Institutional ethnography (IE) explicates puzzles that people confront in their everyday experiences. In this approach, the social is understood to be always brought into being by people's actions that are socially and purposefully organized. Texts are analysed as material components of social organization with the capacity to replicate in different settings concepts and language that shape local actions, coordinating people in local sites with others located elsewhere. There is ruling power in such social organization that as Dorothy Smith, IE's originator, says is put together by relations that extend vastly beyond the everyday. IE is a method of inquiry that discovers how ruling works, and texts are methodologically crucial for an institutional ethnographer's tracking and mapping of the institutionally designed social relations that rule social settings. This paper illustrates doing IE with [8]). My research has important convergences with that of Berg and Bowker [9] and Berg [10]. Berg and Bowker insist that the (paper) medical record that they examine is constitutive of the patient's body, or, at least, of how the body is represented for medical work, arguing however, that the medical record's relation to bodies is complicated, "not merely mirror[ing] the bodies it maps" (…nor) "determin[ing] them" [11]. In addition, Berg and Bowker see the medical record at work in the "constitution of the hospital worker" [12] leading them to attend, as I do here, to the record's political relevance, the power exercised though the record's mediation of the hospital work. Berg's [10] single authored article pursues this question of power, querying how we should comprehend what he calls the "generative power" [13] of the electronic medical record. Both these analyses treat medical records as material elements of the work of medicine that they explore sociologically.I make use of their research on medical records here, as I contrast their sociological analysis with my institutional ethnography 1 . In studying an analytic sketch of nurses using hospital information systems.