diff --git a/.gitignore b/.gitignore
index 87f8ee1d..5c227437 100644
--- a/.gitignore
+++ b/.gitignore
@@ -34,3 +34,4 @@ bin-release/
 /server/.claude
 /.spool
 TUICallKit-Vue3/.env
+/.codegraph
diff --git a/admin/src/views/patient/reception/components/NoteTimeline.vue b/admin/src/views/patient/reception/components/NoteTimeline.vue
index 83f399b8..b55ecee3 100644
--- a/admin/src/views/patient/reception/components/NoteTimeline.vue
+++ b/admin/src/views/patient/reception/components/NoteTimeline.vue
@@ -1,6 +1,15 @@
 <template>
     <div class="note-timeline-wrap">
         <div v-if="!readonly && diagnosisId" class="timeline-actions">
+            <el-button
+                v-if="hasAddDoctorNotePermission"
+                type="primary"
+                plain
+                size="small"
+                @click="showNoteDialog = true"
+            >
+                添加备注
+            </el-button>
             <material-picker
                 v-model="tongueModel"
                 :limit="99"
@@ -95,16 +104,32 @@
             </div>
         </div>
         <el-empty v-if="!notes.length && readonly" description="暂无备注" :image-size="48" />
+
+        <el-dialog v-model="showNoteDialog" title="添加备注" width="480px" append-to-body>
+            <el-input
+                v-model="noteContent"
+                type="textarea"
+                :rows="4"
+                placeholder="输入今日备注..."
+                maxlength="500"
+                show-word-limit
+            />
+            <template #footer>
+                <el-button @click="showNoteDialog = false">取消</el-button>
+                <el-button type="primary" :loading="noteSaving" @click="handleSaveNote">保存</el-button>
+            </template>
+        </el-dialog>
     </div>
 </template>
 
 <script setup lang="ts">
-import { ref, watch } from 'vue'
+import { computed, ref, watch } from 'vue'
 import { CircleClose, Document } from '@element-plus/icons-vue'
 import { ElMessageBox } from 'element-plus'
 import useAppStore from '@/stores/modules/app'
 import { addDoctorNote, deleteDoctorNoteImage } from '@/api/patient'
 import feedback from '@/utils/feedback'
+import { hasPermission } from '@/utils/perm'
 
 export interface DoctorNoteItem {
     id: number
@@ -122,6 +147,13 @@ const props = defineProps<{
 
 const emit = defineEmits<{ refresh: [] }>()
 
+/** 与接诊台悬浮「备注」按钮一致 */
+const hasAddDoctorNotePermission = computed(() => hasPermission(['doctor.appointment/addDoctorNote']))
+
+const showNoteDialog = ref(false)
+const noteContent = ref('')
+const noteSaving = ref(false)
+
 const appStore = useAppStore()
 const getImageUrl = (url: string) => appStore.getImageUrl(url)
 
@@ -201,6 +233,30 @@ watch(() => props.notes, () => {
     prevReportCount.value = 0
 })
 
+const handleSaveNote = async () => {
+    if (!props.diagnosisId) {
+        feedback.msgWarning('当前无诊单，无法添加备注')
+        return
+    }
+    const text = noteContent.value.trim()
+    if (!text) {
+        feedback.msgWarning('请输入备注内容')
+        return
+    }
+    noteSaving.value = true
+    try {
+        await addDoctorNote({ diagnosis_id: props.diagnosisId, content: text })
+        feedback.msgSuccess('备注保存成功')
+        noteContent.value = ''
+        showNoteDialog.value = false
+        emit('refresh')
+    } catch (e: any) {
+        feedback.msgError(e?.message || '保存失败')
+    } finally {
+        noteSaving.value = false
+    }
+}
+
 const handleDeleteImage = async (noteId: number, imageType: 'tongue_images' | 'report_files', imagePath: string) => {
     try {
         await ElMessageBox.confirm('确认删除？', '提示', { type: 'warning' })
@@ -217,6 +273,7 @@ const handleDeleteImage = async (noteId: number, imageType: 'tongue_images' | 'r
 .timeline-actions {
     display: flex;
     flex-direction: column;
+    align-items: flex-start;
     gap: 12px;
     margin-bottom: 12px;
     padding-bottom: 12px;