Medical records do more than document a patient's care. They support clinical decisions, billing, insurance claims, audits, legal requests, continuity of care, and compliance.

For practices reviewing how documentation connects with medical billing and revenue cycle operations, understanding retention requirements is an important part of maintaining an organized billing process.

For Texas healthcare providers, knowing how long medical records must be retained is especially important because the requirement is not identical for every healthcare organization.

For physicians, the Texas Medical Board generally requires medical records to be retained for at least seven years from the date of the physician's last treatment. For patients who were under 18 at the time of treatment, the record must generally be retained until the patient turns 21 or for seven years after the last treatment, whichever is longer.

Hospitals follow a different rule. Under Texas Health and Safety Code §241.103, a hospital may generally authorize disposal of a medical record on or after the 10th anniversary of the patient's last treatment at the hospital. Different rules apply to minor patients and records connected with unresolved litigation.

That distinction matters.

A physician practice should not automatically apply a hospital's retention period to every record, and a hospital should not assume that the physician standard is sufficient.

This guide explains the key Texas medical record retention requirements and what healthcare organizations should consider before archiving or destroying patient records.

Important: This article provides general educational information and is not legal advice. Healthcare organizations should review their specific retention obligations with qualified legal or compliance professionals.

What Is the Medical Record Retention Requirement in Texas?

For physicians regulated by the Texas Medical Board, the general rule is at least seven years from the date of last treatment by the physician. The current Texas Medical Board rule also requires providers to maintain access to the medical records for the duration of the applicable retention period.

The key point is the starting date.

The seven-year period is generally calculated from the last treatment date, not:

• The date the patient first registered
• The date the chart was created
• The date the patient became inactive
• The date the EHR account was closed
• The date an insurance claim was paid

For example, if a physician last treated an adult patient on September 15, 2026, the standard seven-year retention period would extend through September 15, 2033, assuming no other law or obligation requires a longer period.

If the patient receives treatment again later, the later treatment date becomes relevant to calculating the retention period.

Texas Medical Record Retention Requirements at a Glance

These are general requirements. Specific records may be subject to additional state, federal, contractual, payer, licensing, or legal requirements.

How Long Must a Texas Physician Keep Medical Records?

Under the current Texas Medical Board rules, physicians and physician employers, including group practices and certain professional organizations, must retain medical records consistent with Chapter 163.

The standard period is at least seven years from the physician's date of last treatment, unless another federal or state requirement calls for a longer period.

This means a physician practice should have a retention policy that identifies the last treatment date for each applicable record rather than simply assigning every inactive chart a destruction date.

Example

A patient sees a physician several times:

• January 10, 2022: Initial visit
• August 20, 2024: Follow-up
• September 15, 2026: Last treatment

The retention clock is based on September 15, 2026.

The standard physician retention period would therefore extend at least seven years from that date.

This becomes particularly important when practices have large EHR databases containing thousands of inactive patients.

What About Medical Records for Minor Patients?

Texas uses a different calculation when the patient was under 18 at the time of treatment.

For physician records, the record generally must be retained until the patient reaches 21 years of age or seven years have passed from the date of last treatment, whichever is longer.

Consider a 10-year-old patient whose last treatment occurs in 2026.

Seven years after the last treatment would place the standard date in 2033. But the patient would not turn 21 until approximately 2037.

The later date controls.

For a 16-year-old patient, the seven-year calculation may extend beyond the patient's 21st birthday.

This is why a retention process that uses only the last treatment date may not be sufficient for minor patients. Practices should also account for the patient's date of birth.

Do Hospitals Follow the Same Seven-Year Rule?

No.

This is one of the most important distinctions Texas healthcare organizations should understand.

Texas Health and Safety Code §241.103 provides a separate medical record preservation rule for hospitals. A hospital may generally authorize disposal of a medical record on or after the 10th anniversary of the date the patient was last treated at the hospital.

For patients who were younger than 18 when last treated at the hospital, the hospital's rule generally extends until the patient's 20th birthday or the 10th anniversary of the last treatment, whichever is later.

This means a hospital's retention policy should not simply copy the standard used by an independent physician practice.

Hospital vs. Physician Retention

The basic distinction is:

Physician:
At least 7 years from last treatment, with a longer rule for certain minor patients.

Hospital:
Generally 10 years from last treatment, with a different minor-patient calculation.

The record custodian and type of healthcare organization therefore matter when determining the applicable retention period.

What Happens When a Record Is Involved in Litigation?

A record that has reached its normal retention date should not automatically be destroyed.

Texas law specifically addresses hospital records associated with unresolved litigation. A hospital may not destroy medical records relating to a matter involved in litigation when the hospital knows that the litigation has not been finally resolved.

For healthcare organizations, this means a legal hold can override the normal retention schedule.

Before authorizing destruction, compliance teams should determine whether the record is associated with:

• Pending litigation
• A subpoena or legal request
• A government investigation
• A regulatory matter
• A malpractice claim
• An audit or other preservation requirement

A retention policy should therefore contain an exception process instead of treating the scheduled destruction date as an automatic deletion date. For organizations reviewing their documentation and billing processes, a medical billing audit can also help identify documentation, coding, and compliance issues that may affect claims.

How Long Are Forensic Sexual-Assault Examination Records Kept?

Certain hospital records have substantially longer retention requirements.

Under Texas Health and Safety Code §241.1031, a hospital may not destroy a medical record from a forensic medical examination of a sexual assault victim until the 20th anniversary of the date the record was created.

Notice that this calculation is different from the ordinary hospital rule based on the patient's last treatment.

For this type of record, the creation date is important.

Healthcare organizations should therefore classify records appropriately rather than applying one retention period to every patient document.

Does Electronic Health Record Storage Change the Retention Period?

Moving from paper charts to an EHR does not eliminate the underlying retention obligation.

The Texas Medical Board's current rule requires providers to maintain access to medical records for the duration of the required retention period.

For healthcare organizations, that creates an important operational issue.

A practice that changes EHR vendors, merges systems, retires an old platform, or moves historical records into an archive should have a documented plan for preserving records that are still within their required retention period.

Before decommissioning an EHR, organizations should identify:

• Active patient records
• Inactive records still subject to retention
• Records under legal hold
• Records approaching their destruction date
• Scanned documents and attachments
• Diagnostic reports and other supporting information
• Patient access requirements
• Appropriate access controls
• Backup and recovery requirements

Simply keeping an old database somewhere does not necessarily create a workable records-management process. Authorized users must be able to retrieve the records when they are needed.

What Medical Information Should a Practice Retain?

A medical record is more than the physician's progress note.

Depending on the patient and type of care, the record may contain clinical documentation such as:

• Patient history and examination findings
• Diagnoses and assessments
• Treatment plans
• Medication information
• Orders
• Diagnostic results
• Referrals and consultations
• Patient communications
• Follow-up instructions
• Relevant records received from other providers
• Amendments and corrections
• Other documentation required by applicable rules

The current Texas Medical Board rule requires a medical record to be a complete, contemporaneous, and legible account of each patient encounter and identifies specific categories of information that must be included when applicable.

For practices managing billing and revenue cycle operations, this documentation also matters because clinical records support the information submitted through the claims process. Accurate medical coding and documentation work together to support compliant claims and appropriate reimbursement.

When documentation, coding, and claims workflows are managed together, providers have a clearer process for supporting reimbursement. This is one reason practices often evaluate their medical billing services alongside their documentation and compliance processes.

What Happens When a Physician Leaves a Practice?

Record retention responsibilities do not simply disappear when a physician retires, changes practices, or leaves a medical group.

Under the current Texas Medical Board rules, a physician leaving a practice must provide reasonable notice to patients so they can obtain copies of their records or arrange for transfer. The rule includes notice to patients seen during the preceding two years and requires posting notice in the office and on the practice website at least 30 days before the applicable departure, sale, relocation, or termination event.

Practices should therefore establish a transition plan covering:

1. Who will maintain the records?
2. Where will the records be stored?
3. How can patients request copies?
4. How will records be transferred to another provider?
5. Who is responsible for responding to requests?
6. How long will the records remain available?

A physician leaving a practice should not be treated as an EHR shutdown event.

Common Medical Record Retention Mistakes

Texas healthcare organizations can run into problems when retention policies are too general.

Common issues include:

Applying the seven-year rule to every organization

Hospitals have a different statutory retention period than physicians.

Using the wrong starting date

For physician records, the standard calculation is based on the physician's last treatment date.

Treating minor records like adult records

The age-based requirement can extend retention beyond the standard period.

Destroying records without checking for legal holds

A record may remain subject to preservation even after its ordinary retention period has expired.

Losing records during an EHR migration

Changing software does not eliminate the obligation to maintain records that are still subject to retention.

Failing to document destruction

A practice should have an internal process showing which records were reviewed, why they were eligible for disposition, and when the disposition occurred.

How Can Texas Healthcare Providers Build a Better Retention Process?

A practical retention workflow can be built around six questions:

1. Who is the record custodian?
Identify the physician, group, hospital, facility, or other organization responsible for the record.

2. What type of record is it?
Determine whether special retention requirements apply.

3. When did the retention clock start?
For physician records, this is generally the last treatment date.

4. Is the patient a minor?
If so, perform the applicable age-based calculation.

5. Is there an exception?
Check for litigation, legal holds, audits, investigations, or other requirements.

6. Is the record actually eligible for destruction?
Only after the applicable requirements and exceptions have been reviewed should disposition be considered.

This creates a more reliable process than simply deleting records when an EHR labels them "inactive."

Why Medical Record Retention Matters for Revenue Cycle Management

Medical record retention is primarily a compliance and patient-care responsibility, but it also intersects with revenue cycle operations.

Healthcare organizations may need historical documentation to support:

• Claims and payment questions
• Coding reviews
• Medical necessity documentation
• Payer audits
• Denial appeals
• Compliance reviews
• Patient inquiries
• Internal billing audits

When documentation is needed to support a denied or questioned claim, having the appropriate records available can also support denial management and the appeals process.

A complete and accessible record can make it easier for a practice to respond when documentation is needed after the original encounter.

That is particularly relevant when providers manage high claim volumes, multiple payers, multiple locations, or complex specialty services.

Final Takeaway for Texas Healthcare Providers

The phrase "Texas requires medical records to be kept for seven years" is useful as a starting point, but it is not the whole story.

For physicians, the general requirement is at least seven years from the date of last treatment, with a longer period for certain minor patients. Hospitals generally operate under a separate 10-year standard, and records connected with unresolved litigation or specific types of forensic examinations can require longer preservation.

The safest approach is to build a retention policy around the type of organization, type of record, last treatment date, patient age, applicable law, and preservation exceptions.

For practices reviewing their broader billing and documentation workflows, a medical billing audit can also help identify documentation, coding, claims, and revenue-cycle issues that may affect reimbursement.

Atlantis RCM helps U.S. healthcare providers manage medical billing and revenue cycle operations across multiple specialties.