)
+    {
+        try {
+            $diagnosisId = (int)($params['diagnosis_id'] ?? 0);
+            $callRecordId = (int)($params['call_record_id'] ?? 0);
+            $roomId = trim((string)($params['room_id'] ?? ''));
             if ($diagnosisId <= 0 || $roomId === '') {
                 self::setError('诊单ID或房间号不能为空');
                 return false;
@@ -2196,24 +2239,34 @@ class DiagnosisLogic extends BaseLogic
 
             $adminId = (int)($params['admin_id'] ?? 0);
 
-            // 必须与 startCloudRecording 使用同一条「进行中 + 当前管理员」记录写 room_id，否则会写到别的记录上，合流 API 读到 room_id 仍为空 → 关闭全局录制后无任何文件
-            $record = null;
-            if ($adminId > 0) {
-                $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
-                    ->where('status', 1)
-                    ->where('caller_id', $adminId)
+            $record = null;
+            if ($callRecordId > 0) {
+                $record = \app\common\model\tcm\CallRecord::where('id', $callRecordId)
+                    ->where('diagnosis_id', $diagnosisId)
+                    ->where('status', 1)
+                    ->where('caller_id', $adminId)
+                    ->where('caller_type', 'doctor')
+                    ->find();
+                if (!$record) {
+                    self::setError('通话记录不存在或无权绑定房间');
+                    return false;
+                }
+            } elseif ($adminId > 0) {
+                $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
+                    ->where('status', 1)
+                    ->where('caller_id', $adminId)
                     ->order('id', 'desc')
                     ->find();
             }
-            if (!$record) {
-                $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
-                    ->where('status', 1)
+            if (!$record && $callRecordId <= 0) {
+                $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
+                    ->where('status', 1)
                     ->order('id', 'desc')
                     ->find();
             }
-            if (!$record) {
-                $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
-                    ->where('room_id', '')
+            if (!$record && $callRecordId <= 0) {
+                $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
+                    ->where('room_id', '')
                     ->order('id', 'desc')
                     ->find();
             }
@@ -2233,10 +2286,11 @@ class DiagnosisLogic extends BaseLogic
                 'message' => '未尝试合流录制（admin_id 为空）',
             ];
             if ($adminId > 0) {
-                $cloudRec = self::startCloudRecording([
-                    'diagnosis_id' => $diagnosisId,
-                    'admin_id' => $adminId,
-                ], true);
+                $cloudRec = self::startCloudRecording([
+                    'diagnosis_id' => $diagnosisId,
+                    'admin_id' => $adminId,
+                    'call_record_id' => (int)$record['id'],
+                ], true);
                 if ($cloudRec === false) {
                     \think\facade\Log::warning('bindCallRoom: startCloudRecording 未执行或异常', [
                         'diagnosis_id' => $diagnosisId,
@@ -2286,10 +2340,11 @@ class DiagnosisLogic extends BaseLogic
      */
     public static function startCloudRecording(array $params, bool $silent = false)
     {
-        try {
-            $diagnosisId = (int)($params['diagnosis_id'] ?? 0);
-            $adminId = (int)($params['admin_id'] ?? 0);
-            if ($diagnosisId <= 0 || $adminId <= 0) {
+        try {
+            $diagnosisId = (int)($params['diagnosis_id'] ?? 0);
+            $adminId = (int)($params['admin_id'] ?? 0);
+            $callRecordId = (int)($params['call_record_id'] ?? 0);
+            if ($diagnosisId <= 0 || $adminId <= 0) {
                 if (!$silent) {
                     self::setError('参数错误');
                 }
@@ -2297,24 +2352,40 @@ class DiagnosisLogic extends BaseLogic
                 return false;
             }
 
-            $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
-                ->where('caller_id', $adminId)
-                ->where('status', 1)
-                ->order('id', 'desc')
-                ->find();
-            if (!$record) {
-                $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
-                    ->where('status', 1)
-                    ->order('id', 'desc')
-                    ->find();
-                if ($record) {
-                    \think\facade\Log::warning('startCloudRecording: 未找到 caller_id 匹配的进行中记录，已回退到该诊单最新进行中记录', [
-                        'diagnosis_id' => $diagnosisId,
-                        'admin_id' => $adminId,
-                        'record_caller_id' => $record['caller_id'] ?? null,
-                    ]);
-                }
-            }
+            $record = null;
+            if ($callRecordId > 0) {
+                $record = \app\common\model\tcm\CallRecord::where('id', $callRecordId)
+                    ->where('diagnosis_id', $diagnosisId)
+                    ->where('caller_id', $adminId)
+                    ->where('caller_type', 'doctor')
+                    ->where('status', 1)
+                    ->find();
+                if (!$record) {
+                    if (!$silent) {
+                        self::setError('通话记录不存在或无权开启云端录制');
+                    }
+                    return false;
+                }
+            } else {
+                $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
+                    ->where('caller_id', $adminId)
+                    ->where('status', 1)
+                    ->order('id', 'desc')
+                    ->find();
+                if (!$record) {
+                    $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
+                        ->where('status', 1)
+                        ->order('id', 'desc')
+                        ->find();
+                    if ($record) {
+                        \think\facade\Log::warning('startCloudRecording: 未传 call_record_id 且未找到 caller_id 匹配的进行中记录，已回退到该诊单最新进行中记录', [
+                            'diagnosis_id' => $diagnosisId,
+                            'admin_id' => $adminId,
+                            'record_caller_id' => $record['caller_id'] ?? null,
+                        ]);
+                    }
+                }
+            }
             if (!$record) {
                 if (!$silent) {
                     self::setError('没有进行中的通话记录');
@@ -2389,9 +2460,9 @@ class DiagnosisLogic extends BaseLogic
     /**
      * @notes 医生端浏览器本地录制上传后，将文件访问地址合并写入当前诊单下该医生的最近一条通话记录
      */
-    public static function attachLocalCallRecording(array $params): bool
-    {
-        try {
+    public static function attachLocalCallRecording(array $params): bool
+    {
+        try {
             $diagnosisId = (int)($params['diagnosis_id'] ?? 0);
             $adminId = (int)($params['admin_id'] ?? 0);
             $fileUrl = trim((string)($params['file_url'] ?? ''));
@@ -2428,12 +2499,61 @@ class DiagnosisLogic extends BaseLogic
         } catch (\Exception $e) {
             self::setError($e->getMessage());
 
-            return false;
-        }
-    }
-
-    /**
-     * @notes 诊单回放视频分片上传，完成后显式关联到指定通话记录
+            return false;
+        }
+    }
+
+    /**
+     * 将医生工作站本机录音独立关联到通话记录。
+     *
+     * 本机音频与腾讯云混流视频分别持久化，避免录音上传成功后被误计为
+     * 云端视频已生成。
+     */
+    public static function attachLocalCallAudio(array $params): bool
+    {
+        try {
+            $diagnosisId = (int)($params['diagnosis_id'] ?? 0);
+            $adminId = (int)($params['admin_id'] ?? 0);
+            $fileUrl = trim((string)($params['file_url'] ?? ''));
+            $callRecordId = (int)($params['call_record_id'] ?? 0);
+            if ($diagnosisId <= 0 || $adminId <= 0 || $fileUrl === '') {
+                self::setError('参数错误');
+
+                return false;
+            }
+
+            $record = self::resolveCallRecordForAttachment($diagnosisId, $adminId, $callRecordId);
+            if (!$record) {
+                self::setError('未找到通话记录');
+
+                return false;
+            }
+
+            $previousUrls = [];
+            if (!empty($record->local_audio_urls)) {
+                $decodedUrls = json_decode((string)$record->local_audio_urls, true);
+                if (is_array($decodedUrls)) {
+                    $previousUrls = $decodedUrls;
+                }
+            }
+            $mergedUrls = array_values(array_unique(array_merge($previousUrls, [$fileUrl])));
+
+            $record->save([
+                'local_audio_urls' => json_encode($mergedUrls, JSON_UNESCAPED_UNICODE),
+                'local_audio_status' => 2,
+                'update_time' => time(),
+            ]);
+
+            return true;
+        } catch (\Exception $e) {
+            self::setError($e->getMessage());
+
+            return false;
+        }
+    }
+
+    /**
+     * @notes 诊单回放视频分片上传，完成后显式关联到指定通话记录
      * @param array $params
      * @return array|false
      */
@@ -2445,11 +2565,12 @@ class DiagnosisLogic extends BaseLogic
             $diagnosisId = (int)($params['diagnosis_id'] ?? 0);
             $callRecordId = (int)($params['call_record_id'] ?? 0);
             $adminId = (int)($params['admin_id'] ?? 0);
-            $uploadId = trim((string)($params['upload_id'] ?? ''));
-            $fileName = trim((string)($params['file_name'] ?? ''));
-            $fileSize = (int)($params['file_size'] ?? 0);
-            $chunkIndex = (int)($params['chunk_index'] ?? -1);
-            $chunkTotal = (int)($params['chunk_total'] ?? 0);
+            $uploadId = trim((string)($params['upload_id'] ?? ''));
+            $fileName = trim((string)($params['file_name'] ?? ''));
+            $mimeType = strtolower(trim((string)($params['mime_type'] ?? '')));
+            $fileSize = (int)($params['file_size'] ?? 0);
+            $chunkIndex = (int)($params['chunk_index'] ?? -1);
+            $chunkTotal = (int)($params['chunk_total'] ?? 0);
 
             if (
                 $diagnosisId <= 0 ||
@@ -2462,13 +2583,27 @@ class DiagnosisLogic extends BaseLogic
             ) {
                 self::setError('上传参数不完整');
                 return false;
-            }
-
-            $ext = strtolower((string)pathinfo($fileName, PATHINFO_EXTENSION));
-            if ($ext === '' || !in_array($ext, config('project.file_video'), true)) {
-                self::setError('视频格式不支持');
-                return false;
-            }
+            }
+
+            $ext = strtolower((string)pathinfo($fileName, PATHINFO_EXTENSION));
+            $audioExtensions = ['webm', 'ogg', 'opus', 'mp3', 'wav', 'm4a', 'aac', 'amr', 'wma'];
+            $videoExtensions = (array)config('project.file_video');
+            $hasAudioMime = str_starts_with($mimeType, 'audio/');
+            $hasVideoMime = str_starts_with($mimeType, 'video/');
+            $isAmbiguousWebm = $ext === 'webm';
+            $isVideo = in_array($ext, $videoExtensions, true)
+                && (
+                    $mimeType === ''
+                    || $hasVideoMime
+                    || (!$isAmbiguousWebm && $hasAudioMime)
+                );
+            $isLocalAudio = !$isVideo
+                && $hasAudioMime
+                && in_array($ext, $audioExtensions, true);
+            if (!$isLocalAudio && !$isVideo) {
+                self::setError('音视频格式不支持');
+                return false;
+            }
 
             if ($callRecordId <= 0) {
                 $record = self::createSyntheticCallRecord($diagnosisId, $adminId, $fileName);
@@ -2497,10 +2632,12 @@ class DiagnosisLogic extends BaseLogic
                 'diagnosis_id' => $diagnosisId,
                 'call_record_id' => $callRecordId,
                 'admin_id' => $adminId,
-                'file_name' => $fileName,
-                'file_size' => $fileSize,
-                'chunk_total' => $chunkTotal,
-            ], JSON_UNESCAPED_UNICODE));
+                'file_name' => $fileName,
+                'file_size' => $fileSize,
+                'mime_type' => $mimeType,
+                'media_kind' => $isLocalAudio ? 'local_audio' : 'video',
+                'chunk_total' => $chunkTotal,
+            ], JSON_UNESCAPED_UNICODE));
 
             $chunkPath = $uploadDir . DIRECTORY_SEPARATOR . self::callRecordingChunkName($chunkIndex);
             $moved = $chunkFile->move($uploadDir, basename($chunkPath));
@@ -2527,21 +2664,29 @@ class DiagnosisLogic extends BaseLogic
                 return false;
             }
 
-            $uploadResult = self::storeMergedCallRecording($mergedPath, $fileName, $adminId);
-            if (empty($uploadResult['uri'])) {
-                self::setError('保存视频失败');
-                return false;
-            }
-
-            $attached = self::attachLocalCallRecording([
-                'diagnosis_id' => $diagnosisId,
-                'call_record_id' => $callRecordId,
-                'admin_id' => $adminId,
-                'file_url' => (string)$uploadResult['uri'],
-            ]);
-            if (!$attached) {
-                return false;
-            }
+            $uploadResult = self::storeMergedCallRecording(
+                $mergedPath,
+                $fileName,
+                $adminId,
+                $isLocalAudio
+            );
+            if (empty($uploadResult['uri'])) {
+                self::setError($isLocalAudio ? '保存本机录音失败' : '保存视频失败');
+                return false;
+            }
+
+            $attachmentParams = [
+                'diagnosis_id' => $diagnosisId,
+                'call_record_id' => $callRecordId,
+                'admin_id' => $adminId,
+                'file_url' => (string)$uploadResult['uri'],
+            ];
+            $attached = $isLocalAudio
+                ? self::attachLocalCallAudio($attachmentParams)
+                : self::attachLocalCallRecording($attachmentParams);
+            if (!$attached) {
+                return false;
+            }
 
             self::cleanupCallRecordingChunkDir($uploadDir);
 
@@ -2550,10 +2695,12 @@ class DiagnosisLogic extends BaseLogic
                 'uploaded_chunks' => $chunkTotal,
                 'chunk_total' => $chunkTotal,
                 'call_record_id' => $callRecordId,
-                'file_id' => $uploadResult['id'] ?? 0,
-                'file_url' => $uploadResult['uri'] ?? '',
-                'recording_status' => 2,
-            ];
+                'file_id' => $uploadResult['id'] ?? 0,
+                'file_url' => $uploadResult['uri'] ?? '',
+                'media_kind' => $isLocalAudio ? 'local_audio' : 'video',
+                'recording_status' => $isLocalAudio ? 0 : 2,
+                'local_audio_status' => $isLocalAudio ? 2 : 0,
+            ];
         } catch (\Throwable $e) {
             if ($mergedPath !== '' && is_file($mergedPath)) {
                 @unlink($mergedPath);
@@ -2656,19 +2803,31 @@ class DiagnosisLogic extends BaseLogic
         }
     }
 
-    private static function recordingStatusText(int $status): string
-    {
-        $map = [
+    private static function recordingStatusText(int $status): string
+    {
+        $map = [
             0 => '无录制',
             1 => '录制中',
             2 => '已生成',
             3 => '录制失败',
         ];
-
-        return $map[$status] ?? '未知';
-    }
-    
-    /**
+
+        return $map[$status] ?? '未知';
+    }
+
+    private static function localAudioStatusText(int $status): string
+    {
+        $map = [
+            0 => '无本地录音',
+            1 => '上传中',
+            2 => '已保存',
+            3 => '上传失败',
+        ];
+
+        return $map[$status] ?? '未知';
+    }
+
+    /**
      * @notes 获取TRTC配置
      * @return array|null
      */
@@ -4228,12 +4387,52 @@ class DiagnosisLogic extends BaseLogic
     }
 
     /**
-     * 与 readonlyDetail 共用的诊单行级可见性入口。
+     * 与诊单列表共用语义的只读行级可见性入口。
      *
-     * 复用“我的患者”统一行权策略：医生按有效接诊关系，医助按归属关系，
-     * 团队管理角色才使用 DataScope。不存在与越权使用同一错误避免枚举。
+     * 医助仍仅能查看本人归属诊单；其他角色按 DataScope 查看列表范围内的诊单。
+     * “我的患者”的本人接诊关系只用于管理/写操作，不能限制通用诊单只读页。
+     * 不存在与越权使用同一错误，避免枚举诊单。
      */
     public static function canViewReadonlyDiagnosis(int $diagnosisId, int $adminId, array $adminInfo): bool
+    {
+        self::$error = '';
+        if ($diagnosisId <= 0 || $adminId <= 0) {
+            self::setError('诊单不存在或无权访问');
+
+            return false;
+        }
+
+        $query = Diagnosis::where('id', $diagnosisId)->whereNull('delete_time');
+        $roleIds = array_map('intval', AdminRole::where('admin_id', $adminId)->column('role_id'));
+        if (in_array(2, $roleIds, true)) {
+            $query->where('assistant_id', $adminId);
+        }
+
+        if (DataScopeService::isEnabled()) {
+            $visibleIds = DataScopeService::getVisibleAdminIds($adminId, $adminInfo);
+            if ($visibleIds === []) {
+                self::setError('诊单不存在或无权访问');
+
+                return false;
+            }
+            if (is_array($visibleIds)) {
+                $query->whereIn('assistant_id', $visibleIds);
+            }
+        }
+
+        if (!$query->find()) {
+            self::setError('诊单不存在或无权访问');
+
+            return false;
+        }
+
+        return true;
+    }
+
+    /**
+     * 诊单管理/写操作的行级权限入口，保留“我的患者”的本人关系约束。
+     */
+    public static function canManageDiagnosis(int $diagnosisId, int $adminId, array $adminInfo): bool
     {
         self::$error = '';
         if (!MyPatientLogic::canAccessDiagnosis($diagnosisId, $adminId, $adminInfo)) {
@@ -4526,25 +4725,33 @@ class DiagnosisLogic extends BaseLogic
         }
     }
 
-    private static function storeMergedCallRecording(string $mergedPath, string $fileName, int $adminId): array
-    {
-        $config = [
-            'default' => ConfigService::get('storage', 'default', 'local'),
+    private static function storeMergedCallRecording(
+        string $mergedPath,
+        string $fileName,
+        int $adminId,
+        bool $isLocalAudio = false
+    ): array
+    {
+        $config = [
+            'default' => ConfigService::get('storage', 'default', 'local'),
             'engine' => ConfigService::get('storage') ?? ['local' => []],
         ];
-
-        $storageDriver = new StorageDriver($config);
-        $storageDriver->setUploadFileByReal($mergedPath);
-        $saveDir = 'uploads/video/' . date('Ymd');
-        if (!$storageDriver->upload($saveDir)) {
-            throw new \RuntimeException($storageDriver->getError() ?: '上传视频到存储失败');
-        }
-
-        $relativePath = $saveDir . '/' . str_replace('\\', '/', $storageDriver->getFileName());
-        $storedFile = FileModel::create([
-            'cid' => 0,
-            'type' => FileEnum::VIDEO_TYPE,
-            'name' => mb_substr($fileName, 0, 128),
+
+        $storageDriver = new StorageDriver($config);
+        $storageDriver->setUploadFileByReal($mergedPath);
+        $saveDir = ($isLocalAudio ? 'uploads/audio/' : 'uploads/video/') . date('Ymd');
+        if (!$storageDriver->upload($saveDir)) {
+            throw new \RuntimeException(
+                $storageDriver->getError()
+                    ?: ($isLocalAudio ? '上传本机录音到存储失败' : '上传视频到存储失败')
+            );
+        }
+
+        $relativePath = $saveDir . '/' . str_replace('\\', '/', $storageDriver->getFileName());
+        $storedFile = FileModel::create([
+            'cid' => 0,
+            'type' => $isLocalAudio ? FileEnum::FILE_TYPE : FileEnum::VIDEO_TYPE,
+            'name' => mb_substr($fileName, 0, 128),
             'uri' => $relativePath,
             'source' => FileEnum::SOURCE_ADMIN,
             'source_id' => $adminId,

server/app/adminapi/logic/tcm/PrescriptionLogic.php

@@ -4,7 +4,6 @@ declare(strict_types=1);
 
 namespace app\adminapi\logic\tcm;
 
-use app\adminapi\logic\firstvisit\MyPatientLogic;
 use app\common\model\auth\Admin;
 use app\common\model\doctor\Appointment;
 use app\common\model\doctor\Medicine as DoctorMedicine;
@@ -938,8 +937,8 @@ class PrescriptionLogic
     public static function listByDiagnosis(int $diagnosisId, int $viewerAdminId, array $viewerAdminInfo): array
     {
         self::$error = '';
-        if (!MyPatientLogic::canAccessDiagnosis($diagnosisId, $viewerAdminId, $viewerAdminInfo)) {
-            self::setError('诊单不存在或无权访问');
+        if (!DiagnosisLogic::canViewReadonlyDiagnosis($diagnosisId, $viewerAdminId, $viewerAdminInfo)) {
+            self::setError(DiagnosisLogic::getError() ?: '诊单不存在或无权访问');
 
             return [];
         }
@@ -968,16 +967,29 @@ class PrescriptionLogic
     /**
      * 根据预约ID获取处方（带权限检查）
      */
-    public static function getByAppointment(int $appointmentId, int $viewerAdminId, array $viewerAdminInfo): ?array
-    {
+    public static function getByAppointment(int $appointmentId, int $viewerAdminId, array $viewerAdminInfo): ?array
+    {
         self::$error = '';
-        $row = Prescription::where('appointment_id', $appointmentId)
+        $rows = Prescription::where('appointment_id', $appointmentId)
             ->whereNull('delete_time')
             ->order('id', 'desc')
-            ->find();
-       
-        if (!$row) {
-            return null;
+            ->select();
+
+        $row = null;
+        $fallback = null;
+        foreach ($rows as $candidate) {
+            if ($fallback === null) {
+                $fallback = $candidate;
+            }
+            if ((int) ($candidate->void_status ?? 0) === 0) {
+                $row = $candidate;
+                break;
+            }
+        }
+        $row = $row ?? $fallback;
+
+        if (!$row) {
+            return null;
         }
         
         // 权限检查：只返回当前用户有权限查看的处方

server/app/adminapi/validate/tcm/DiagnosisValidate.php

@@ -133,12 +133,21 @@ class DiagnosisValidate extends BaseValidate
     }
 
     /** 拉取跟踪备注列表：诊单ID */
-    public function sceneTrackingNotes()
-    {
-        return $this->only(['diagnosis_id']);
-    }
-
-    public function sceneGenerateQrcode()
+    public function sceneTrackingNotes()
+    {
+        return $this->only(['diagnosis_id']);
+    }
+
+    /** IM / video identity: validate shape here; ownership is checked in the logic layer. */
+    public function sceneCallIdentity()
+    {
+        return $this->only(['diagnosis_id', 'patient_id'])
+            ->remove('diagnosis_id', 'checkDiagnosisId')
+            ->append('diagnosis_id', 'gt:0')
+            ->append('patient_id', 'require|integer|gt:0');
+    }
+
+    public function sceneGenerateQrcode()
     {
         return $this->only(['diagnosis_id', 'doctor_id', 'patient_id', 'share_user_id', 'mini_program_path'])
             // The global diagnosis_id rule is required for diagnosis APIs, but

server/app/common/service/storage/engine/Server.php

@@ -4,6 +4,7 @@ namespace app\common\service\storage\engine;
 
 use think\Request;
 use think\Exception;
+use think\File;
 
 /**
  * 存储引擎抽象类
@@ -67,12 +68,22 @@ abstract class Server
     {
         // 设置为系统内部上传
         $this->isInternal = true;
+        // 内部上传的是磁盘文件，不是 HTTP UploadedFile。这里统一成与
+        // 普通上传相同的存储契约：云存储需要 realPath，本地存储需要 File 对象。
+        $this->file = new File($filePath);
+        $realPath = $this->file->getRealPath();
+        if ($realPath === false || !$this->file->isReadable()) {
+            throw new Exception('内部上传文件不可读取');
+        }
         // 文件信息
         $this->fileInfo = [
-            'name' => basename($filePath),
-            'size' => filesize($filePath),
-            'tmp_name' => $filePath,
-            'error' => 0,
+            'ext'      => strtolower($this->file->getExtension()),
+            'size'     => $this->file->getSize(),
+            'mime'     => $this->file->getMime(),
+            'name'     => basename($filePath),
+            'realPath' => $realPath,
+            'tmp_name' => $realPath,
+            'error'    => UPLOAD_ERR_OK,
         ];
         // 生成保存文件名
         $this->fileName = $this->buildSaveName();
@@ -118,7 +129,11 @@ abstract class Server
 
     protected function getRealPath()
     {
-        return $this->fileInfo['realPath'];
+        $realPath = $this->fileInfo['realPath'] ?? '';
+        if (!is_string($realPath) || $realPath === '' || !is_file($realPath)) {
+            throw new Exception('上传文件真实路径无效');
+        }
+        return $realPath;
     }
 
     /**

server/database/migrations/2026_08_19_add_local_call_audio_fields.sql

@@ -0,0 +1,34 @@
+-- 本机录音必须与腾讯云混流视频分开保存。
+-- 此迁移可重复执行，兼容已经手工补过字段的部署环境。
+
+SET @local_audio_urls_exists = (
+    SELECT COUNT(*)
+    FROM information_schema.COLUMNS
+    WHERE TABLE_SCHEMA = DATABASE()
+      AND TABLE_NAME = 'zyt_tcm_call_record'
+      AND COLUMN_NAME = 'local_audio_urls'
+);
+SET @local_audio_urls_sql = IF(
+    @local_audio_urls_exists = 0,
+    'ALTER TABLE `zyt_tcm_call_record` ADD COLUMN `local_audio_urls` LONGTEXT NULL COMMENT ''本机录音地址JSON数组'' AFTER `recording_urls`',
+    'SELECT 1'
+);
+PREPARE local_audio_urls_statement FROM @local_audio_urls_sql;
+EXECUTE local_audio_urls_statement;
+DEALLOCATE PREPARE local_audio_urls_statement;
+
+SET @local_audio_status_exists = (
+    SELECT COUNT(*)
+    FROM information_schema.COLUMNS
+    WHERE TABLE_SCHEMA = DATABASE()
+      AND TABLE_NAME = 'zyt_tcm_call_record'
+      AND COLUMN_NAME = 'local_audio_status'
+);
+SET @local_audio_status_sql = IF(
+    @local_audio_status_exists = 0,
+    'ALTER TABLE `zyt_tcm_call_record` ADD COLUMN `local_audio_status` TINYINT UNSIGNED NOT NULL DEFAULT 0 COMMENT ''本机录音状态:0无录音,1上传中,2已保存,3上传失败'' AFTER `local_audio_urls`',
+    'SELECT 1'
+);
+PREPARE local_audio_status_statement FROM @local_audio_status_sql;
+EXECUTE local_audio_status_statement;
+DEALLOCATE PREPARE local_audio_status_statement;

server/tests/CallRecordLifecycleIdentityContractTest.php

@@ -0,0 +1,80 @@
+<?php
+
+declare(strict_types=1);
+
+require dirname(__DIR__) . '/vendor/autoload.php';
+
+use app\adminapi\logic\tcm\DiagnosisLogic;
+
+function callRecordIdentityExpect(bool $condition, string $message): void
+{
+    if (!$condition) {
+        throw new RuntimeException($message);
+    }
+}
+
+function callRecordIdentityMethodSource(ReflectionMethod $method): string
+{
+    $lines = file($method->getFileName());
+    if (!is_array($lines)) {
+        throw new RuntimeException('call-record lifecycle source is readable');
+    }
+
+    return implode('', array_slice(
+        $lines,
+        $method->getStartLine() - 1,
+        $method->getEndLine() - $method->getStartLine() + 1
+    ));
+}
+
+$logic = new ReflectionClass(DiagnosisLogic::class);
+$endCall = callRecordIdentityMethodSource($logic->getMethod('endCall'));
+$bindCallRoom = callRecordIdentityMethodSource($logic->getMethod('bindCallRoom'));
+$startCloudRecording = callRecordIdentityMethodSource($logic->getMethod('startCloudRecording'));
+
+foreach (
+    [
+        'endCall' => $endCall,
+        'bindCallRoom' => $bindCallRoom,
+        'startCloudRecording' => $startCloudRecording,
+    ] as $methodName => $source
+) {
+    callRecordIdentityExpect(
+        str_contains($source, "\$callRecordId = (int)(\$params['call_record_id'] ?? 0)")
+            && str_contains($source, 'if ($callRecordId > 0)')
+            && str_contains($source, "CallRecord::where('id', \$callRecordId)")
+            && str_contains($source, "->where('diagnosis_id', \$diagnosisId)")
+            && str_contains($source, "->where('caller_id', \$adminId)")
+            && str_contains($source, "->where('caller_type', 'doctor')"),
+        $methodName . ' uses the exact doctor-owned call record when its id is supplied'
+    );
+}
+
+callRecordIdentityExpect(
+    str_contains($bindCallRoom, "'call_record_id' => (int)\$record['id']")
+        && str_contains($bindCallRoom, 'startCloudRecording(['),
+    'room binding forwards the exact saved record to cloud recording'
+);
+callRecordIdentityExpect(
+    str_contains($endCall, "(int)(\$record['status'] ?? 0) === 2")
+        && str_contains($endCall, 'return true;'),
+    'ending the same exact call remains idempotent'
+);
+
+$workspace = dirname(__DIR__, 2);
+$repository = (string) file_get_contents(
+    $workspace . '/app/src/doctor_workstation/services/repository.py'
+);
+$lifecycle = (string) file_get_contents(
+    $workspace . '/app/src/doctor_workstation/video/lifecycle.py'
+);
+callRecordIdentityExpect(
+    substr_count($repository, 'body["call_record_id"] = normalized_id') >= 2,
+    'desktop repository sends call_record_id for bind and end requests'
+);
+callRecordIdentityExpect(
+    substr_count($lifecycle, '"call_record_id": record_id') >= 2,
+    'desktop lifecycle keeps the created call record identity through later phases'
+);
+
+echo "Call-record lifecycle identity contract: OK\n";

server/tests/CallSignatureIdentityContractTest.php

@@ -0,0 +1,91 @@
+<?php
+
+declare(strict_types=1);
+
+require dirname(__DIR__) . '/vendor/autoload.php';
+
+use app\adminapi\controller\tcm\DiagnosisController;
+use app\adminapi\logic\tcm\DiagnosisLogic;
+use app\adminapi\validate\tcm\DiagnosisValidate;
+
+function callSignatureExpect(bool $condition, string $message): void
+{
+    if (!$condition) {
+        throw new RuntimeException($message);
+    }
+}
+
+function callSignatureMethodSource(ReflectionMethod $method): string
+{
+    $lines = file($method->getFileName());
+    if (!is_array($lines)) {
+        throw new RuntimeException('call signature source is readable');
+    }
+
+    return implode('', array_slice(
+        $lines,
+        $method->getStartLine() - 1,
+        $method->getEndLine() - $method->getStartLine() + 1
+    ));
+}
+
+$logicMethod = (new ReflectionClass(DiagnosisLogic::class))->getMethod('getCallSignature');
+$logicSource = callSignatureMethodSource($logicMethod);
+$controllerSource = callSignatureMethodSource(
+    (new ReflectionClass(DiagnosisController::class))->getMethod('getCallSignature')
+);
+$validatorSource = callSignatureMethodSource(
+    (new ReflectionClass(DiagnosisValidate::class))->getMethod('sceneCallIdentity')
+);
+
+callSignatureExpect(
+    $logicMethod->getNumberOfParameters() === 2,
+    'call signature accepts request params and authenticated admin context'
+);
+callSignatureExpect(
+    str_contains($logicSource, 'canManageDiagnosis($diagnosisId, $adminId, $adminInfo)')
+        && strpos($logicSource, 'canManageDiagnosis($diagnosisId, $adminId, $adminInfo)')
+            < strpos($logicSource, "Diagnosis::where('id', \$diagnosisId)")
+        && strpos($logicSource, "Diagnosis::where('id', \$diagnosisId)")
+            < strpos($logicSource, 'self::getTrtcConfig()'),
+    'row authorization and the exact diagnosis/patient pair are checked before TRTC work'
+);
+callSignatureExpect(
+    str_contains($logicSource, "->where('patient_id', \$patientId)")
+        && str_contains($logicSource, "'diagnosis_id' => \$diagnosisId")
+        && str_contains($logicSource, "'patient_id' => \$patientId")
+        && !str_contains($logicSource, "Diagnosis::where('id', \$patientId)"),
+    'diagnosis id and source patient id stay distinct throughout the signature contract'
+);
+callSignatureExpect(
+    str_contains($controllerSource, "goCheck('callIdentity')")
+        && str_contains(
+            $controllerSource,
+            'DiagnosisLogic::getCallSignature($params, $this->adminInfo)'
+        ),
+    'controller validates both ids and forwards the authenticated row-scope context'
+);
+callSignatureExpect(
+    str_contains($validatorSource, "only(['diagnosis_id', 'patient_id'])")
+        && str_contains($validatorSource, "append('patient_id', 'require|integer|gt:0')"),
+    'call identity validation requires positive diagnosis and patient ids'
+);
+
+$root = dirname(__DIR__, 2);
+foreach (
+    [
+        $root . '/admin/src/views/tcm/appointment/list.vue',
+        $root . '/admin/src/views/tcm/appointment/list_h5.vue',
+        $root . '/admin/src/views/patient/reception/index.vue',
+    ] as $callerPath
+) {
+    $caller = (string) file_get_contents($callerPath);
+    callSignatureExpect(
+        str_contains($caller, 'patient_id: sourcePatientId')
+            && str_contains($caller, 'patientId: sourcePatientId')
+            && str_contains($caller, 'diagnosis_id: diagnosisId'),
+        basename($callerPath) . ' keeps appointment, diagnosis and source patient ids separate'
+    );
+}
+
+echo "Call signature identity contract: OK\n";

server/tests/ConversionFanEventRuleTest.php

@@ -0,0 +1,67 @@
+<?php
+
+declare(strict_types=1);
+
+use app\adminapi\logic\stats\ConversionLogic;
+
+require dirname(__DIR__) . '/vendor/autoload.php';
+
+function conversionFanRuleExpect(bool $condition, string $message): void
+{
+    if (!$condition) {
+        throw new RuntimeException($message);
+    }
+}
+
+$method = new ReflectionMethod(ConversionLogic::class, 'loadFanRows');
+$sourceLines = file($method->getFileName());
+if ($sourceLines === false) {
+    throw new RuntimeException('无法读取加粉统计源码');
+}
+$methodSource = implode('', array_slice(
+    $sourceLines,
+    $method->getStartLine() - 1,
+    $method->getEndLine() - $method->getStartLine() + 1
+));
+
+conversionFanRuleExpect(
+    str_contains($methodSource, "->where('e.change_type', 'add_external_contact')"),
+    '加粉必须继续以企微 add_external_contact 事件为事实来源'
+);
+conversionFanRuleExpect(
+    !str_contains($methodSource, 'msg_audit_approved'),
+    '会话存档同意是独立能力，不能再次成为加粉统计的硬性条件'
+);
+conversionFanRuleExpect(
+    str_contains($methodSource, "['del_external_contact', \$endTimestamp]"),
+    '加粉统计必须继续排除区间内已删除客户'
+);
+conversionFanRuleExpect(
+    str_contains($methodSource, "['add_external_contact', \$startTimestamp]"),
+    '加粉统计必须继续排除区间开始前已添加的重加客户'
+);
+conversionFanRuleExpect(
+    str_contains($methodSource, "->group('e.user_id, e.external_userid')"),
+    '加粉统计必须继续按员工和客户去重'
+);
+
+$excludeMethod = new ReflectionMethod(ConversionLogic::class, 'excludeUncountedFanPairs');
+$excludeSource = implode('', array_slice(
+    $sourceLines,
+    $excludeMethod->getStartLine() - 1,
+    $excludeMethod->getEndLine() - $excludeMethod->getStartLine() + 1
+));
+conversionFanRuleExpect(
+    str_contains($excludeSource, '[1, 2, 3, 201, 202]'),
+    '取消会话存档条件后仍须排除扫一扫、搜手机号、名片分享及继承/分配客户'
+);
+
+$pageSource = file_get_contents(
+    dirname(__DIR__, 2) . '/admin/src/views/first_visit/conversion/index.vue'
+);
+conversionFanRuleExpect(
+    is_string($pageSource) && !str_contains($pageSource, '须会话同意'),
+    '页面口径说明不能继续宣称加粉依赖会话存档同意'
+);
+
+echo "Conversion fan event rule: OK\n";

server/tests/DiagnosisWorkspaceRowAuthorizationTest.php

@@ -121,6 +121,9 @@ $myPatientScopeMethod = diagnosisWorkspaceMethodSource(
 $diagnosisReadonlyAuthMethod = diagnosisWorkspaceMethodSource(
     (new ReflectionClass(DiagnosisLogic::class))->getMethod('canViewReadonlyDiagnosis')
 );
+$diagnosisManageAuthMethod = diagnosisWorkspaceMethodSource(
+    (new ReflectionClass(DiagnosisLogic::class))->getMethod('canManageDiagnosis')
+);
 $diagnosisAiAuthMethod = diagnosisWorkspaceMethodSource(
     (new ReflectionClass(DiagnosisAiLogic::class))->getMethod('loadAuthorizedDiagnosis')
 );
@@ -161,9 +164,16 @@ diagnosisWorkspaceAuthExpect(
     'DataScope ALL is reserved for team roles before ordinary doctor and assistant self-relations'
 );
 diagnosisWorkspaceAuthExpect(
-    str_contains($diagnosisReadonlyAuthMethod, 'MyPatientLogic::canAccessDiagnosis(')
-        && !str_contains($diagnosisReadonlyAuthMethod, 'DataScopeService::getVisibleAdminIds'),
-    'readonly diagnosis authorization reuses the canonical patient row policy'
+    str_contains($diagnosisReadonlyAuthMethod, "Diagnosis::where('id', \$diagnosisId)")
+        && str_contains($diagnosisReadonlyAuthMethod, "in_array(2, \$roleIds, true)")
+        && str_contains($diagnosisReadonlyAuthMethod, "\$query->where('assistant_id', \$adminId)")
+        && str_contains($diagnosisReadonlyAuthMethod, 'DataScopeService::getVisibleAdminIds(')
+        && !str_contains($diagnosisReadonlyAuthMethod, 'MyPatientLogic::canAccessDiagnosis('),
+    'readonly diagnosis authorization matches diagnosis-list visibility instead of my-patient ownership'
+);
+diagnosisWorkspaceAuthExpect(
+    str_contains($diagnosisManageAuthMethod, 'MyPatientLogic::canAccessDiagnosis('),
+    'diagnosis write authorization keeps the canonical my-patient ownership policy'
 );
 diagnosisWorkspaceAuthExpect(
     str_contains($diagnosisAiAuthMethod, 'MyPatientLogic::canAccessDiagnosis(')
@@ -192,10 +202,10 @@ diagnosisWorkspaceAuthExpect(
     'doctorNotes authorizes the diagnosis before reading notes'
 );
 diagnosisWorkspaceAuthExpect(
-    str_contains($addDoctorNoteControllerMethod, 'DiagnosisLogic::canViewReadonlyDiagnosis(')
-        && strpos($addDoctorNoteControllerMethod, 'DiagnosisLogic::canViewReadonlyDiagnosis(')
+    str_contains($addDoctorNoteControllerMethod, 'DiagnosisLogic::canManageDiagnosis(')
+        && strpos($addDoctorNoteControllerMethod, 'DiagnosisLogic::canManageDiagnosis(')
             < strpos($addDoctorNoteControllerMethod, 'DoctorNoteLogic::addOrAppend('),
-    'addDoctorNote authorizes the diagnosis before writing any note data'
+    'addDoctorNote keeps the stricter ownership check before writing any note data'
 );
 diagnosisWorkspaceAuthExpect(
     str_contains($receptionMethod, 'appointmentRowManageableByAdmin(')
@@ -204,10 +214,10 @@ diagnosisWorkspaceAuthExpect(
     'reception authorizes the appointment before loading its detail DTO'
 );
 diagnosisWorkspaceAuthExpect(
-    str_contains($prescriptionListMethod, 'MyPatientLogic::canAccessDiagnosis(')
-        && strpos($prescriptionListMethod, 'MyPatientLogic::canAccessDiagnosis(')
+    str_contains($prescriptionListMethod, 'DiagnosisLogic::canViewReadonlyDiagnosis(')
+        && strpos($prescriptionListMethod, 'DiagnosisLogic::canViewReadonlyDiagnosis(')
             < strpos($prescriptionListMethod, "Prescription::where('diagnosis_id', \$diagnosisId)"),
-    'listByDiagnosis authorizes its parent diagnosis before the first prescription SQL query'
+    'listByDiagnosis uses read visibility before the first prescription SQL query'
 );
 diagnosisWorkspaceAuthExpect(
     str_contains($prescriptionLogicSource, 'self::canViewPrescription($row, $viewerAdminId, $viewerAdminInfo)')

server/tests/LocalAudioUploadContractTest.php

@@ -0,0 +1,168 @@
+<?php
+
+declare(strict_types=1);
+
+require_once dirname(__DIR__) . '/vendor/autoload.php';
+
+final class LocalAudioUploadContractExpect
+{
+    public static function contains(string $haystack, string $needle, string $message): void
+    {
+        if (!str_contains($haystack, $needle)) {
+            throw new RuntimeException($message . ': missing ' . $needle);
+        }
+    }
+
+    public static function isTrue(bool $condition, string $message): void
+    {
+        if (!$condition) {
+            throw new RuntimeException($message);
+        }
+    }
+}
+
+$root = dirname(__DIR__);
+$controllerPath = $root . '/app/adminapi/controller/tcm/DiagnosisController.php';
+$logicPath = $root . '/app/adminapi/logic/tcm/DiagnosisLogic.php';
+$migrationPath = $root . '/database/migrations/2026_08_19_add_local_call_audio_fields.sql';
+
+$controller = (string)file_get_contents($controllerPath);
+$logic = (string)file_get_contents($logicPath);
+$migration = (string)file_get_contents($migrationPath);
+
+LocalAudioUploadContractExpect::contains(
+    $controller,
+    'public function uploadCallRecording()',
+    'The ThinkPHP controller must expose the desktop upload action'
+);
+LocalAudioUploadContractExpect::contains(
+    $controller,
+    'DiagnosisLogic::uploadCallRecording($params)',
+    'The controller must delegate multipart uploads to the diagnosis logic'
+);
+
+foreach (
+    [
+        "'webm'",
+        "'ogg'",
+        "'media_kind' => \$isLocalAudio ? 'local_audio' : 'video'",
+        'attachLocalCallAudio($attachmentParams)',
+        "'local_audio_urls'",
+        "'local_audio_status' => 2",
+        "'local_audio_urls_list'",
+        "'local_audio_status_text'",
+        "'uploads/audio/'",
+        'FileEnum::FILE_TYPE',
+    ] as $needle
+) {
+    LocalAudioUploadContractExpect::contains(
+        $logic,
+        $needle,
+        'Local audio upload and DTO contract must remain complete'
+    );
+}
+
+foreach (
+    [
+        "'uploads/video/'",
+        'FileEnum::VIDEO_TYPE',
+        'attachLocalCallRecording($attachmentParams)',
+        "'recording_status' => \$isLocalAudio ? 0 : 2",
+    ] as $needle
+) {
+    LocalAudioUploadContractExpect::contains(
+        $logic,
+        $needle,
+        'Manual video uploads must remain separate from local audio'
+    );
+}
+
+LocalAudioUploadContractExpect::isTrue(
+    str_contains($logic, '!$isAmbiguousWebm && $hasAudioMime'),
+    'Known non-WebM video extensions must not be misclassified when an old client sends audio/webm'
+);
+
+foreach (['zyt_tcm_call_record', 'local_audio_urls', 'local_audio_status'] as $needle) {
+    LocalAudioUploadContractExpect::contains(
+        $migration,
+        $needle,
+        'The database migration must include every local audio field'
+    );
+}
+
+// Exercise the real internal-file path used after all recording chunks are
+// merged. A source-code assertion alone did not catch the missing realPath key
+// (or the missing File object required by the local storage engine).
+$sourceBase = tempnam(sys_get_temp_dir(), 'zyt-audio-source-');
+LocalAudioUploadContractExpect::isTrue(
+    is_string($sourceBase),
+    'A temporary local-audio source file must be creatable'
+);
+$sourcePath = $sourceBase . '.webm';
+LocalAudioUploadContractExpect::isTrue(
+    rename($sourceBase, $sourcePath),
+    'The temporary local-audio source must keep its WebM extension'
+);
+$payload = "\x1A\x45\xDF\xA3local-audio-regression";
+LocalAudioUploadContractExpect::isTrue(
+    file_put_contents($sourcePath, $payload) === strlen($payload),
+    'The local-audio fixture must be written completely'
+);
+$targetDir = sys_get_temp_dir() . DIRECTORY_SEPARATOR
+    . 'zyt-local-audio-target-' . bin2hex(random_bytes(6));
+
+try {
+    $localStorage = new \app\common\service\storage\engine\Local();
+    $localStorage->setUploadFileByReal($sourcePath);
+    $fileInfo = $localStorage->getFileInfo();
+
+    LocalAudioUploadContractExpect::isTrue(
+        isset($fileInfo['realPath']) && $fileInfo['realPath'] === realpath($sourcePath),
+        'Internal storage metadata must include the merged recording realPath'
+    );
+    LocalAudioUploadContractExpect::isTrue(
+        ($fileInfo['tmp_name'] ?? '') === realpath($sourcePath),
+        'Internal storage metadata must preserve a compatible temporary path'
+    );
+    LocalAudioUploadContractExpect::isTrue(
+        str_ends_with($localStorage->getFileName(), '.webm'),
+        'The generated storage name must preserve the recording extension'
+    );
+    LocalAudioUploadContractExpect::isTrue(
+        $localStorage->upload($targetDir),
+        'The local storage driver must accept a merged internal recording'
+    );
+
+    $storedPath = $targetDir . DIRECTORY_SEPARATOR . $localStorage->getFileName();
+    LocalAudioUploadContractExpect::isTrue(
+        is_file($storedPath) && file_get_contents($storedPath) === $payload,
+        'The internally uploaded local recording must remain byte-identical'
+    );
+} finally {
+    if (isset($storedPath) && is_file($storedPath)) {
+        unlink($storedPath);
+    }
+    if (is_file($sourcePath)) {
+        unlink($sourcePath);
+    }
+    if (is_dir($targetDir)) {
+        rmdir($targetDir);
+    }
+}
+
+$missingPath = sys_get_temp_dir() . DIRECTORY_SEPARATOR
+    . 'zyt-missing-local-audio-' . bin2hex(random_bytes(8)) . '.webm';
+$missingRejected = false;
+try {
+    $localStorage = new \app\common\service\storage\engine\Local();
+    $localStorage->setUploadFileByReal($missingPath);
+} catch (Throwable $exception) {
+    $missingRejected = !str_contains($exception->getMessage(), 'realPath')
+        && str_contains($exception->getMessage(), 'does not exist');
+}
+LocalAudioUploadContractExpect::isTrue(
+    $missingRejected,
+    'A missing merged recording must fail clearly before storage-name generation'
+);
+
+echo "Local audio upload contract: OK\n";

server/tests/PrescriptionAppointmentScopeContractTest.php

@@ -0,0 +1,70 @@
+<?php
+
+declare(strict_types=1);
+
+require_once dirname(__DIR__) . '/vendor/autoload.php';
+
+use app\adminapi\lists\doctor\AppointmentLists;
+use app\adminapi\lists\tcm\DiagnosisLists;
+use app\adminapi\logic\tcm\PrescriptionLogic;
+
+function prescriptionAppointmentScopeExpect(bool $condition, string $message): void
+{
+    if (!$condition) {
+        throw new RuntimeException($message);
+    }
+}
+
+function prescriptionAppointmentScopeMethod(ReflectionMethod $method): string
+{
+    $lines = file($method->getFileName());
+    if (!is_array($lines)) {
+        throw new RuntimeException('method source must be readable');
+    }
+
+    return implode('', array_slice(
+        $lines,
+        $method->getStartLine() - 1,
+        $method->getEndLine() - $method->getStartLine() + 1
+    ));
+}
+
+$diagnosisLists = prescriptionAppointmentScopeMethod(
+    (new ReflectionClass(DiagnosisLists::class))->getMethod('lists')
+);
+$appointmentLists = prescriptionAppointmentScopeMethod(
+    (new ReflectionClass(AppointmentLists::class))->getMethod('lists')
+);
+$getByAppointment = prescriptionAppointmentScopeMethod(
+    (new ReflectionClass(PrescriptionLogic::class))->getMethod('getByAppointment')
+);
+
+foreach ([$diagnosisLists, $appointmentLists] as $listSource) {
+    prescriptionAppointmentScopeExpect(
+        str_contains($listSource, "whereIn('appointment_id', \$appointmentIds)"),
+        'list action state must be selected by the current appointment ids'
+    );
+    prescriptionAppointmentScopeExpect(
+        str_contains($listSource, "['current_has_prescription']"),
+        'list DTO must expose an appointment-scoped prescription flag'
+    );
+    prescriptionAppointmentScopeExpect(
+        str_contains($listSource, "['current_prescription_id']"),
+        'list DTO must expose the exact appointment-scoped prescription id'
+    );
+}
+
+prescriptionAppointmentScopeExpect(
+    !str_contains(
+        $diagnosisLists,
+        "['prescription_audit_status'] = (\$item['has_prescription'] && \$fu)"
+    ),
+    'diagnosis history must not drive the current appointment action state'
+);
+prescriptionAppointmentScopeExpect(
+    str_contains($getByAppointment, "(int) (\$candidate->void_status ?? 0) === 0")
+        && str_contains($getByAppointment, '$row = $row ?? $fallback;'),
+    'detail lookup must prefer the same active prescription and only fall back when all are voided'
+);
+
+echo "Prescription appointment scope contract: OK\n";