Medical records aimed at the orderly administration in an effort toimprove health services in the hospital. One of the forms used in the inpatientmedical record service is a Summary Entry and Exit Form (RM 1). The summaryentry and exit form in hospitals Salatiga still did not agree with the theory, fromthe aspect of anatomy, physical and contents. This study aimed to analyze thedesign of summary entry and exit form (RM 1) in Salatiga City Hospital from theaspect of anatomy, physical and contents. And also provide design solutionsdesign summary entry and exit form (RM 1) accordingly.This type of research is descriptive qualitative research. This research wasconducted in Salatiga City Hospital on May 19 to May 26 in 2016, using themethod of observation, interviews, documentary studies and FGD (Focus GroupDiscussion). Data processing techniques used in this study is reduction, display,conclusion drawing and verification.Observations based design summary entry and exit form in Salatiga CityHospital that aspect has not been included heading anatomy complete form andlack of instruction. From the physical aspect is not well seen from the still opaquepaper with a weight of 60 grams. While aspects of the content has been effectivebecause it has provided to record the necessary data to the back of the form, butthere has been no cause of death certificates.