diff --git a/apps/web-antd/src/store/prescription.ts b/apps/web-antd/src/store/prescription.ts
index 4fd8bf89..62e9a19d 100644
--- a/apps/web-antd/src/store/prescription.ts
+++ b/apps/web-antd/src/store/prescription.ts
@@ -1094,7 +1094,7 @@ export const usePrescriptionStore = defineStore('prescription', () => {
         },
         userStore.currentUser.doctor_id,
       );
-      // 在线复诊开方后自动连发购药指引与用药温馨提示
+      // 在线复诊开方后自动连发购药指引与用药温馨提示（小助手发送）
       const tipTexts = [
         '根据您的病情描述，已为您开具电子处方，请点击上方的‘立即支付’，进行购药;如有商品价格和订单等问题请咨询平台客服。',
         '温馨提示:用药前请详细阅读药品说明书，并严格按照线下医嘱用药。如用药过程中出现病情变化或其它不适症状，请立即停药并及时就医。(请您注意，如果您尚未在医院就诊或未曾使用过本次申请的药品，请暂时不要支付订单。我们建议您在医生的指导下使用药品，以确保用药安全。)',
@@ -1102,7 +1102,7 @@ export const usePrescriptionStore = defineStore('prescription', () => {
       tipTexts.forEach((tip, tipIdx) => {
         sendMessage({
           roomId: chatStore.currentFriend.room_id,
-          senderId: userStore.currentUser.doctor_id,
+          senderId: 'doctor_assistant',
           receiverId: chatStore.currentFriend.id,
           type: 'text',
           content: tip,
@@ -1111,7 +1111,7 @@ export const usePrescriptionStore = defineStore('prescription', () => {
           {
             id: `${Date.now()}_tip_${tipIdx}`,
             room_id: chatStore.currentFriend.room_id,
-            sender_user_id: `doctor-${userStore.currentUser.doctor_id}`,
+            sender_user_id: 'doctor_assistant',
             receiver_user_id: chatStore.currentFriend.id,
             message_type: 0,
             message_content: tip,
diff --git a/apps/web-antd/src/views/business/chat/components/FollowUpDrugAssistantCard.vue b/apps/web-antd/src/views/business/chat/components/FollowUpDrugAssistantCard.vue
index ac6daf77..abc921af 100644
--- a/apps/web-antd/src/views/business/chat/components/FollowUpDrugAssistantCard.vue
+++ b/apps/web-antd/src/views/business/chat/components/FollowUpDrugAssistantCard.vue
@@ -43,6 +43,14 @@ const answeredLabel = computed(() => {
   return '';
 });
 
+/** 是否就诊过：有明确 0/1 才展示 */
+const visitedLabel = computed(() => {
+  const v = data.value.has_visited;
+  if (v === 1 || v === '1') return '是';
+  if (v === 0 || v === '0') return '否';
+  return '';
+});
+
 const drugs = computed(() =>
   Array.isArray(data.value.drugs) ? data.value.drugs : [],
 );
@@ -98,6 +106,11 @@ const canShowAddBtn = computed(
       <span class="value">{{ answeredLabel }}</span>
     </div>
 
+    <div v-if="visitedLabel" class="answer-row">
+      <span class="label">是否就诊过</span>
+      <span class="value">{{ visitedLabel }}</span>
+    </div>
+
     <div v-if="illnessInfo" class="info-block">
       <div class="info-block-label">适用症/症状</div>
       <div class="info-block-content">{{ illnessInfo }}</div>
diff --git a/apps/web-antd/src/views/business/chat/components/MessageBubble.vue b/apps/web-antd/src/views/business/chat/components/MessageBubble.vue
index 71bbb95a..cc5930be 100644
--- a/apps/web-antd/src/views/business/chat/components/MessageBubble.vue
+++ b/apps/web-antd/src/views/business/chat/components/MessageBubble.vue
@@ -747,9 +747,13 @@ const getSexText = (sex) => {
             </div>
           </div>
 
-          <!-- 主诉 / 所选药品（逐药：缩略图 + 规格 + 数量，对齐小程序） -->
+          <!-- 主诉 / 适用症 / 所选药品（逐药：缩略图 + 规格 + 数量，对齐小程序） -->
           <div
-            v-if="registerCardDisplay.chief_complaint || registerCardDrugRows.length"
+            v-if="
+              registerCardDisplay.chief_complaint ||
+              registerCardDisplay.illnessInfo ||
+              registerCardDrugRows.length
+            "
             class="mt-3 space-y-2 rounded-lg border border-gray-100 p-3 text-sm dark:border-gray-600"
           >
             <div v-if="registerCardDisplay.chief_complaint">
@@ -758,6 +762,33 @@ const getSexText = (sex) => {
                 registerCardDisplay.chief_complaint
               }}</span>
             </div>
+            <div v-if="registerCardDisplay.illnessInfo">
+              <span class="font-medium text-gray-600 dark:text-gray-300">适用症/症状：</span>
+              <span class="text-gray-800 dark:text-gray-100">{{
+                registerCardDisplay.illnessInfo
+              }}</span>
+            </div>
+            <div
+              v-if="registerCardDisplay.illnessInfo"
+              class="flex flex-wrap gap-x-4 gap-y-1 text-gray-700 dark:text-gray-200"
+            >
+              <span>
+                是否就诊过：{{
+                  registerCardDisplay.has_visited === 1 ||
+                  registerCardDisplay.has_visited === '1'
+                    ? '是'
+                    : '否'
+                }}
+              </span>
+              <span>
+                是否使用过药品：{{
+                  registerCardDisplay.has_used_drug === 1 ||
+                  registerCardDisplay.has_used_drug === '1'
+                    ? '是'
+                    : '否'
+                }}
+              </span>
+            </div>
             <div v-if="registerCardDrugRows.length" class="space-y-2">
               <div class="font-medium text-gray-600 dark:text-gray-300">所选药品：</div>
               <div
diff --git a/apps/web-antd/src/views/business/chat/utils/request.ts b/apps/web-antd/src/views/business/chat/utils/request.ts
index e7cb1642..28425df0 100644
--- a/apps/web-antd/src/views/business/chat/utils/request.ts
+++ b/apps/web-antd/src/views/business/chat/utils/request.ts
@@ -134,9 +134,12 @@ export const sendMessage = (data) => {
   const receiverId = data.receiverId.toString();
   const normalizedReceiverId = receiverId.startsWith('user-') ? receiverId : `user-${receiverId}`;
   
-  // 确保 sender_user_id 有 doctor- 前缀（医生端）
+  // 确保 sender_user_id：小助手保持 doctor_assistant；医生端补 doctor- 前缀
   const senderId = data.senderId.toString();
-  const normalizedSenderId = senderId.startsWith('doctor-') ? senderId : `doctor-${senderId}`;
+  const normalizedSenderId =
+    senderId === 'doctor_assistant' || senderId.startsWith('doctor-')
+      ? senderId
+      : `doctor-${senderId}`;
   
   const requestData = {
     room_id: data.roomId,
diff --git a/apps/web-antd/src/views/doctor/online-consultation-clinic/components/PatientInfoPanel.vue b/apps/web-antd/src/views/doctor/online-consultation-clinic/components/PatientInfoPanel.vue
index 5af30c27..f65522b0 100644
--- a/apps/web-antd/src/views/doctor/online-consultation-clinic/components/PatientInfoPanel.vue
+++ b/apps/web-antd/src/views/doctor/online-consultation-clinic/components/PatientInfoPanel.vue
@@ -1,14 +1,15 @@
 <script setup>
 import { computed, ref, watch } from 'vue';
-import { Descriptions, Button, Empty, Image } from 'ant-design-vue';
+import { Descriptions, Button, Empty, Image, message } from 'ant-design-vue';
+import { useVbenModal } from '@vben/common-ui';
 import { getPatientDetail, reception } from '../api/index.ts';
-import { message } from 'ant-design-vue';
 import { sendMessage } from '#/views/business/chat/utils/request';
 import { useUserStore } from '#/views/business/chat/stores/user';
 import { getTransferPrescriptionByRegisterApi } from '#/views/business/chat/api/transferPrescription';
 import TransferPrescriptionCard from '#/views/doctor/online-consultation/components/TransferPrescriptionCard.vue';
 import SensitiveText from '#/components/sensitive-text/SensitiveText.vue';
 import { usePrescriptionStore } from '#/store/prescription';
+import RefusalOfTreatmentModal from '#/views/doctor/doctor-reception/components/RefusalOfTreatmentModal.vue';
 
 const userStore = useUserStore();
 const prescriptionStore = usePrescriptionStore();
@@ -24,7 +25,7 @@ const props = defineProps({
   }
 });
 
-const emit = defineEmits(['reception-success', 'enter-chat', 'refresh-list', 'transfer-import-success']);
+const emit = defineEmits(['reception-success', 'enter-chat', 'refresh-list', 'transfer-import-success', 'refuse-success']);
 
 const patientDetail = ref(null);
 const loading = ref(false);
@@ -32,6 +33,11 @@ const receptionLoading = ref(false);
 const transferPrescription = ref(null);
 const loadingTransfer = ref(false);
 
+/** 拒诊弹窗：复用接诊模块 RefusalOfTreatmentModal */
+const [RefusalOfTreatmentModals, RefusalOfTreatmentModalApi] = useVbenModal({
+  connectedComponent: RefusalOfTreatmentModal,
+});
+
 // 获取患者详情
 const fetchPatientDetail = async () => {
   // 至少需要 room_id 或 register_id 其中之一
@@ -106,6 +112,19 @@ const handleReception = async () => {
   }
 };
 
+/** 打开拒诊原因弹窗；成功后通知父页刷新列表并清空当前患者 */
+const handleRefuse = () => {
+  if (!props.patient?.register_id) {
+    message.error('缺少挂号ID');
+    return;
+  }
+  RefusalOfTreatmentModalApi.setData({
+    values: { register_id: props.patient.register_id },
+    getPatientListByReception: () => emit('refuse-success'),
+  });
+  RefusalOfTreatmentModalApi.open();
+};
+
 // 获取转诊信息
 const fetchTransferPrescription = async (registerId) => {
   if (!registerId) return;
@@ -330,23 +349,34 @@ watch(
         </div>
       </div>
 
-      <!-- 接诊按钮 -->
+      <!-- 接诊 / 拒诊：待接诊时并列展示，避免只能进聊天卡才能拒诊 -->
       <div v-if="!patientDetail.is_recepted" class="action-section border-t border-gray-200 dark:border-gray-700">
-        <Button
-          type="primary"
-          :loading="receptionLoading"
-          size="large"
-          block
-          @click="handleReception"
-        >
-          接诊
-        </Button>
+        <div class="action-row">
+          <Button
+            type="primary"
+            :loading="receptionLoading"
+            size="large"
+            class="action-btn"
+            @click="handleReception"
+          >
+            接诊
+          </Button>
+          <Button
+            danger
+            size="large"
+            class="action-btn"
+            @click="handleRefuse"
+          >
+            拒诊
+          </Button>
+        </div>
       </div>
 
       <div v-else class="recepted-info bg-green-50 dark:bg-green-900/20">
         <text class="recepted-text text-green-600 dark:text-green-400">已接诊</text>
       </div>
     </div>
+    <RefusalOfTreatmentModals />
   </div>
 </template>
 
@@ -505,6 +535,15 @@ watch(
   padding-top: 24px;
 }
 
+.action-row {
+  display: flex;
+  gap: 12px;
+}
+
+.action-btn {
+  flex: 1;
+}
+
 .recepted-info {
   margin-top: 24px;
   padding: 16px;
diff --git a/apps/web-antd/src/views/doctor/online-consultation-clinic/index.vue b/apps/web-antd/src/views/doctor/online-consultation-clinic/index.vue
index edd230aa..4498c1b4 100644
--- a/apps/web-antd/src/views/doctor/online-consultation-clinic/index.vue
+++ b/apps/web-antd/src/views/doctor/online-consultation-clinic/index.vue
@@ -227,6 +227,13 @@ const handleRefreshList = () => {
   patientListRef.value?.fetchPatientList();
 };
 
+/** 拒诊成功：刷新列表并清空当前选中，回到待选状态 */
+const handleRefuseSuccess = () => {
+  selectedPatient.value = null;
+  registerId.value = null;
+  patientListRef.value?.fetchPatientList();
+};
+
 // 结束接诊
 const handleEndConsultation = () => {
   if (!selectedPatient.value) {
@@ -517,6 +524,7 @@ const handleAddPatientProductsToPrescription = async () => {
             :patient="selectedPatient"
             :doctor-id="userStore.currentUser?.doctor_id"
             @reception-success="handleReceptionSuccess"
+            @refuse-success="handleRefuseSuccess"
             @enter-chat="handleEnterChat"
             @refresh-list="handleRefreshList"
             @transfer-import-success="handleTransferImportSuccess"
diff --git a/apps/web-antd/src/views/doctor/online-consultation/components/PatientInfoPanel.vue b/apps/web-antd/src/views/doctor/online-consultation/components/PatientInfoPanel.vue
index 878b5b01..d7c5f943 100644
--- a/apps/web-antd/src/views/doctor/online-consultation/components/PatientInfoPanel.vue
+++ b/apps/web-antd/src/views/doctor/online-consultation/components/PatientInfoPanel.vue
@@ -1,14 +1,15 @@
 <script setup>
 import { computed, ref, watch } from 'vue';
-import { Descriptions, Button, Empty, Image } from 'ant-design-vue';
+import { Descriptions, Button, Empty, Image, message } from 'ant-design-vue';
+import { useVbenModal } from '@vben/common-ui';
 import { getPatientDetail, reception } from '../api/index.ts';
-import { message } from 'ant-design-vue';
 import { sendMessage } from '#/views/business/chat/utils/request';
 import { useUserStore } from '#/views/business/chat/stores/user';
 import { getTransferPrescriptionByRegisterApi } from '#/views/business/chat/api/transferPrescription';
 import TransferPrescriptionCard from './TransferPrescriptionCard.vue';
 import SensitiveText from '#/components/sensitive-text/SensitiveText.vue';
 import { usePrescriptionStore } from '#/store/prescription';
+import RefusalOfTreatmentModal from '#/views/doctor/doctor-reception/components/RefusalOfTreatmentModal.vue';
 
 const userStore = useUserStore();
 const prescriptionStore = usePrescriptionStore();
@@ -24,7 +25,7 @@ const props = defineProps({
   }
 });
 
-const emit = defineEmits(['reception-success', 'enter-chat', 'transfer-import-success']);
+const emit = defineEmits(['reception-success', 'enter-chat', 'transfer-import-success', 'refuse-success']);
 
 const patientDetail = ref(null);
 const loading = ref(false);
@@ -32,6 +33,11 @@ const receptionLoading = ref(false);
 const transferPrescription = ref(null);
 const loadingTransfer = ref(false);
 
+/** 拒诊弹窗：复用接诊模块 RefusalOfTreatmentModal */
+const [RefusalOfTreatmentModals, RefusalOfTreatmentModalApi] = useVbenModal({
+  connectedComponent: RefusalOfTreatmentModal,
+});
+
 // 获取患者详情
 const fetchPatientDetail = async () => {
   // 至少需要 room_id 或 register_id 其中之一
@@ -132,6 +138,19 @@ const handleReception = async () => {
   }
 };
 
+/** 打开拒诊原因弹窗；成功后通知父页刷新列表并清空当前患者 */
+const handleRefuse = () => {
+  if (!props.patient?.register_id) {
+    message.error('缺少挂号ID');
+    return;
+  }
+  RefusalOfTreatmentModalApi.setData({
+    values: { register_id: props.patient.register_id },
+    getPatientListByReception: () => emit('refuse-success'),
+  });
+  RefusalOfTreatmentModalApi.open();
+};
+
 // 获取性别文本
 const getSexText = (sex) => {
   if (sex === 1) return '男';
@@ -330,23 +349,34 @@ watch(
         </div>
       </div>
 
-      <!-- 接诊按钮 -->
+      <!-- 接诊 / 拒诊：待接诊时并列展示，避免只能进聊天卡才能拒诊 -->
       <div v-if="!patientDetail.is_recepted" class="action-section border-t border-gray-200 dark:border-gray-700">
-        <Button
-          type="primary"
-          :loading="receptionLoading"
-          size="large"
-          block
-          @click="handleReception"
-        >
-          接诊
-        </Button>
+        <div class="action-row">
+          <Button
+            type="primary"
+            :loading="receptionLoading"
+            size="large"
+            class="action-btn"
+            @click="handleReception"
+          >
+            接诊
+          </Button>
+          <Button
+            danger
+            size="large"
+            class="action-btn"
+            @click="handleRefuse"
+          >
+            拒诊
+          </Button>
+        </div>
       </div>
 
       <div v-else class="recepted-info bg-green-50 dark:bg-green-900/20">
         <text class="recepted-text text-green-600 dark:text-green-400">已接诊</text>
       </div>
     </div>
+    <RefusalOfTreatmentModals />
   </div>
 </template>
 
@@ -504,6 +534,15 @@ watch(
   padding-top: 24px;
 }
 
+.action-row {
+  display: flex;
+  gap: 12px;
+}
+
+.action-btn {
+  flex: 1;
+}
+
 .recepted-info {
   margin-top: 24px;
   padding: 16px;
diff --git a/apps/web-antd/src/views/doctor/online-consultation/index.vue b/apps/web-antd/src/views/doctor/online-consultation/index.vue
index 3c96bdb4..26ff65ea 100644
--- a/apps/web-antd/src/views/doctor/online-consultation/index.vue
+++ b/apps/web-antd/src/views/doctor/online-consultation/index.vue
@@ -217,6 +217,13 @@ const handleReceptionSuccess = (patient) => {
   patientListRef.value?.fetchPatientList();
 };
 
+/** 拒诊成功：刷新列表并清空当前选中，回到待选状态 */
+const handleRefuseSuccess = () => {
+  selectedPatient.value = null;
+  registerId.value = null;
+  patientListRef.value?.fetchPatientList();
+};
+
 // 结束接诊
 const handleEndConsultation = () => {
   if (!selectedPatient.value) {
@@ -385,6 +392,7 @@ const handleAddPatientProductsToPrescription = async () => {
             :patient="selectedPatient"
             :doctor-id="userStore.currentUser?.doctor_id"
             @reception-success="handleReceptionSuccess"
+            @refuse-success="handleRefuseSuccess"
             @enter-chat="handleEnterChat"
             @transfer-import-success="handleTransferImportSuccess"
             class="patient-info-panel"