Texas Medical Records Request Rules for Practices (2026)

Texas gives physicians 15 business days to provide records after a written consent, whether the request comes from the patient or from a third party such as the patient's attorney. Texas Medical Board rules set flat fee caps: $25 for the first 20 paper pages and $0.50 per page after that, or $25 to $50 for electronic records. For injury cases, Texas also has a billing affidavit procedure (Civil Practice and Remedies Code § 18.001) that relies on itemized bills from the practice.

At a glance

When the patient asks

Physician records in Texas are confidential and privileged under Occupations Code Chapter 159. A written consent to release them must be signed by the patient (or a parent or guardian of a minor, a guardian, an attorney ad litem, or the personal representative of a deceased patient). It must list the records covered, the reason for the release and the person who will receive them (§ 159.005).

Once a physician receives that consent, the physician must provide copies of the requested billing or medical records, or a summary or narrative, no later than the 15th business day after receipt (§ 159.006). This includes records the practice received from other providers. A physician can withhold records only if access would harm the patient's physical, mental or emotional health. In that case the physician must give a signed, dated written statement of the reason and place a copy in the patient's file.

A separate statute covers electronic records. A provider whose electronic health records system can fulfill the request must provide the electronic record in electronic form within 15 business days of a written request, unless the person agrees to another form (Health and Safety Code § 181.102).

The Occupations Code allows a reasonable fee "as prescribed by board rule" (§ 159.008). The Texas Medical Board rule (22 TAC § 163.3) sets these maximums:

• Paper records: $25 for the first 20 pages and $0.50 per page after that
• Electronic records: $25 for 500 pages or less, and $50 for more than 500 pages
• Records that are part paper and part electronic: the fee for each format
• An affidavit, if requested: up to $15
• A narrative instead of the records: up to $20
• Actual postage if the records are mailed

If the requester insists on paper even though the records are electronic, the paper fee can be charged. A practice cannot deny a request because the patient owes money. The Texas Medical Board says no fee may be charged when the request relates to a benefits or assistance claim based on the patient's disability. For a patient's own request, HIPAA's cost-based fee limit also applies, so the board amounts are ceilings, not set prices.

When the patient's attorney asks

Texas does not have a separate attorney-request statute. An attorney uses the same written consent under § 159.005, signed by the patient, and the physician must respond by the 15th business day. The board's fee caps apply to any request that complies with § 159.005, so they cover attorney requests too. Under 22 TAC § 163.3, a practice cannot require a subpoena when it receives a proper written consent. The Texas Medical Board's patient page also states that patients can have records sent to a third party with proper written authorization.

Subpoenas

Occupations Code § 159.002(f) lets a physician disclose records without the patient's consent when the disclosure relates to a judicial proceeding in which the patient is a party and is requested by a subpoena issued under the Texas Rules of Civil Procedure, the Code of Criminal Procedure or Civil Practice and Remedies Code Chapter 121. The physician can still claim the privilege on the patient's behalf.

Section 159.003 also lists court-related exceptions. These include a civil action in which the patient seeks money damages for a physical or mental condition (when the records are relevant), a written consent, and a court order. For mental health records, Health and Safety Code § 611.006 allows disclosure in a proceeding where the court or agency has issued an order or subpoena. HIPAA's subpoena rules are covered on our federal page.

We could not confirm the current text of the Texas Rules of Civil Procedure notice requirements for nonparty records subpoenas in an official source.

Records that need extra consent

• Mental health records. Health and Safety Code Chapter 611 covers records of diagnosis, evaluation or treatment of a mental or emotional condition, including alcoholism or drug addiction, made by a professional (physicians included). Release outside a court proceeding generally needs the patient's written consent. Patients have a right of access, and a reasonable fee is allowed (§ 611.0045).
• HIV test results. Results are confidential. A patient can authorize release in a signed writing that names the person or class of persons who may receive them (Health and Safety Code § 81.103). Releasing results with criminal negligence is a Class A misdemeanor.
• Sensitive test results in a portal. Pathology or radiology reports reasonably likely to show cancer, and test results that may reveal a genetic marker, cannot be released through a patient portal or app until the third day after they are finalized (Occupations Code § 159.0062).

Billing records and medical bills

Texas treats billing records and medical records as separate. A "billing record" describes charges for a physician's services, and a "medical record" does not include billing records (Occupations Code § 159.001). Both are covered by the consent and 15-business-day rules. The Texas Medical Board says a physician does not have to include billing records unless they are specifically requested, and may charge separate fees for medical and billing records.

In injury cases, Civil Practice and Remedies Code § 18.001 lets a party prove that charges were reasonable and services were necessary with an affidavit, unless the other side serves a counteraffidavit. The affidavit does not prove causation. It must be sworn before an officer authorized to give oaths, made by the person who provided the service or the person in charge of the records showing the service and charge, and include an itemized statement of each service and charge. The party offering it must serve it by set deadlines, generally the earlier of 90 days after the defendant answers or the expert designation deadline. A practice may charge up to $15 for an affidavit under the board rule.

How long to keep records

Under 22 TAC § 163.2, physicians or their employers (including group practices) must keep medical records for at least 7 years from the date of last treatment, or longer if other law requires. For patients under 18, records must be kept until the patient turns 21 or for 7 years from the last treatment, whichever is longer. Practices must keep access to the records for the full retention period.

Recent changes

• Texas Medical Board rules reorganized, effective January 9, 2025: the old medical records chapter (22 TAC Chapter 165) was repealed and replaced by Chapter 163. Fee caps and the 7-year retention rule now sit in §§ 163.3 and 163.2.
• SB 922 (2025), effective September 1, 2025: added the 3-day hold on releasing sensitive test results through a patient portal (Occupations Code § 159.0062) and tied the § 159.006 response deadline to it.

What this means for your practice

• Count 15 business days from receipt of a valid written consent, whether it comes from the patient or the patient's attorney.
• Check that the consent names the records, the purpose and the recipient before releasing anything.
• Charge no more than the board caps, and for a patient's own request stay within HIPAA's cost-based fee.
• Do not ask for a subpoena when a proper consent is provided, and do not hold records over an unpaid balance.
• Send billing records only when asked, and be ready to sign an itemized § 18.001 affidavit for injury cases.
• Set your patient portal to hold cancer-related pathology and radiology reports and genetic results until the third day after they are finalized.

Sources

1. Texas Occupations Code Chapter 159 (§§ 159.001–159.008, physician-patient confidentiality and records)
2. Texas Health and Safety Code § 181.102 (electronic health records access)
3. 22 Texas Administrative Code § 163.3 (requests for medical records and fees)
4. 22 Texas Administrative Code § 163.2 (medical record retention)
5. Texas Medical Board, Patient Information and Medical Records
6. Texas Civil Practice and Remedies Code § 18.001 (affidavit of cost and necessity of services)
7. Texas Health and Safety Code Chapter 611 (mental health records)
8. Texas Health and Safety Code § 81.103 (HIV test result confidentiality)
9. SB 922, 89th Legislature (2025), enrolled text

How we verified: we read the statutes on the official Texas Constitution and Statutes site, SB 922 on the Texas Legislature site, the Texas Medical Board's patient records page, and the current board rules in the Cornell LII copy of the Texas Administrative Code on November 12, 2026.