How long should a Texas medical practice keep a patient’s medical record?
For physicians, Texas generally requires medical records to be retained for at least seven years from the date of last treatment. Records for patients who were under 18 at the time of last treatment may require a longer period. Hospitals follow a separate rule and generally may not authorize disposal until at least 10 years after the patient’s last treatment.
The correct retention period depends on more than the patient’s last visit. The provider type, patient age, payer requirements, unresolved litigation, and other federal or state requirements can affect how long records should remain available.
This guide explains the major medical record retention requirements in Texas, including physician and hospital rules, minor records, Medicare and Medicaid requirements, HIPAA, electronic records, record requests, and secure disposal.
Texas Medical Record Retention Requirements at a Glance
Texas does not have one retention period that applies to every healthcare organization. Different laws and programs can impose different requirements.
| Provider or Requirement | General Retention Period | Important Consideration |
| Texas physician | At least 7 years | Measured from the date of last treatment |
| Physician treating a minor | Until age 21 or 7 years from last treatment, whichever is longer | The longer period controls |
| Texas hospital | At least 10 years | Measured from the patient’s last treatment |
| Hospital treating a minor | Until age 20 or 10 years from last treatment, whichever is later | Hospital rule differs from physician rule |
| Medicare records covered by 42 CFR 424.516(f) | 7 years from date of service | Applies to specified Medicare documentation |
| Texas Medicaid providers | At least 5 years under TMHP guidance | Records must also remain available while audits, appeals, investigations, or court cases remain unresolved |
| HIPAA documentation | Generally 6 years for required HIPAA documentation | This is not a general medical-record retention rule |
| Electronic health records in Texas | Storage requirements apply | Texas law includes U.S. physical-storage requirements for covered EHRs |
These are not interchangeable rules. A practice should apply the requirement that governs the specific record and situation, including any longer applicable requirement.
Texas Physician Medical Record Retention Requirements
Texas Medical Board guidance states that physicians generally must retain medical records for at least seven years from the last treatment date. Maintaining accessible and complete documentation is also important when records are needed to support coding, claims, or reimbursement activities. Practices can use medical coding services to help maintain accurate coding and documentation workflows.
The Seven-Year Rule
For an adult patient, the basic calculation is:
Date of last treatment + 7 years = minimum physician retention period
The last treatment date is important because the retention period is not simply seven years from the patient’s first appointment.
For example, if a physician last treated a patient on September 22, 2026, the seven-year period would generally run through September 22, 2033.
Practices should build their retention systems around the date of last treatment rather than relying on the date the patient was first registered.
Records for Patients Under 18
Texas applies a longer rule when the patient was under 18 at the time of last treatment. The physician must retain the record until:
The patient reaches age 21, or 7 years after the last treatment, whichever is longer.
For example, suppose a physician last treats a patient at age 10.
- Patient turns 21: 11 years after treatment
- Seven years from last treatment: 7 years
- Longer period: 11 years
The record should therefore remain available until the patient reaches age 21, assuming no other rule requires a longer period.
For a patient last treated at age 16:
- Patient turns 21: approximately 5 years later
- Seven years from last treatment: 7 years
- Longer period: 7 years
This means practices should track both the patient’s date of birth and last treatment date when managing retention for minors.
Physician vs. Hospital Medical Record Retention in Texas
One of the most important distinctions is that physician and hospital records do not follow the same basic retention period.
Physician Records
Texas physician rules generally require retention for at least seven years from the date of last treatment. For patients under 18, the record must generally be retained until age 21 or seven years after last treatment, whichever is longer.
Hospital Records
Texas Health and Safety Code §241.103 allows a hospital to authorize disposal of a medical record on or after the 10th anniversary of the patient’s last treatment. For a patient who was younger than 18 at the time of last treatment, a hospital may authorize disposal on or after:
- The patient’s 20th birthday, or
- The 10th anniversary of the last treatment,
whichever date is later.
Why the Difference Matters
A physician’s office should not automatically apply the hospital’s 10-year rule to every record. Likewise, a hospital should not use the physician’s seven-year rule as its general retention period.
The organization responsible for the record should first identify the applicable rule before scheduling the record for destruction.
Texas Medical Record Retention for Minors
Minor records require special attention because the retention period can extend beyond the standard adult period.
| Record Type | Minor Patient Retention Rule |
| Physician record | Until age 21 or 7 years after last treatment, whichever is longer |
| Hospital record | Until age 20 or 10 years after last treatment, whichever is later |
The different age thresholds are easy to overlook when a practice uses one automated retention rule for every patient.
A better process identifies minor records separately and calculates the applicable date based on the provider type.
What Happens If a Medical Record Is Related to Litigation?
A record should not be destroyed simply because the normal retention period has expired if an applicable law requires it to remain available. This is particularly important when records are connected to outstanding claims, payment disputes, payer reviews, or denial management activities.
For Texas hospitals, Health and Safety Code §241.103 specifically states that a hospital may not destroy medical records related to a matter involved in litigation when the hospital knows the litigation has not been finally resolved.
The same principle is important for physician practices when other applicable law, legal requirements, or a litigation hold prevents destruction.
Does HIPAA Require Medical Records to Be Kept for Six Years?
No. This is one of the most common points of confusion in medical record retention.
The HIPAA Privacy Rule does not establish a general retention period for patient medical records. HHS explains that state law generally determines how long medical records must be retained. HIPAA does, however, require appropriate safeguards for PHI while it is maintained and when it is disposed of.
HIPAA does contain six-year documentation requirements for certain policies, procedures, communications, and other documentation. That six-year requirement should not be confused with a six-year medical record retention rule.
HIPAA Still Matters During Retention
Even when a record reaches the end of its retention period, a practice cannot simply dispose of it without protecting patient information.
HHS requires covered entities to use reasonable safeguards when disposing of PHI. Paper records may need to be shredded or otherwise destroyed so the information cannot be reconstructed. Electronic PHI and media require appropriate disposal or sanitization procedures.
Medicare Medical Record Retention Requirements
Texas practices that treat Medicare patients may also have federal record-maintenance requirements.
CMS states that under 42 CFR 424.516(f), certain Medicare providers and suppliers, including physicians and other professionals who order, certify, refer, or prescribe covered services, must maintain medical records for seven years from the date of service. CMS also explains that the provider or professional remains responsible for producing the records when requested, even if another organization maintains them.
This creates an important operational point:
The organization storing the record and the provider responsible for producing it may not always be the same entity.
Practices that outsource billing, EHR hosting, document management, or other administrative functions should make sure their agreements and workflows preserve access to required records.
Texas Medicaid Medical Record Retention Requirements
Texas Medicaid has its own record-retention requirements that should be considered separately from the general Texas physician rule.
Texas Medicaid and Healthcare Partnership guidance updated in May 2026 states that:
- Individual providers must retain medical records for a minimum of five years.
- Freestanding rural health clinics must retain records for at least six years.
- Hospital-based rural health clinics must retain records for at least 10 years.
TMHP also states that records must remain available until medical billing audit questions, appeal hearings, investigations, or court cases are resolved.
This illustrates why practices should not choose a retention period based on a single rule.
A Texas physician participating in Medicaid should consider the Texas physician requirement, Medicaid requirements, and any other applicable federal or contractual requirements before disposing of records.
Electronic Medical Record Storage Requirements in Texas
Medical record retention is not only about how long records remain available. Texas also has requirements concerning the storage of electronic health records.
Texas Senate Bill 1188 added Chapter 183 to the Health and Safety Code. For covered entities, electronic health records containing patient information must be physically maintained in the United States or a U.S. territory. The storage requirement applies to records stored through third-party, subcontracted, or cloud computing services and applies to EHR storage on or after January 1, 2026.
What This Means for Texas Practices
When selecting or reviewing an EHR, cloud storage platform, or records-management vendor, practices should confirm:
- Where patient records are physically stored
- Whether cloud or third-party vendors are involved
- Who can access the records
- How access is controlled
- How records are backed up
- How records can be retrieved
- How records are preserved during system changes
- How records are securely destroyed when eligible
The retention schedule is only useful if the practice can actually retrieve the records when required.
How to Dispose of Medical Records in Texas
When a record becomes eligible for disposal, the practice should first confirm that no other rule requires continued retention.
A basic process is:
Identify eligible records → Check for legal or audit holds → Confirm retention period → Approve destruction → Securely destroy records → Document the destruction
Paper Record Disposal
Paper PHI should be destroyed so it cannot be reconstructed. Shredding is a common method when performed appropriately.
Electronic Record Disposal
Electronic records and storage media require a process that prevents unauthorized recovery or access. HHS explains that electronic media may require clearing, purging, or physical destruction depending on the circumstances.
Using an Outside Disposal Vendor
A covered entity may use a business associate to dispose of PHI, provided the required contractual and safeguarding obligations are addressed. Practices should maintain documentation showing that disposal followed their written policy.
Medical Record Requests in Texas
Retention and access are closely connected. Texas Medical Board guidance states that physicians must retain medical records for at least seven years from the last treatment date. TMB also states that patients can request copies of their records and that physicians must respond within 15 business days after receiving a proper written request.
A retention policy should support both record preservation and timely retrieval.
What Happens When a Texas Medical Practice Closes?
Closing a practice does not mean medical records can simply be discarded. Records may still be subject to applicable retention requirements, patient access rights, legal holds, and other regulatory obligations.
TMB guidance addresses access to records when a physician retires, closes a practice, or is otherwise no longer available. Practices should establish who will serve as the records custodian and how patients can obtain their records.
Texas Medical Record Retention Compliance Checklist
Use this checklist when reviewing your practice’s record-retention process:
- Identify the provider type
- Determine the applicable retention period
- Confirm the patient’s last treatment date
- Check whether the patient was a minor
- Review Medicare or Medicaid requirements
- Check for litigation, audits, or investigations
- Confirm patient-access requirements
- Review applicable EHR storage requirements
- Confirm the record is eligible for destruction
- Document the destruction
Conclusion
Medical record retention in Texas is not governed by one rule for every healthcare organization. Texas physicians generally follow a seven-year minimum from the last treatment date, while hospitals generally follow a 10-year rule. Minor records, Medicare and Medicaid requirements, litigation, and electronic health record rules can create additional obligations.
The safest approach is to maintain a written retention schedule, track the correct starting date, separate minor records, preserve records subject to legal or payer holds, and use secure storage and disposal procedures.
For Texas practices, strong record management should also connect with accurate coding, claims processing, denial management, and A/R follow-up. A structured revenue cycle workflow helps keep the financial and documentation sides of the practice organized.
