diff --git a/virtual-patient-manage/src/main/java/com/supervision/manage/pojo/vo/MedicalRecManageVO.java b/virtual-patient-manage/src/main/java/com/supervision/manage/pojo/vo/MedicalRecManageVO.java
index 89f0a328..ac83c15b 100644
--- a/virtual-patient-manage/src/main/java/com/supervision/manage/pojo/vo/MedicalRecManageVO.java
+++ b/virtual-patient-manage/src/main/java/com/supervision/manage/pojo/vo/MedicalRecManageVO.java
@@ -21,4 +21,7 @@ public class MedicalRecManageVO extends MedicalRec {
     @ApiModelProperty("step:4 应答策略")
     private List<MedicalRecQaVO> qaList;
 
+    @ApiModelProperty("step:4 应答策略(默认回答)")
+    private List<MedicalRecQaVO> defaultQaList;
+
 }
diff --git a/virtual-patient-manage/src/main/java/com/supervision/manage/service/impl/MedicalRecManageServiceImpl.java b/virtual-patient-manage/src/main/java/com/supervision/manage/service/impl/MedicalRecManageServiceImpl.java
index b05adc93..6cf1ea96 100644
--- a/virtual-patient-manage/src/main/java/com/supervision/manage/service/impl/MedicalRecManageServiceImpl.java
+++ b/virtual-patient-manage/src/main/java/com/supervision/manage/service/impl/MedicalRecManageServiceImpl.java
@@ -81,7 +81,16 @@ public class MedicalRecManageServiceImpl implements MedicalRecManageService {
         // 这里生成一个新的编号(首先去数据库里面查询编号,然后用最大的编号+1)(可能存在并发修改导致编码重复问题,不是重点,等有问题再说)
         medicalRecService.updateMedicalRecNo("QL", "男".equals(reqVO.getPatientGender()) ? "M" : "F", medicalRec.getId());
         // 然后保存病历对应的问题
-        List<MedicalRecQaVO> qaList = reqVO.getQaList();
+        saveAskPatientAnswer(reqVO.getQaList(), medicalRec.getId(), "1");
+        saveAskPatientAnswer(reqVO.getDefaultQaList(), medicalRec.getId(), "0");
+    }
+
+
+    private void  saveAskPatientAnswer(List<MedicalRecQaVO> qaList,String medicalRecId,String answerType){
+        if (CollUtil.isEmpty(qaList)) {
+            return;
+        }
+
         for (MedicalRecQaVO medicalRecQaVO : qaList) {
             if (StrUtil.isBlank(medicalRecQaVO.getLibraryQuestionId())) {
                 throw new BusinessException("问题ID不能为空");
@@ -89,12 +98,12 @@ public class MedicalRecManageServiceImpl implements MedicalRecManageService {
             AskPatientAnswer askPatientAnswer = new AskPatientAnswer();
             askPatientAnswer.setLibraryQuestionId(medicalRecQaVO.getLibraryQuestionId());
             askPatientAnswer.setAnswer(medicalRecQaVO.getMedicalRecAnswer());
-            askPatientAnswer.setMedicalId(medicalRec.getId());
+            askPatientAnswer.setMedicalId(medicalRecId);
             askPatientAnswer.setAnswerResourceId(medicalRecQaVO.getAnswerResourceId());
+            askPatientAnswer.setAnswerType(answerType);
             askPatientAnswer.insert();
         }
     }
-
     @Override
     public List<DiseaseAncillaryResVo> queryDiseaseAncillaryByCreat(String diseaseId) {
         // 辅助检查