diff --git a/src/Shentun.ColumnReferencePlugIns/WebAppoints/WebAppointWebPeisPlugIns.cs b/src/Shentun.ColumnReferencePlugIns/WebAppoints/WebAppointWebPeisPlugIns.cs
index e231882a..f401186c 100644
--- a/src/Shentun.ColumnReferencePlugIns/WebAppoints/WebAppointWebPeisPlugIns.cs
+++ b/src/Shentun.ColumnReferencePlugIns/WebAppoints/WebAppointWebPeisPlugIns.cs
@@ -150,10 +150,25 @@ namespace Shentun.Peis.PlugIns.WebAppoints
                     sql += " and is_upload='N' ";
                 }
 
+
+                var parameters = new DynamicParameters();
+                parameters.Add("HandDate", DateTime.Now.Date.AddDays(-input.QueryDays));
+                parameters.Add("CompleteFlag", PatientRegisterCompleteFlag.SumCheck);
+
+
+                if (input.ExcludeMedicalTypeIds.Any())
+                {
+                    // 构建IN子句的字符串
+                    var excludeIdsList = input.ExcludeMedicalTypeIds.Select(id => $"'{id}'");
+                    var excludeIdsString = string.Join(",", excludeIdsList);
+                    sql += $" AND medical_type_id NOT IN ({excludeIdsString}) ";
+                }
+
+
                 sql += $" limit {input.UploadCountLimit} ";
 
-                var patientRegisterIds = (await conn.QueryAsync<SyncPatientRegisterIdsDto>(sql,
-                     new { HandDate = DateTime.Now.Date.AddDays(-input.QueryDays), CompleteFlag = PatientRegisterCompleteFlag.SumCheck })).ToList();
+
+                var patientRegisterIds = (await conn.QueryAsync<SyncPatientRegisterIdsDto>(sql, parameters)).ToList();
                 return patientRegisterIds;
             }
         }
diff --git a/src/Shentun.Peis.Application.Contracts/TransToWebPeiss/SyncPatientRegisterReportInputDto.cs b/src/Shentun.Peis.Application.Contracts/TransToWebPeiss/SyncPatientRegisterReportInputDto.cs
index 6cc914a1..d0ae0eb4 100644
--- a/src/Shentun.Peis.Application.Contracts/TransToWebPeiss/SyncPatientRegisterReportInputDto.cs
+++ b/src/Shentun.Peis.Application.Contracts/TransToWebPeiss/SyncPatientRegisterReportInputDto.cs
@@ -25,5 +25,7 @@ namespace Shentun.Peis.TransToWebPeiss
         public char UploadDateType { get; set; }
 
         public int UploadCountLimit { get; set; } = 100;
+
+        public List<string> ExcludeMedicalTypeIds { get; set; } = new List<string>();
     }
 }
diff --git a/src/Shentun.Peis.HttpApi.Host/Schedulers/SyncPatientRegisterReportInterfaceWorker.cs b/src/Shentun.Peis.HttpApi.Host/Schedulers/SyncPatientRegisterReportInterfaceWorker.cs
index 53460d21..b0fcccca 100644
--- a/src/Shentun.Peis.HttpApi.Host/Schedulers/SyncPatientRegisterReportInterfaceWorker.cs
+++ b/src/Shentun.Peis.HttpApi.Host/Schedulers/SyncPatientRegisterReportInterfaceWorker.cs
@@ -147,6 +147,9 @@ namespace Shentun.Peis.Schedulers
                     //单次最大的上传数量
                     var uploadCountLimit = Convert.ToInt32(interfaceConfig.GetValue("Interface:Scheduler:UploadCountLimit", "100"));
 
+
+
+
                     SyncPatientRegisterReportInputDto input = new SyncPatientRegisterReportInputDto
                     {
                         QueryDays = QueryDays,
@@ -157,6 +160,15 @@ namespace Shentun.Peis.Schedulers
                     };
 
 
+                    //剔除的体检类别id  集合   a,b
+                    var excludeMedicalTypeIdsValue = interfaceConfig.GetValue("Interface:ExcludeMedicalTypeIds", "");
+                    if (!string.IsNullOrWhiteSpace(excludeMedicalTypeIdsValue))
+                    {
+                        List<string> excludeMedicalTypeIds = excludeMedicalTypeIdsValue.Split(",", StringSplitOptions.RemoveEmptyEntries).ToList();
+                        input.ExcludeMedicalTypeIds = excludeMedicalTypeIds;
+                        // input.ExcludeMedicalTypeIds = excludeMedicalTypeIds.Select(s => Guid.Parse(s)).ToList();
+                    }
+
                     var assemblyName = interfaceConfig.GetSection("Interface").GetSection("AssemblyName").Value;
                     var className = interfaceConfig.GetSection("Interface").GetSection("ClassName").Value;