更新

app/src/doctor_workstation/__init__.py

@@ -7,5 +7,5 @@ __version__ = "1.4.2"
 
 # 调试模式开启时，登录页显示“演示模式”和“服务器设置”。
 # 正式发布请保持 False；此时程序只使用下面配置的线上域名。
-DEBUG_MODE = False
+DEBUG_MODE = True
 ONLINE_API_BASE_URL = "https://admin.zhenyangtang.com.cn"

app/src/doctor_workstation/app.py

@@ -412,7 +412,8 @@ class ApplicationController(QObject):
         self.current_repository: Any = None
         self.current_demo_mode = self.debug_mode and config.demo_mode
         self.video_calls: dict[str, Any] = {}
-        self.video_pending: dict[str, object] = {}
+        self.video_pending: dict[str, object] = {}
+        self._pending_im_request: tuple[str, object] | None = None
         self.demo_video_dialogs: dict[str, DemoVideoDialog] = {}
         self._video_preview_state: dict[str, Any] | None = None
         self._video_preview_generation = 0
@@ -725,7 +726,8 @@ class ApplicationController(QObject):
                 call.close()
         self._wait_for_video_lifecycle(calls, timeout=1.25)
         self.video_calls.clear()
-        self.video_pending.clear()
+        self.video_pending.clear()
+        self._pending_im_request = None
         for dialog in self.demo_video_dialogs.values():
             dialog.close()
         self.demo_video_dialogs.clear()
@@ -746,7 +748,8 @@ class ApplicationController(QObject):
         if parent is None or self.current_repository is None:
             return
         patient_id = payload.get("patient_id")
-        diagnosis_id = payload.get("diagnosis_id")
+        diagnosis_id = payload.get("diagnosis_id")
+        appointment_id = int(payload.get("appointment_id") or 0)
         patient_name = str(payload.get("patient_name") or "患者")
         open_im = str(payload.get("mode") or "video").lower() == "im"
         fallback_record = payload.get("record")
@@ -754,8 +757,16 @@ class ApplicationController(QObject):
             show_toast(parent, "患者或诊单信息不完整，无法发起视频。", "danger", 4200)
             return
 
-        call_key = str(diagnosis_id)
-        existing_call = self.video_calls.get(call_key)
+        call_key = f"{diagnosis_id}:{appointment_id}"
+        if open_im and self._pending_im_request is not None:
+            pending_key, pending_marker = self._pending_im_request
+            if pending_key != call_key:
+                # Retire a previous selection before any early return, including
+                # when the selected IM window is already open.
+                if self.video_pending.get(pending_key) is pending_marker:
+                    self.video_pending.pop(pending_key, None)
+                self._pending_im_request = None
+        existing_call = self.video_calls.get(call_key)
         if open_im and existing_call is not None and getattr(existing_call, "open_im", False):
             qt_window = getattr(existing_call, "qt_window", None)
             if qt_window is not None:
@@ -801,13 +812,18 @@ class ApplicationController(QObject):
         )
         repository = self.current_repository
         marker = object()
-        self.video_pending[call_key] = marker
+        self.video_pending[call_key] = marker
+        if open_im:
+            self._pending_im_request = (call_key, marker)
 
         def get_video_context() -> tuple[Any, dict[str, str]]:
             ticket = repository.get_call_ticket(
                 patient_id=int(patient_id),
-                diagnosis_id=int(diagnosis_id),
-            )
+                diagnosis_id=int(diagnosis_id),
+                appointment_id=appointment_id,
+            )
+            if appointment_id and int(ticket.raw.get("appointment_id") or 0) != appointment_id:
+                raise ValueError("通话凭证与本次挂号不匹配，请重新打开聊天窗口。")
             detail: Any = {}
             detail_loader = getattr(repository, "patient_detail", None)
             if callable(detail_loader):
@@ -868,10 +884,12 @@ class ApplicationController(QObject):
         parent: QWidget,
         error: Exception,
     ) -> None:
-        if self.video_pending.get(call_key) is not marker:
-            return
-        self.video_pending.pop(call_key, None)
-        if self.shell_window is parent:
+        if self.video_pending.get(call_key) is not marker:
+            return
+        self.video_pending.pop(call_key, None)
+        if self._pending_im_request == (call_key, marker):
+            self._pending_im_request = None
+        if self.shell_window is parent:
             show_toast(
                 parent,
                 f"视频准备失败：{friendly_error(error)}",
@@ -892,9 +910,11 @@ class ApplicationController(QObject):
         patient_name: str = "患者",
         patient_case: Mapping[str, Any] | None = None,
     ) -> None:
-        if self.video_pending.get(call_key) is not marker:
-            return
-        self.video_pending.pop(call_key, None)
+        if self.video_pending.get(call_key) is not marker:
+            return
+        self.video_pending.pop(call_key, None)
+        if self._pending_im_request == (call_key, marker):
+            self._pending_im_request = None
         if (
             self.shell_window is None
             or self.current_repository is not repository
@@ -919,8 +939,8 @@ class ApplicationController(QObject):
                 open_im=open_im,
                 patient_name=patient_name,
                 patient_case=patient_case,
-                on_open_diagnosis=lambda current_id=diagnosis_id: (
-                    self._open_video_diagnosis(current_id)
+                on_open_diagnosis=lambda current_id=diagnosis_id, current_key=call_key: (
+                    self._open_video_diagnosis(current_id, call_key=current_key)
                 ),
             )
         except Exception as error:
@@ -942,7 +962,7 @@ class ApplicationController(QObject):
                 )
             )
 
-    def _open_video_diagnosis(self, diagnosis_id: Any) -> None:
+    def _open_video_diagnosis(self, diagnosis_id: Any, *, call_key: str) -> None:
         """Open the diagnosis while keeping its live video visible as a preview."""
 
         shell = self.shell_window
@@ -951,7 +971,7 @@ class ApplicationController(QObject):
         dialog = shell.open_diagnosis_by_id(diagnosis_id, modeless=True)
         if dialog is None:
             return
-        call = self.video_calls.get(str(diagnosis_id))
+        call = self.video_calls.get(call_key)
         video_window = getattr(call, "qt_window", None)
         if video_window is not None:
             self._show_video_preview(video_window, dialog)

app/src/doctor_workstation/core/appointment_modes.py

@@ -0,0 +1,48 @@
+"""Appointment medium labels, separate from first-visit/follow-up diagnosis type."""
+
+from collections.abc import Mapping
+from typing import Any
+
+APPOINTMENT_MODES = (("视频问诊", "video"), ("图文问诊", "text"))
+
+
+def appointment_type_description(value: Any) -> str:
+    if value is None or isinstance(value, str) and not value.strip():
+        return "视频问诊"
+    return {"video": "视频问诊", "text": "图文问诊", "phone": "电话问诊"}.get(str(value), "未知")
+
+
+def can_appointment_video(value: Any) -> bool:
+    """UI hint only; actual call permission must come from the server ticket."""
+    return value is None or isinstance(value, str) and (not value.strip() or value == "video")
+
+
+def appointment_type_value(record: Any) -> Any:
+    """Read appointment rows and diagnosis-list projections without visit-type aliases."""
+    def read(value: Any, key: str) -> Any:
+        if isinstance(value, Mapping):
+            return value.get(key)
+        result = getattr(value, key, None)
+        raw = getattr(value, "raw", None)
+        return raw.get(key) if result is None and isinstance(raw, Mapping) else result
+
+    appointment_id = read(record, "appointment_id") or read(record, "latest_appointment_id")
+    rows = read(record, "appointments")
+    if isinstance(rows, (list, tuple)) and rows:
+        if appointment_id:
+            for row in rows:
+                if str(read(row, "id")) == str(appointment_id):
+                    return read(row, "appointment_type")
+        elif len(rows) == 1:
+            return read(rows[0], "appointment_type")
+        else:
+            return "unknown"
+    for key in ("appointment_type", "latest_appointment_type"):
+        value = read(record, key)
+        if value is not None and value != "":
+            return value
+    for key in ("appointment", "latest_appointment"):
+        nested = read(record, key)
+        if nested is not None:
+            return read(nested, "appointment_type")
+    return None

app/src/doctor_workstation/services/mock_repository.py

@@ -3022,7 +3022,7 @@ class DemoDoctorRepository:
             raise ValueError("order_no is required")
         return {"qrcode_url": f"https://demo.invalid/qrcode/order/{clean}.png"}
 
-    def get_call_ticket(self, patient_id: int, diagnosis_id: int) -> CallTicket:
+    def get_call_ticket(self, patient_id: int, diagnosis_id: int, *, appointment_id: int = 0) -> CallTicket:
         """Return non-production placeholder credentials for UI demonstration."""
 
         with self._lock:
@@ -3036,21 +3036,22 @@ class DemoDoctorRepository:
                 assistant_id="assistant_2001",
                 diagnosis_id=diagnosis_id,
                 is_lochost_vod=False,
-                raw={"demo": True},
+                raw={"demo": True, "appointment_id": appointment_id},
             )
 
     def start_call(
-        self, diagnosis_id: int, patient_id: int, *, call_type: int = 2
+        self, diagnosis_id: int, patient_id: int, *, call_type: int = 2, appointment_id: int = 0
     ) -> dict[str, Any]:
         """Create a mutable demo call record."""
 
         with self._lock:
-            self.get_call_ticket(patient_id, diagnosis_id)
+            self.get_call_ticket(patient_id, diagnosis_id, appointment_id=appointment_id)
             record = {
                 "id": self._next_call_id,
                 "diagnosis_id": diagnosis_id,
                 "patient_id": patient_id,
-                "call_type": call_type,
+                "call_type": call_type,
+                "appointment_id": appointment_id,
                 "status": "ringing",
                 "room_id": "",
             }

app/src/doctor_workstation/services/repository.py

@@ -712,10 +712,10 @@ class DoctorRepository(Protocol):
     def generate_order_qrcode(self, order_no: str) -> dict[str, Any]:
         """Generate the payment mini-program QR code for a generic order."""
 
-    def get_call_ticket(self, patient_id: int, diagnosis_id: int) -> CallTicket:
+    def get_call_ticket(self, patient_id: int, diagnosis_id: int, *, appointment_id: int = 0) -> CallTicket:
         """Return short-lived call credentials."""
 
-    def start_call(self, diagnosis_id: int, patient_id: int, *, call_type: int = 2) -> Any:
+    def start_call(self, diagnosis_id: int, patient_id: int, *, call_type: int = 2, appointment_id: int = 0) -> Any:
         """Create a call record."""
 
     def end_call(
@@ -2629,22 +2629,51 @@ class RemoteDoctorRepository:
             )
         return result
 
-    def get_call_ticket(self, patient_id: int, diagnosis_id: int) -> CallTicket:
+    def get_call_ticket(self, patient_id: int, diagnosis_id: int, *, appointment_id: int = 0) -> CallTicket:
         """Obtain short-lived Tencent credentials for a consultation call."""
 
-        result = _require_mapping(
-            self.client.post(
-                "tcm.diagnosis/getCallSignature",
-                {"patient_id": patient_id, "diagnosis_id": diagnosis_id},
+        result = _require_mapping(
+            self.client.post(
+                "tcm.diagnosis/getCallSignature",
+                {"patient_id": patient_id, "diagnosis_id": diagnosis_id, "appointment_id": appointment_id},
             ),
-            "tcm.diagnosis/getCallSignature",
-        )
-        ticket = CallTicket.from_dict(result)
+            "tcm.diagnosis/getCallSignature",
+        )
+        policy_fields = {
+            "appointment_id", "appointmentId", "appointment_type", "appointment_type_desc",
+            "can_video_call", "can_audio_call", "call_disabled_reason",
+        }
+        if appointment_id > 0 and not policy_fields.intersection(result):
+            # Older signature endpoints authenticate the patient/diagnosis but
+            # do not echo the appointment. Keep the requested chat context;
+            # never treat it as server authorization for an audio/video call.
+            if (
+                str(result.get("diagnosis_id", "")).strip() != str(diagnosis_id)
+                or str(result.get("patient_id", "")).strip() != str(patient_id)
+                or result.get("patientUserId") != f"patient_{patient_id}"
+            ):
+                raise ValueError("聊天凭证与当前患者或诊单不匹配，请重新打开聊天窗口。")
+            result = dict(result)
+            result.update(
+                appointment_id=appointment_id,
+                can_video_call=False,
+                can_audio_call=False,
+                call_disabled_reason="暂未获取到本次挂号的通话权限，仍可图文聊天",
+            )
+        if appointment_id > 0:
+            returned_id = result.get("appointment_id")
+            if (
+                isinstance(returned_id, bool)
+                or not isinstance(returned_id, (int, str))
+                or str(returned_id).strip() != str(appointment_id)
+            ):
+                raise ValueError("通话凭证与本次挂号不匹配，请重新打开聊天窗口。")
+        ticket = CallTicket.from_dict(result)
         if ticket.diagnosis_id is None:
             ticket.diagnosis_id = diagnosis_id
         return ticket
 
-    def start_call(self, diagnosis_id: int, patient_id: int, *, call_type: int = 2) -> Any:
+    def start_call(self, diagnosis_id: int, patient_id: int, *, call_type: int = 2, appointment_id: int = 0) -> Any:
         """Create the server-side call record before ringing participants."""
 
         payload = self.client.post(
@@ -2652,7 +2681,8 @@ class RemoteDoctorRepository:
             {
                 "diagnosis_id": diagnosis_id,
                 "patient_id": patient_id,
-                "call_type": call_type,
+                "call_type": call_type,
+                "appointment_id": appointment_id,
             },
         )
         if not isinstance(payload, Mapping):

app/src/doctor_workstation/ui/appointment_drawer.py

@@ -42,7 +42,8 @@ from PySide6.QtWidgets import (
     QWidget,
 )
 
-from .widgets import (
+from ..core.appointment_modes import APPOINTMENT_MODES
+from .widgets import (
     display_text,
     first_value,
     friendly_error,
@@ -972,13 +973,24 @@ class AppointmentDrawer(QDialog):
         type_container = QWidget()
         type_layout = QHBoxLayout(type_container)
         type_layout.setContentsMargins(0, 0, 0, 0)
-        self.appointment_type_radio = QRadioButton("视频问诊")
-        self.appointment_type_radio.setChecked(True)
-        type_layout.addWidget(self.appointment_type_radio)
+        self.appointment_type_radio = QRadioButton("视频问诊")
+        self.appointment_type_radio.setChecked(True)
+        type_layout.addWidget(self.appointment_type_radio)
+        self.text_appointment_type_radio = QRadioButton("图文问诊")
+        type_layout.addWidget(self.text_appointment_type_radio)
+        self.appointment_type_group = QButtonGroup(self)
+        self.appointment_type_group.addButton(self.appointment_type_radio, 0)
+        self.appointment_type_group.addButton(self.text_appointment_type_radio, 1)
         type_layout.addStretch(1)
         self._add_form_row("预约类型:", type_container)
         self.appointment_type = QComboBox(self)
-        self.appointment_type.addItem("视频问诊", "video")
+        for label, value in APPOINTMENT_MODES:
+            self.appointment_type.addItem(label, value)
+        self.appointment_type_group.idClicked.connect(self.appointment_type.setCurrentIndex)
+        self.appointment_type.currentIndexChanged.connect(
+            lambda index: self.appointment_type_group.button(index).setChecked(True)
+            if self.appointment_type_group.button(index) is not None else None
+        )
         self.appointment_type.hide()
 
         patient_container = QWidget()

app/src/doctor_workstation/ui/diagnosis_index_widgets.py

@@ -26,9 +26,9 @@ from PySide6.QtCore import (
 )
 from PySide6.QtGui import (
     QAction,
-    QColor,
-    QFont,
-    QFontMetrics,
+    QColor,
+    QFont,
+    QFontMetrics,
     QIcon,
     QLinearGradient,
     QMouseEvent,
@@ -61,8 +61,13 @@ from PySide6.QtWidgets import (
     QWidgetItem,
 )
 
-from . import icons
-from .reception_style import TECH_BLUE, body_family, heading_family
+from ..core.appointment_modes import (
+    appointment_type_description,
+    appointment_type_value,
+    can_appointment_video,
+)
+from . import icons
+from .reception_style import TECH_BLUE, body_family, heading_family
 from .widgets import display_text, first_value, gender_text, get_value
 
 PRIMARY = QColor("#4F63D9")
@@ -112,7 +117,7 @@ def _blue_appointment_text(record: Any, appointment: Any) -> tuple[str, str]:
     This returns display strings without mutating either repository record.
     """
 
-    current_id = _as_int(first_value(record, "appointment_id", default=0))
+    current_id = _as_int(first_value(record, "appointment_id", "latest_appointment_id", default=0))
     appointment_id = _as_int(first_value(appointment, "id", "appointment_id", default=0))
     current = current_id > 0 and appointment_id == current_id
     doctor = first_value(appointment, "doctor_name", "appointment_doctor_name")
@@ -130,6 +135,11 @@ def _blue_appointment_text(record: Any, appointment: Any) -> tuple[str, str]:
     when = time_text if date_text and date_text in time_text else " ".join(
         part for part in (date_text, time_text) if part
     )
+    mode = appointment_type_value(appointment)
+    if current and get_value(appointment, "appointment_type", None) is None:
+        mode = appointment_type_value(record)
+    if appointment_id > 0:
+        when = f"{when} · {appointment_type_description(mode)}"
     return display_text(doctor, "—"), when
 
 
@@ -297,7 +307,8 @@ def _appointments(record: Any) -> list[Any]:
     return [
         {
             "id": first_value(record, "appointment_id"),
-            "status": first_value(record, "appointment_status"),
+            "status": first_value(record, "appointment_status"),
+            "appointment_type": appointment_type_value(record),
             "doctor_name": first_value(
                 record, "appointment_doctor_name", "doctor_name", default=""
             ),
@@ -392,7 +403,8 @@ def _video_ids_complete(record: Any) -> bool:
     appointment_id = _as_int(
         first_value(
             record,
-            "appointment_id",
+            "appointment_id",
+            "latest_appointment_id",
             default=first_value(
                 _appointments(record)[0] if _appointments(record) else None,
                 "id",
@@ -770,7 +782,8 @@ class DiagnosisTableModel(QAbstractTableModel):
                     part
                     for part in (
                         display_text(first_value(apt, "doctor_name"), "-"),
-                        display_text(first_value(apt, "time_text", "appointment_time"), "-"),
+                        display_text(first_value(apt, "time_text", "appointment_time"), "-"),
+                        appointment_type_description(appointment_type_value(apt)),
                     )
                     if part
                 )
@@ -1776,12 +1789,14 @@ class DiagnosisTableHost(QFrame):
         layout.setAlignment(Qt.AlignmentFlag.AlignCenter)
         video_capable = self.action_policy.get("video_call", False)
         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")
+        is_text = appointment_type_value(record) == "text"
+        if video_capable and _appointment_active(record) and (is_text or call_state == "live"):
+            button = QToolButton(host)
+            button.setText("图文沟通" if is_text else "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.setToolTip("发送文字、图片和文件；不支持音视频通话" if is_text
+                              else "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")
@@ -1900,7 +1915,8 @@ class DiagnosisTableHost(QFrame):
                         "cancel_assign", item
                     ),
                 )
-        if self.action_policy.get("video_qr", False) and _appointment_active(record):
+        if (self.action_policy.get("video_qr", False) and _appointment_active(record)
+                and can_appointment_video(appointment_type_value(record))):
             _add_menu_action(
                 menu,
                 "视频二维码",

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

@@ -33,6 +33,7 @@ from PySide6.QtWidgets import (
     QWidget,
 )
 
+from ...core.appointment_modes import appointment_type_description, appointment_type_value
 from ..diagnosis_drawer import (
     DIAGNOSIS_QSS,
     CaseGrid,
@@ -3589,7 +3590,7 @@ class DiagnosisDialog(QDialog):
                 first_value(row, "assistant_name"),
                 first_value(row, "appointment_date"),
                 first_value(row, "appointment_time", "period"),
-                first_value(row, "appointment_type_text", "appointment_type"),
+                appointment_type_description(appointment_type_value(row)),
                 " / ".join(
                     part
                     for part in (

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

@@ -10,7 +10,7 @@ from types import MappingProxyType
 from typing import Any
 
 from PySide6.QtCore import QDate, Qt, QTimer, QUrl, Signal
-from PySide6.QtGui import QBrush, QColor, QDesktopServices, QFont, QPixmap
+from PySide6.QtGui import QBrush, QColor, QDesktopServices, QFont, QPixmap
 from PySide6.QtWidgets import (
     QAbstractItemView,
     QButtonGroup,
@@ -36,8 +36,13 @@ from PySide6.QtWidgets import (
     QWidget,
 )
 
-from ..appointments_style import appointments_stylesheet
-from ..dialogs import DiagnosisDialog
+from ...core.appointment_modes import (
+    appointment_type_description,
+    appointment_type_value,
+    can_appointment_video,
+)
+from ..appointments_style import appointments_stylesheet
+from ..dialogs import DiagnosisDialog
 from ..dialogs.ai_consult import can_open_ai_consult, present_ai_consult
 from ..dialogs.prescription import (
     PrescriptionDetailDialog,
@@ -49,11 +54,11 @@ from ..dialogs.prescription_ai import (
     can_open_diagnosis_ai_report,
     present_diagnosis_ai_report,
 )
-from ..filter_disclosure import FilterDisclosure
-from ..icons import icon
-from ..infinite_list import InfiniteList
-from ..reception_style import heading_family
-from ..theme import mark_business_dialog
+from ..filter_disclosure import FilterDisclosure
+from ..icons import icon
+from ..infinite_list import InfiniteList
+from ..reception_style import heading_family
+from ..theme import mark_business_dialog
 from ..widgets import (
     MessageBanner,
     PageHeader,
@@ -312,7 +317,8 @@ def _appointment_info_cell(_value: Any, row: Any) -> str:
     channel = display_text(
         first_value(row, "channel_name", "channel_source_name", "source_name"), "—"
     )
-    return f"{status}  {doctor}\n{date_text} {time_text}\n最近渠道：{channel}"
+    mode = appointment_type_description(appointment_type_value(row))
+    return f"{status}  {doctor}\n{date_text} {time_text} · {mode}\n最近渠道：{channel}"
 
 
 def _revisit_cell(_value: Any, row: Any) -> str:
@@ -1273,7 +1279,16 @@ class AppointmentsPage(QWidget):
                 host,
             )
             date_label.setProperty("tableAppointmentMeta", True)
-            layout.addWidget(date_label)
+            date_row = QHBoxLayout()
+            date_row.setContentsMargins(0, 0, 0, 0)
+            date_row.setSpacing(6)
+            date_row.addWidget(date_label)
+            mode_label = QLabel(appointment_type_description(appointment_type_value(row)), host)
+            mode_label.setObjectName("AppointmentModeLabel")
+            mode_label.setProperty("tableAppointmentMeta", True)
+            date_row.addWidget(mode_label)
+            date_row.addStretch(1)
+            layout.addLayout(date_row)
             channel = display_text(
                 first_value(row, "channel_name", "channel_source_name", "source_name"),
                 "—",
@@ -1310,7 +1325,8 @@ class AppointmentsPage(QWidget):
             layout.setContentsMargins(5, 0, 5, 0)
             layout.setAlignment(Qt.AlignmentFlag.AlignCenter)
 
-            button = QPushButton("IM 问诊", host)
+            is_text = appointment_type_value(row) == "text"
+            button = QPushButton("图文沟通" if is_text else "IM 问诊", host)
             button.setObjectName("AppointmentImConsultButton")
             button.setProperty("appointmentImAction", True)
             patient_name = display_text(first_value(row, "patient_name"), "患者")
@@ -1338,7 +1354,8 @@ class AppointmentsPage(QWidget):
             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"
+                tooltip = ("打开图文问诊，可发送文字、图片和文件；不支持音视频通话"
+                           if is_text else "打开患者 IM，可发送消息；通话能力由本次挂号决定")
             button.setToolTip(tooltip)
             button.clicked.connect(
                 lambda _checked=False, source=row: self._run_video_row_action(
@@ -1425,8 +1442,9 @@ class AppointmentsPage(QWidget):
         status = _status_value(row) if has_row else 0
         not_completed = has_row and status != 3
         self.edit_button.setEnabled(has_row and _diagnosis_id(row) > 0)
-        self.qr_button.setEnabled(
-            not_completed
+        self.qr_button.setEnabled(
+            not_completed
+            and can_appointment_video(appointment_type_value(row))
             and _video_patient_id(row) > 0
             and _as_int(first_value(row, "doctor_id", default=0)) > 0
         )
@@ -1448,8 +1466,9 @@ class AppointmentsPage(QWidget):
         )
         self.cancel_button.setEnabled(has_row and status == 1)
         self.toolbar_edit_button.setEnabled(has_row and _diagnosis_id(row) > 0)
-        self.toolbar_qr_button.setEnabled(
-            not_completed
+        self.toolbar_qr_button.setEnabled(
+            not_completed
+            and can_appointment_video(appointment_type_value(row))
             and _video_patient_id(row) > 0
             and _as_int(first_value(row, "doctor_id", default=0)) > 0
         )
@@ -1537,7 +1556,8 @@ class AppointmentsPage(QWidget):
         self.video_requested.emit(
             {
                 "source": "appointments",
-                "appointment_id": appointment_id,
+                "appointment_id": appointment_id,
+                "appointment_type": appointment_type_value(row),
                 "patient_id": patient_id,
                 "diagnosis_id": diagnosis_id,
                 "patient_name": first_value(row, "patient_name", default="患者"),
@@ -1559,9 +1579,12 @@ class AppointmentsPage(QWidget):
         if not all(callable(getattr(self.repository, name, None)) for name in required_methods):
             show_toast(self, "当前仓库未提供视频二维码能力。", "warning")
             return
-        row = self._current_row()
-        if row is None or _status_value(row) == 3:
-            return
+        row = self._current_row()
+        if row is None or _status_value(row) == 3:
+            return
+        if not can_appointment_video(appointment_type_value(row)):
+            show_toast(self, "本次挂号不支持视频问诊二维码。", "warning")
+            return
         diagnosis_id = _diagnosis_id(row)
         patient_id = _video_patient_id(row)
         doctor_id = _as_int(first_value(row, "doctor_id", default=0))
@@ -2214,7 +2237,7 @@ class AppointmentsPage(QWidget):
                     ("时段", period_text),
                     (
                         "预约类型",
-                        first_value(detail, "appointment_type_desc", "appointment_type_text"),
+                        appointment_type_description(appointment_type_value(detail)),
                     ),
                 ],
             ),

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

@@ -38,7 +38,8 @@ from PySide6.QtWidgets import (
     QWidget,
 )
 
-from .. import icons
+from ...core.appointment_modes import appointment_type_value, can_appointment_video
+from .. import icons
 from ..consultations_style import consultations_stylesheet
 from ..diagnosis_index_widgets import (
     DiagnosisChip,
@@ -226,7 +227,7 @@ def _appointment_status(record: Any) -> Any:
 
 
 def _appointment_id(record: Any) -> int:
-    value = first_value(record, "appointment_id", default=None)
+    value = first_value(record, "appointment_id", "latest_appointment_id", default=None)
     if value is None:
         value = first_value(get_value(record, "latest_appointment", None), "id", default=None)
     if value is None:
@@ -289,7 +290,8 @@ def _video_payload(record: Any) -> dict[str, Any]:
 
     return {
         "source": "consultations",
-        "appointment_id": _appointment_id(record),
+        "appointment_id": _appointment_id(record),
+        "appointment_type": appointment_type_value(record),
         "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"),
@@ -2655,7 +2657,11 @@ class ConsultationsPage(QWidget):
             or ""
         ).strip()
 
-    def _request_video_qr(self) -> None:
+    def _request_video_qr(self) -> None:
+        record = self.table.current_data()
+        if record is not None and not can_appointment_video(appointment_type_value(record)):
+            show_toast(self, "本次挂号不支持视频问诊二维码。", "warning")
+            return
         self._request_qr(
             capability="video_qr",
             permission="tcm.diagnosis/videoQr",
@@ -3050,11 +3056,11 @@ class ConsultationsPage(QWidget):
         self.video_button.setEnabled(
             has_record
             and is_video_available(record)
-            and video_call_is_live(record)
+            and (appointment_type_value(record) == "text" or video_call_is_live(record))
             and valid_ids
         )
         self.call_toolbar_button.setEnabled(self.video_button.isEnabled())
-        self.video_qr_toolbar_button.setEnabled(has_record)
+        self.video_qr_toolbar_button.setEnabled(has_record and can_appointment_video(appointment_type_value(record)))
         self.complete_toolbar_button.setEnabled(has_record)
         self.case_toolbar_button.setEnabled(has_record)
         self.prescription_toolbar_button.setEnabled(has_record and not self._prescription_busy)
@@ -3498,7 +3504,7 @@ 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):
+        if appointment_type_value(record) != "text" and 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)

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

@@ -43,13 +43,18 @@ from PySide6.QtWidgets import (
     QWidget,
 )
 
+from ...core.appointment_modes import (
+    APPOINTMENT_MODES,
+    appointment_type_description,
+    appointment_type_value,
+)
 from .. import icons
 from ..appointment_drawer import AppointmentDrawer
 from ..dialogs import DiagnosisDialog, present_ai_consult, present_order_detail
 from ..dialogs.ai_consult import can_open_ai_consult
-from ..dialogs.prescription import PrescriptionOrderListDialog
-from ..filter_disclosure import FilterDisclosure
-from ..infinite_list import InfiniteList
+from ..dialogs.prescription import PrescriptionOrderListDialog
+from ..filter_disclosure import FilterDisclosure
+from ..infinite_list import InfiniteList
 from ..patient_orders_style import patient_orders_stylesheet
 from ..patient_progress_style import patient_progress_stylesheet
 from ..patients_style import patient_list_stylesheet, patients_chrome_stylesheet
@@ -499,7 +504,8 @@ class _LegacyAppointmentDialog(QDialog):
         form = QFormLayout()
         form.setVerticalSpacing(10)
         self.appointment_type = QComboBox()
-        self.appointment_type.addItem("视频问诊", "video")
+        for label, value in APPOINTMENT_MODES:
+            self.appointment_type.addItem(label, value)
         form.addRow("预约类型 *", self.appointment_type)
         self.channel_source = QComboBox()
         self.channel_source.addItem("正在加载渠道…", "")
@@ -1367,12 +1373,14 @@ class _PatientInfoDelegate(QStyledItemDelegate):
                 painter.setBrush(QColor(fill))
                 painter.drawRoundedRect(badge, 3, 3)
                 draw(status, badge.toRect(), color, True)
-        elif index.column() == 4:
-            value = display_text(first_value(row, "appointment_time_text"))
-            date_text, separator, time_text = value.partition(" ")
-            if separator and time_text:
-                draw(date_text, top)
-                draw(time_text, bottom)
+        elif index.column() == 4:
+            value = display_text(first_value(row, "appointment_time_text"))
+            date_text, separator, time_text = value.partition(" ")
+            if separator and time_text:
+                draw(date_text, top)
+                has_appointment = _as_int(first_value(row, "appointment_id", default=0)) > 0
+                mode = appointment_type_description(appointment_type_value(row)) if has_appointment else ""
+                draw(f"{time_text} · {mode}" if mode else time_text, bottom)
             else:
                 draw(value, rect)
         else:
@@ -3005,7 +3013,7 @@ class PatientProgressWorkspace(QWidget):
                     "appointment_time",
                     "预约时间",
                     95,
-                    lambda value, _row: display_text(value)[:5],
+                    lambda value, row: f"{display_text(value)[:5]} · {appointment_type_description(appointment_type_value(row))}",
                 ),
                 TableColumn(
                     "ahead_count",

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

@@ -73,6 +73,7 @@ from PySide6.QtWidgets import (
     QWidget,
 )
 
+from ...core.appointment_modes import appointment_type_description, appointment_type_value
 from .. import icons
 from ..diagnosis_drawer import DailyRecordPanel
 from ..diagnosis_editors import FlowLayout
@@ -7824,6 +7825,7 @@ class ReceptionPage(QWidget):
         meta_parts = [f"{gender} · {display_text(age)}岁", phone]
         if visit_id not in (None, ""):
             meta_parts.append(f"就诊号：{display_text(visit_id)}")
+        meta_parts.append(appointment_type_description(appointment_type_value(appointment)))
         self.patient_meta_label.setText("   |   ".join(meta_parts))
         self.patient_meta_label.setToolTip(" · ".join(condition_parts))
         status_number = (
@@ -7866,15 +7868,7 @@ class ReceptionPage(QWidget):
             display_text(first_value(appointment, "assistant_name"))
         )
         self.appointment_labels["type"].setText(
-            display_text(
-                first_value(
-                    appointment,
-                    "appointment_type_text",
-                    "type_text",
-                    "appointment_type",
-                    "type",
-                )
-            )
+            appointment_type_description(appointment_type_value(appointment))
         )
         self.appointment_labels["channel"].setText(
             display_text(
@@ -8928,6 +8922,12 @@ class ReceptionPage(QWidget):
         self.video_button.setEnabled(
             appointment_id is not None and diagnosis_id is not None and patient_id is not None
         )
+        is_text = appointment_type_value(appointment) == "text"
+        self.video_button.setText("图文沟通" if is_text else "IM 问诊")
+        self.video_button.setToolTip(
+            "发送文字、图片和文件；图文问诊不支持音视频通话" if is_text
+            else "打开患者 IM，会话通话能力由本次挂号决定"
+        )
         self.edit_button.setEnabled(diagnosis_id is not None)
         report_enabled = (
             self._can_ai_report
@@ -9684,6 +9684,7 @@ class ReceptionPage(QWidget):
         payload = {
             "source": "reception",
             "appointment_id": appointment_id,
+            "appointment_type": appointment_type_value(appointment),
             "patient_id": patient_id,
             "diagnosis_id": diagnosis_id,
             "patient_name": first_value(

app/src/doctor_workstation/video/launcher.py

@@ -85,6 +85,18 @@ def _normalized_key(key: Any) -> str:
     return "".join(character for character in str(key).lower() if character.isalnum())
 
 
+def _appointment_id(value: Any) -> int:
+    if value is None:
+        return 0
+    try:
+        parsed = int(value)
+    except (TypeError, ValueError) as exc:
+        raise VideoTicketError("appointment_id must be a nonnegative integer") from exc
+    if isinstance(value, bool) or parsed < 0 or str(value) != str(parsed):
+        raise VideoTicketError("appointment_id must be a nonnegative integer")
+    return parsed
+
+
 _FORBIDDEN_SECRET_KEYS = {"sdksecret", "sdksecretkey", "secretkey"}
 
 
@@ -138,7 +150,8 @@ def _ticket_mapping(ticket: Any) -> Mapping[str, Any]:
         if hasattr(ticket, attribute_name)
     }
     if adapted:
-        return adapted
+        # Preserve server policy and identities; model attributes alone omit them.
+        return {**(dict(raw) if isinstance(raw, Mapping) else {}), **adapted}
     raise VideoTicketError("backend ticket must be a mapping or call-ticket object")
 
 
@@ -199,8 +212,15 @@ class VideoCallRequest:
     patient_id: Identifier | None = None
     call_record_id: Identifier | None = None
     backend_mode: BackendMode = BackendMode.EMBEDDED
+    appointment_id: int = 0
+    appointment_type: Any = None
+    appointment_type_desc: str = ""
+    can_video_call: bool = False
+    can_audio_call: bool = False
+    call_disabled_reason: str = ""
 
     def __post_init__(self) -> None:
+        object.__setattr__(self, "appointment_id", _appointment_id(self.appointment_id))
         object.__setattr__(self, "sdk_app_id", _sdk_app_id(self.sdk_app_id))
         object.__setattr__(self, "user_id", _non_empty_string(self.user_id, "userID"))
         object.__setattr__(self, "user_sig", _non_empty_string(self.user_sig, "userSig"))
@@ -257,6 +277,13 @@ class VideoCallRequest:
             "userSig": self.user_sig,
             "targetUserId": self.target_user_id,
             "diagnosisId": self.diagnosis_id,
+            "patientId": self.patient_id,
+            "appointmentId": self.appointment_id,
+            "appointment_type": self.appointment_type,
+            "appointment_type_desc": self.appointment_type_desc,
+            "can_video_call": self.can_video_call is True,
+            "can_audio_call": self.can_audio_call is True,
+            "call_disabled_reason": self.call_disabled_reason,
         }
 
     def safe_log_context(self) -> dict[str, Any]:
@@ -340,6 +367,12 @@ def normalize_backend_ticket(
         diagnosis_id=normalized_diagnosis,
         patient_id=normalized_patient,
         call_record_id=payload_call_record,
+        appointment_id=_appointment_id(payload.get("appointment_id", 0)),
+        appointment_type=payload.get("appointment_type"),
+        appointment_type_desc=str(payload.get("appointment_type_desc") or ""),
+        can_video_call=payload.get("can_video_call") is True,
+        can_audio_call=payload.get("can_audio_call") is True,
+        call_disabled_reason=str(payload.get("call_disabled_reason") or ""),
         backend_mode=BackendMode.parse(backend_mode),
     )
 

app/src/doctor_workstation/video/lifecycle.py

@@ -18,7 +18,7 @@ from dataclasses import dataclass
 from pathlib import Path
 from typing import Any, TypeVar
 
-from .launcher import VideoCallRequest
+from .launcher import VideoCallRequest, normalize_backend_ticket
 
 ResultT = TypeVar("ResultT")
 
@@ -288,7 +288,29 @@ class OrderedCallLifecycle:
         with self._lock:
             return self.bound_room_id or self._claimed_room_id
 
-    def start(self) -> Future[bool]:
+    def refresh_call_policy(self) -> Future[dict[str, Any]]:
+        """Fetch policy for this exact immutable consultation on the worker."""
+        def operation() -> dict[str, Any]:
+            ticket = self.repository.get_call_ticket(
+                patient_id=self.request.patient_id,
+                diagnosis_id=self.request.diagnosis_id,
+                appointment_id=self.request.appointment_id,
+            )
+            refreshed = normalize_backend_ticket(
+                ticket, patient_id=self.request.patient_id,
+                diagnosis_id=self.request.diagnosis_id,
+            )
+            if (refreshed.appointment_id != self.request.appointment_id
+                    or refreshed.target_user_id != self.request.target_user_id
+                    or refreshed.user_id != self.request.user_id
+                    or refreshed.sdk_app_id != self.request.sdk_app_id):
+                raise ValueError("当前问诊已变更，请重新打开聊天窗口")
+            return refreshed.to_web_config()
+        return self._worker.submit("refresh_policy", operation)
+
+    def start(self, *, call_type: int = 2) -> Future[bool]:
+        if type(call_type) is not int or call_type not in (1, 2):
+            raise ValueError("call_type must be 1 or 2")
         with self._lock:
             if self._start_future is not None:
                 return self._start_future
@@ -297,7 +319,8 @@ class OrderedCallLifecycle:
                 raise ValueError("video repository does not implement start_call")
             payload: dict[str, Any] = {
                 "diagnosis_id": self.request.diagnosis_id,
-                "call_type": 2,
+                "call_type": call_type,
+                "appointment_id": self.request.appointment_id,
             }
             if self.request.patient_id is not None:
                 payload["patient_id"] = self.request.patient_id

app/src/doctor_workstation/video/window.py

@@ -279,6 +279,7 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
         call_ended = Signal(str)  # type: ignore[misc]
         call_error = Signal(str)  # type: ignore[misc]
         _start_completed = Signal(bool)  # type: ignore[misc]
+        _policy_completed = Signal(str, object)  # 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]
@@ -369,6 +370,7 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
             self._connect_permissions()
 
             self._start_completed.connect(self._on_lifecycle_started)
+            self._policy_completed.connect(self._on_policy_completed)
             self._room_completed.connect(self._on_room_completed)
             self._screenshot_completed.connect(self._on_screenshot_completed)
             self._transcription_completed.connect(self._on_transcription_completed)
@@ -509,7 +511,10 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
                     QTimer.singleShot(0, self._open_diagnosis_safely)
                 return
             if event == "call-start-request":
-                self._start_call_cycle()
+                self._start_call_cycle(call_type=message.get("callType", 2))
+                return
+            if event == "call-policy-request":
+                self._refresh_call_policy(str(message.get("requestId") or ""))
                 return
             if event == "screenshot":
                 self._save_screenshot(str(message.get("dataUrl") or ""))
@@ -934,16 +939,48 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
                 "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
+        def _prepare_call_cycle(self) -> None:
             if self._call_cycle_closed:
                 self.lifecycle = self._lifecycle_factory()
                 self._lifecycles.append(self.lifecycle)
                 self._call_cycle_closed = False
+
+        def _refresh_call_policy(self, request_id: str) -> None:
+            if not request_id or self._closing or self._shutdown_requested:
+                return
+            self._prepare_call_cycle()
+            def completed(future: Future[dict[str, Any]]) -> None:
+                try:
+                    policy = future.result()
+                except Exception:
+                    policy = {"call_disabled_reason": "无法确认本次挂号通话权限，请重新打开聊天窗口"}
+                with suppress(RuntimeError):
+                    self._policy_completed.emit(request_id, policy)
+            try:
+                self.lifecycle.refresh_call_policy().add_done_callback(completed)
+            except Exception:
+                self._on_policy_completed(request_id, {})
+
+        def _on_policy_completed(self, request_id: str, policy: dict[str, Any]) -> None:
+            if self._closing or self._shutdown_requested or self._released:
+                return
+            # Send policy only; refreshed credentials never enter logs or notices.
+            payload = {key: policy.get(key) for key in (
+                "appointmentId", "appointment_type", "can_video_call", "can_audio_call",
+                "call_disabled_reason", "appointment_type_desc",
+            )}
+            self._page.runJavaScript(
+                "window.doctorConsultation?.callPolicyResult?.("
+                + json.dumps(request_id) + "," + json.dumps(payload, ensure_ascii=True) + ");"
+            )
+
+        def _start_call_cycle(self, *, call_type: int = 2) -> None:
+            if self._closing or self._shutdown_requested or self._start_requested:
+                return
+            self._prepare_call_cycle()
             self._start_requested = True
             try:
-                future = self.lifecycle.start()
+                future = self.lifecycle.start(call_type=call_type)
             except Exception:
                 self._start_requested = False
                 self._on_lifecycle_started(False)
@@ -1149,8 +1186,8 @@ if WEBENGINE_AVAILABLE:  # pragma: no cover - GUI behavior needs an integration
             self._closing = True
             self._media_active = False
             self._shutdown_timer.stop()
-            if self._start_requested and not self._call_cycle_closed:
-                self.lifecycle.end(self._close_reason)
+            # Also retire policy-only workers for IM sessions without a live call.
+            self.lifecycle.end(self._close_reason)
             self._abort_local_audio_recording("")
             self._release_webengine()