| Summary: | Background: Admission/ Discharge Form (RMK) in RS PKU Muhammadiyah Yogyakarta Unit II has not been found. RMK form during the inpatient hospitalization replaced with sheets, but the sheets can not be used as a medium for collecting data in the subsequent hospitalization input in SIRS because there are minimal data items listed in the RMK sheet. As a result, interested parties who need the information from RMK form quickly and accurately on a summary of the patient as a whole can not be served by such insurers and other health services. Objective: Designing RMK form instead of the data input process in SIRS is used as a complete source of information, with emphasis on the content aspect, the physical and anatomic. Design process: referral form analysis and interviews are used as a basis for designing RMK form as substitute input data process in SIRS and promoting the concept design RMK form. The designer makes two alternative designs which are then conducted the election so get selected alternative design, consider the form of input and output items in SIRS and make alternative embodiment elected. Results: The design of the selected alternative RMK second form. Form size is 21 x 29.7 cm, using HVS 80 gr, color logo, and letters body and the color of the item is green letters on the field data items are colored black. Input data item names of parents, doctors and immunization recipients who have obtained not in the SIRS were used.
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