diff --git a/src/Shentun.Peis.Application/PacsBusiness/PacsBusinessAppService.cs b/src/Shentun.Peis.Application/PacsBusiness/PacsBusinessAppService.cs
index c14dbdb3..be4c2826 100644
--- a/src/Shentun.Peis.Application/PacsBusiness/PacsBusinessAppService.cs
+++ b/src/Shentun.Peis.Application/PacsBusiness/PacsBusinessAppService.cs
@@ -757,8 +757,8 @@ namespace Shentun.Peis.PacsBusiness
 
 
                     var registerCheck = patientRegisterCompleteFlag.First().registerCheck;
-                    registerCheck.CheckDate =DateTime.Now;
-                    registerCheck.CheckDoctorId= userEnt.Id.ToString();
+                    registerCheck.CheckDate = DateTime.Now;
+                    registerCheck.CheckDoctorId = userEnt.Id.ToString();
                     registerCheck.CompleteFlag = RegisterCheckCompleteFlag.Checked;
 
                     await _registerCheckRepository.UpdateAsync(registerCheck);
@@ -767,17 +767,24 @@ namespace Shentun.Peis.PacsBusiness
                     //更新体检标识跟体检日期
                     if (patientRegister.CompleteFlag == PatientRegisterCompleteFlag.Registration)
                     {
+                        var firstResultIsUpdateMedicalStartDate = await _sysParmValueManager.GetSysParmValueAsync(Guid.Empty, "first_result_is_update_medical_start_date");
+                        if (string.IsNullOrWhiteSpace(firstResultIsUpdateMedicalStartDate))
+                        {
+                            firstResultIsUpdateMedicalStartDate = "Y";
+                        }
+
                         //第一次保存
                         patientRegister.IsMedicalStart = 'Y';
-                        patientRegister.MedicalStartDate = DateTime.Now;
+                        if (firstResultIsUpdateMedicalStartDate == "Y")
+                            patientRegister.MedicalStartDate = DateTime.Now;
 
                         //更新人员登记信息完成标志
                         patientRegister.CompleteFlag = PatientRegisterCompleteFlag.PartCheck;
 
                         await _patientRegisterRepository.UpdateAsync(patientRegister);
- 
+
                     }
-          
+
 
                     //删除原有小结
                     await _registerCheckSummaryRepository.DeleteAsync(d => d.RegisterCheckId == registerCheckId);
diff --git a/src/Shentun.Peis.Application/RegisterChecks/RegisterCheckAppService.cs b/src/Shentun.Peis.Application/RegisterChecks/RegisterCheckAppService.cs
index 43ad53ef..2b8a7a59 100644
--- a/src/Shentun.Peis.Application/RegisterChecks/RegisterCheckAppService.cs
+++ b/src/Shentun.Peis.Application/RegisterChecks/RegisterCheckAppService.cs
@@ -13,6 +13,7 @@ using Shentun.Peis.PatientRegisters;
 using Shentun.Peis.PrintReports;
 using Shentun.Peis.RegisterCheckItems;
 using Shentun.Peis.RegisterCheckSummarys;
+using Shentun.Peis.SysParmValues;
 using System;
 using System.Collections.Generic;
 using System.Linq;
@@ -64,6 +65,7 @@ namespace Shentun.Peis.RegisterChecks
         private readonly IRepository<GuideType, char> _guideTypeRepository;
         private readonly UnitOfWorkManager _unitOfWorkManager;
         private readonly IRepository<Room, Guid> _roomRepository;
+        private readonly SysParmValueManager _sysParmValueManager;
 
         public RegisterCheckAppService(IRepository<RegisterCheck, Guid> registerCheckRepository,
             IRepository<RegisterCheckItem> registerCheckItemRepository,
@@ -87,7 +89,8 @@ namespace Shentun.Peis.RegisterChecks
             IRepository<DoctorSignIn, Guid> doctorSignInRepository,
             IRepository<GuideType, char> guideTypeRepository,
             UnitOfWorkManager unitOfWorkManager,
-            IRepository<Room, Guid> roomRepository)
+            IRepository<Room, Guid> roomRepository,
+            SysParmValueManager sysParmValueManager)
         {
             _registerCheckRepository = registerCheckRepository;
             _userRepository = userRepository;
@@ -112,6 +115,7 @@ namespace Shentun.Peis.RegisterChecks
             _guideTypeRepository = guideTypeRepository;
             _unitOfWorkManager = unitOfWorkManager;
             _roomRepository = roomRepository;
+            _sysParmValueManager = sysParmValueManager;
         }
 
         /// <summary>
@@ -388,9 +392,18 @@ namespace Shentun.Peis.RegisterChecks
             //更新体检标识跟体检日期
             if (patientRegister.CompleteFlag == PatientRegisterCompleteFlag.Registration)
             {
+                var firstResultIsUpdateMedicalStartDate = await _sysParmValueManager.GetSysParmValueAsync(Guid.Empty, "first_result_is_update_medical_start_date");
+                if (string.IsNullOrWhiteSpace(firstResultIsUpdateMedicalStartDate))
+                {
+                    firstResultIsUpdateMedicalStartDate = "Y";
+                }
+
                 //第一次保存
                 patientRegister.IsMedicalStart = 'Y';
-                patientRegister.MedicalStartDate = DateTime.Now;
+
+                if (firstResultIsUpdateMedicalStartDate == "Y")
+                    patientRegister.MedicalStartDate = DateTime.Now;
+ 
             }
             //更新人员登记信息完成标志
             patientRegister.CompleteFlag = PatientRegisterCompleteFlag.PartCheck;