Introduction: The admission and discharge form is a concise record. It includes medical, administrative, and financial data. Current form because of not applicable data and lack of appropriate place for recording the information, it needs redesign. The purpose of this study was to redesign the form that cover the information needs of key users was conducted.

Methods: This study is a descriptive and cross-sectional study. People of research included admission staff, physicians, and insurers in teaching hospitals in Isfahan. Initially we compare admission forms of the ministry of health and other countries. Similar and different data was extracted then opinion of the population collected and computed the distribution of their opinions. And the new form of admission and discharge on the basis of consensus above 50% was designed.

Results: According to the need assessment, some data elements deleted and some data elements were replaced. Finally a new form was designed.

Conclusion: Given the importance of admission and discharge form it necessities to be careful in be correct documentation. Achieving this requires revision of the current form.