Abstract :
The ICU (Intensive Care Unit) form is a form that contains notes about the progress and examination of the patient as well as the actions given to patients treated in the ICU. Based on the preliminary study, it was known that at RSD Balung in making the ICU there were aspects of the form that were not appropriate, such as in the physical aspect, namely the paper used was A3 70 grams, in the anatomical aspect there was no heading or head of the form, and in the content aspect there was no TTD and doctor's name. This study aims to redesign the ICU Form of the Balung Jember Regional Hospital in 2021. The type of research is a qualitative research with research subjects including medical record officers, ICU nurses, and the head of the ICU room. Data collection techniques in this study using interviews, observation and documentation. The results of this study are seen from the physical aspect of the ICU form using white paper with A3 size 70 grams (42 cm and 29.8 cm) in landscape. From the anatomical aspect of the ICU form, the heading includes the logo, agency name but agency address, agency telephone number, agency website, agency email, and the title of the form, for the introduction the title has been represented. Judging from the aspect of the contents of the ICU form, the added data consists of TTD and doctor's name, the columns are extended. Suggestions from researchers from the ICU form design are expected to be a reference for ICU design at the Balung Jember Regional Hospital.