The Bed Head Ticket (BHT) is the medical record of the in-ward patient in the Sri Lankan health system. Nursing Officers (NOs) are one of the main stakeholders in maintaining medical records for hospitalized patients. The aim of the present study was to assess the knowledge and practices of NOs in medical record keeping regarding inward patient care. All NOs Base Hospital Warakapola (BHW) were recruited in the study. Their knowledge and practices regarding medical record keeping were assessed using a self-administered questionnaire. Five hundred BHTs were studied retrospectively in the same hospital with the use of a check list to ascertain the actual practices. More than half of NOs were not aware of the existence of the general circular pertaining to the maintenance of medical records. Only 62% NOs were found to be aware of when to send the BHT to the record room once the patient was discharged. A majority of 91.8% NOs were not aware that the BHT was the sole source of information for Indoor Morbidity and Mortality Return (IMMR). Legibility and completeness of entries made by NOs were satisfactory in 83.6% and 16.2% of BHTs respectively. The knowledge regarding the guidelines pertaining to the management of medical records was poor among NOs. Their basic knowledge on the timeliness of record keeping and flow of medical information system was also not satisfactory according to the study. Selected aspects in practices of NOs in medical record keeping reflected the gaps in knowledge.