diff --git a/IRaCIS.Core.Application/Service/Reading/Dto/ReadingMedicineQuestionViewModel.cs b/IRaCIS.Core.Application/Service/Reading/Dto/ReadingMedicineQuestionViewModel.cs
index 41b1d9fe7..0b049f669 100644
--- a/IRaCIS.Core.Application/Service/Reading/Dto/ReadingMedicineQuestionViewModel.cs
+++ b/IRaCIS.Core.Application/Service/Reading/Dto/ReadingMedicineQuestionViewModel.cs
@@ -1,6 +1,8 @@
 using System;
 using IRaCIS.Core.Domain.Share;
 using System.Collections.Generic;
+using System.ComponentModel.DataAnnotations;
+
 namespace IRaCIS.Core.Application.ViewModel
 {
 
@@ -65,6 +67,11 @@ namespace IRaCIS.Core.Application.ViewModel
 		public Guid Id { get; set; }
 
 		public string QuestionName { get; set; }
+
+		/// <summary>
+		/// 类型值
+		/// </summary>
+		public string TypeValue { get; set; }
 	}
 
 	public class AddTrialDataFromSystemInDto
@@ -74,6 +81,23 @@ namespace IRaCIS.Core.Application.ViewModel
 		public List<Guid> SystemQuestionIds { get; set; }
 	}
 
+	public class ConfirmReadingMedicineQuestionInDto
+    {
+		[NotDefault]
+		public Guid TrialId { get; set; }
+	}
+
+	public class TrialQuestion
+    {
+		public Guid Id { get; set; }
+
+		public int ShowOrder { get; set; }
+
+
+		public int? ParentShowOrder { get; set; }
+
+	}
+
 	/// <summary>
 	/// 获取项目的其他问题
 	/// </summary>
diff --git a/IRaCIS.Core.Application/Service/Reading/ReadingMedicineQuestionService.cs b/IRaCIS.Core.Application/Service/Reading/ReadingMedicineQuestionService.cs
index df81cfdb8..058198a8b 100644
--- a/IRaCIS.Core.Application/Service/Reading/ReadingMedicineQuestionService.cs
+++ b/IRaCIS.Core.Application/Service/Reading/ReadingMedicineQuestionService.cs
@@ -5,6 +5,7 @@ using IRaCIS.Core.Application.Interfaces;
 using IRaCIS.Core.Application.ViewModel;
 using IRaCIS.Core.Infra.EFCore.Common;
 using MassTransit;
+using IRaCIS.Core.Infrastructure;
 
 namespace IRaCIS.Core.Application.Service
 {	
@@ -16,14 +17,17 @@ namespace IRaCIS.Core.Application.Service
     {
 
 	    private readonly IRepository<ReadingMedicineTrialQuestion> _readingMedicineTrialQuestionRepository;
+        private readonly IRepository<Trial> _trialRepository;
         private readonly IRepository<ReadingMedicineSystemQuestion> _readingMedicineSystemQuestionRepository;
 
         public ReadingMedicineQuestionService(
 			IRepository<ReadingMedicineTrialQuestion> readingMedicineTrialQuestionRepository,
+			IRepository<Trial> trialRepository,
 			IRepository<ReadingMedicineSystemQuestion> readingMedicineSystemQuestionRepository
 			)
 		{
             this._readingMedicineTrialQuestionRepository = readingMedicineTrialQuestionRepository;
+            this._trialRepository = trialRepository;
             this._readingMedicineSystemQuestionRepository = readingMedicineSystemQuestionRepository;
         }
 
@@ -84,7 +88,7 @@ namespace IRaCIS.Core.Application.Service
 		/// <param name="inDto"></param>
 		/// <returns></returns>
 		[HttpPost]
-		public async Task<List<ReadingMedicineTrialQuestionView>>  GetReadingMedicineTrialQuestionList(ReadingMedicineTrialQuestionQuery inDto)
+		public async Task<(List<ReadingMedicineTrialQuestionView>,object)>  GetReadingMedicineTrialQuestionList(ReadingMedicineTrialQuestionQuery inDto)
 		{
 			var query = _readingMedicineTrialQuestionRepository.AsQueryable()
 				   .Where(x=>x.TrialId==inDto.TrialId)
@@ -93,7 +97,12 @@ namespace IRaCIS.Core.Application.Service
 				   .WhereIf(!inDto.QuestionName.IsNullOrEmpty(), x => x.QuestionName.Contains(inDto.QuestionName))
 				   .WhereIf(!inDto.Type.IsNullOrEmpty(), x => x.Type.Contains(inDto.Type))
 				   .ProjectTo<ReadingMedicineTrialQuestionView>(_mapper.ConfigurationProvider).OrderBy(x=>x.ShowOrder);
-			return await query.ToListAsync();
+
+
+			var isConfirmMedicineQuestion = await _trialRepository.Where(x => x.Id == inDto.TrialId).Select(x => x.IsConfirmMedicineQuestion).FirstOrDefaultAsync();
+			return ((await query.ToListAsync()), new {
+				IsConfirmMedicineQuestion= isConfirmMedicineQuestion
+			});
 		}
 
 		/// <summary>
@@ -131,6 +140,8 @@ namespace IRaCIS.Core.Application.Service
 				{
 					Id = x.Id,
 					QuestionName = x.QuestionName,
+					TypeValue=x.TypeValue,
+
 				}).ToListAsync();
 
 			return questionList;
@@ -180,16 +191,53 @@ namespace IRaCIS.Core.Application.Service
 		}
 
 
-		///// <summary>
-		///// 确认医学审核问题
-		///// </summary>
-		///// <returns></returns>
-		//public async Task<IResponseOutput> ConfirmReadingMedicineQuestion()
-		//{
-			
-		//}
+        /// <summary>
+        /// 确认医学审核问题
+        /// </summary>
+        /// <returns></returns>
+        public async Task<IResponseOutput> ConfirmReadingMedicineQuestion(ConfirmReadingMedicineQuestionInDto inDto)
+        {
+			var readingMedicineQuestionList = await _readingMedicineTrialQuestionRepository.Where(x => x.TrialId == inDto.TrialId)
+				.Select(x => new TrialQuestion() {
+					Id = x.Id,
+					ParentShowOrder = (int?)x.ParentQuestion.ShowOrder,
+
+				}).ToListAsync();					
+			if (readingMedicineQuestionList.Count == 0)
+			{
+				throw new BusinessValidationFailedException("当前未添加医学审核问题。请先添加医学审核问题，再进行确认。");
+			}
+
+			if (readingMedicineQuestionList.Count() != readingMedicineQuestionList.Select(t => t.ShowOrder).Distinct().Count())
+			{
+				throw new BusinessValidationFailedException("影像医学审核问题显示序号不能重复。");
+			}
+
+
+			if (readingMedicineQuestionList.Where(t => t.ParentShowOrder != null).Any(t => t.ParentShowOrder > t.ShowOrder))
+			{
+				throw new BusinessValidationFailedException("父问题的显示序号要比子问题的显示序号小，请确认。");
+			}
+
+
+			await _readingMedicineTrialQuestionRepository.BatchUpdateNoTrackingAsync(x => x.TrialId == inDto.TrialId, x => new ReadingMedicineTrialQuestion()
+			{
+				IsConfirm = true
+			});
+
+			await _trialRepository.UpdatePartialFromQueryAsync(inDto.TrialId, x => new Trial()
+			{
+				IsConfirmMedicineQuestion = true
+			});
+
+			var result = await _trialRepository.SaveChangesAsync();
+			return ResponseOutput.Result(result);
 
 
 
-	}
+		}
+
+
+
+    }
 } 
diff --git a/IRaCIS.Core.Domain/Reading/ReadingMedicineTrialQuestion.cs b/IRaCIS.Core.Domain/Reading/ReadingMedicineTrialQuestion.cs
index dfc4ec374..7e37c0585 100644
--- a/IRaCIS.Core.Domain/Reading/ReadingMedicineTrialQuestion.cs
+++ b/IRaCIS.Core.Domain/Reading/ReadingMedicineTrialQuestion.cs
@@ -85,8 +85,11 @@ namespace IRaCIS.Core.Domain.Models
         /// 是否确认
         /// </summary>
 		public bool? IsConfirm { get; set; }
-	 
-	 }
+
+		[ForeignKey("ParentId")]
+		public ReadingMedicineTrialQuestion ParentQuestion { get; set; }
+
+	}
 
 	 
 }	 
diff --git a/IRaCIS.Core.Domain/Trial/Trial.cs b/IRaCIS.Core.Domain/Trial/Trial.cs
index 18bf74e4c..016a09682 100644
--- a/IRaCIS.Core.Domain/Trial/Trial.cs
+++ b/IRaCIS.Core.Domain/Trial/Trial.cs
@@ -361,6 +361,12 @@ namespace IRaCIS.Core.Domain.Models
         /// </summary>
         public DateTime? SyncClinicalDataTime { get; set; }
 
+        /// <summary>
+        /// ��ȷ��ҽѧ�������
+        /// </summary>
+
+        public bool IsConfirmMedicineQuestion { get; set; } = false;
+
 
         //public Guid? ReviewTypeId { get; set; } = Guid.Empty;