Introduction: Medical record chart is a multifunctional document that is used document and to communicate information about patients’ health status and medical care to patients and among health care professionals. Problem statement: In Ayder referral hospital, there is high medical record chart loss. Objective: To improve patient’s medical record handling in Ayder referral hospital by reducing medical record chart lost from 5.9% to 3% by the end of July, 2013. Methods Setting: Ayder referral hospital located in Mekelle city of Tigray Regional State... Project Design: A pre and post intervention was conducted. Source population: All medical record charts in the card room. Target population: 3000 medical records. This was registered from October 01, 2005 - October 21, 2005 E. C in Ayder referral hospital. The study samples were selected systematically from the target population. Data collection procedures: Before the data collection using a simple form a one hour orientation was given for both data collectors and log book rewriters on the objectives of the capstone project, ethical issues, and how to use the data collection tools. Data analysis: The raw data was recorded using paper based system and McNamara’s chisquare test was applied. Selected intervention: Establishing properly designed medical record chart handover system and a team that tries to find lost medical record charts by undergoing room-to-room searching. This is the best intervention because, it has high political acceptance, takes shorter time and the expense incurred for medical record hand over form is low as compare to the other strategies. Result: After implementing the selected strategy, the percentage of medical record chart loss was 17(5.9%) in pre and 9 (3.13%) in the post intervention and the usage of medical record chart handover form was 0% in pre and 100% in the post intervention. Conclusion: Sustainable usage of well developed handover form during the withdrawal of medical record chart from the card room and room-to-room searching of medical record chart have a big impact in reducing the loss. Because, it hands them the responsibility. Recommendation: Medical record chart handover form should be used when cards are taken from hospital card room and room-to-room search should be made weekly.