HB 4503

relating to electronic health record requirements.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1.  Subtitle I, Title 2, Health and Safety Code, is
amended by adding Chapter 183 to read as follows:
CHAPTER 183.  ELECTRONIC HEALTH RECORDS
Sec. 183.001.  DEFINITIONS.  In this chapter:
(1)  "Biological sex" means the biological trait that
determines whether a sexually reproducing organism produces male or
(2)  "Female" means an individual whose reproductive
system is developed to produce ova.
(3)  "Governmental entity" means this state, an agency
of the executive, legislative, or judicial branch of state
government, or a political subdivision of this state.  The term
includes a local health department.
(4)  "Health care practitioner" means an individual who
is licensed, certified, or otherwise authorized to provide health
(5)  "Male" means an individual whose reproductive
system is developed to produce sperm.
(A)  a facility licensed or registered by a state
agency to provide medical care and other health care services; or
(B)  a health care facility in this state that
provides medical care and other health care services and that
receives reimbursement under the state Medicaid program or receives
any other state funding, including pass-through federal money
provided to a state agency for grant awards.
(7)  "Sexual development disorder" means a congenital
condition associated with atypical development of internal or
external genital structures.  The term includes a chromosomal,
gonadal, and anatomic abnormality.
Sec. 183.002.  REQUIREMENTS FOR ELECTRONIC HEALTH RECORD
STORAGE.  (a)  Each medical facility, health care practitioner, and
governmental entity shall store all electronic health record
information of residents of this state only at a location in the
(b)  Each medical facility, health care practitioner, and
governmental entity shall ensure electronic health record
information of residents of this state, other than open data, is
inaccessible to any person located outside of the United States.
Sec. 183.003.  REQUIRED MEDICAL HISTORY INFORMATION IN
ELECTRONIC HEALTH RECORD.  A medical facility, health care
practitioner, or governmental entity shall ensure each electronic
health record maintained for an individual includes the
individual's medical history and any communications between the
practitioner and a specialty health care practitioner related to
the individual's metabolic health and diet in the treatment of a
Sec. 183.004.  INFORMATION RESTRICTIONS IN ELECTRONIC
HEALTH RECORD.  A medical facility, health care practitioner, or
governmental entity may not collect or store any information
regarding an individual's credit score or voter registration status
in the individual's electronic health record.
Sec. 183.005.  ARTIFICIAL INTELLIGENCE IN ELECTRONIC HEALTH
RECORD.  A health care practitioner who uses artificial
intelligence for diagnostic or other purposes, including the use of
artificial intelligence for recommendations on a diagnosis or
course of treatment based on a patient's medical record, shall
review all information obtained through the artificial
intelligence process to ensure the accuracy of the information for
that patient before entering the information in the patient's
Sec. 183.006.  ACCESS TO ELECTRONIC HEALTH RECORD OF MINOR.
(a)  In this section, "minor" means an individual under 18 years of
age who has not had the disabilities of minority removed for general
(b)  A medical facility, health care practitioner, or
governmental entity shall ensure each electronic health record
system the facility, practitioner, or entity uses to store
electronic health records of minors automatically allows a minor's
parent, guardian, or conservator to fully access the minor's
electronic health record unless access to all or a portion of the
record is restricted under state or federal law or by a court order.
Sec. 183.007.  ELECTRONIC HEALTH RECORD REQUIREMENTS
REGARDING BIOLOGICAL SEX.  (a)  Notwithstanding any other law, the
commission, the Texas Medical Board, and the Texas Department of
Insurance shall jointly ensure that:
(1)  each electronic health record prepared or
maintained by a medical facility, health care practitioner, or
governmental entity in this state includes a separate space for the
health care practitioner to document:
(A)  an individual's biological sex as either male
or female based on the individual's observed biological sex
recorded by a health care practitioner at birth; and
(B)  information on any sexual development
disorder of the individual, whether identified at birth or later in
(2)  any algorithm or decision assistance tool included
in an electronic health record to assist a health care practitioner
in making medical treatment decisions is based on an individual's
biological sex as recorded in the space described by Subdivision
(b)  This section does not prohibit an electronic health
record from including spaces for recording other information
related to an individual's biological sex or gender identity.
Sec. 183.008.  AMENDING CERTAIN BIOLOGICAL SEX INFORMATION
IN ELECTRONIC HEALTH RECORDS.  (a)  A medical facility, health care
practitioner, or governmental entity may amend on an electronic
health record an individual's biological sex as recorded in the
space described by Section 183.007(a)(1)(A) only if:
(1)  the amendment is to correct a clerical error; or
(2)  the individual is diagnosed with a sexual
development disorder and the amendment changes the individual's
listed biological sex to the opposite biological sex.
(b)  If an individual's biological sex is amended under
Subsection (a)(2), the medical facility, health care practitioner,
or governmental entity shall include in the individual's electronic
health record information on the individual's sexual development
disorder in the space described by Section 183.007(a)(1)(B).
Sec. 183.009.  DISCIPLINARY ACTION BY LICENSING AGENCY;
MEDICAID REIMBURSEMENT INELIGIBILITY.  (a)  The appropriate state
licensing agency may take disciplinary action against a medical
facility or health care practitioner that violates this chapter as
if the medical facility or health care practitioner violated an
(b)  The commission may not provide Medicaid reimbursement
to a medical facility or health care practitioner that violates
this chapter and shall disenroll the medical facility or health
care practitioner from participation as a Medicaid provider.
Sec. 183.010.  RULES.  The commission, the Texas Medical
Board, and the Texas Department of Insurance shall adopt rules as
necessary to implement this chapter.
SECTION 2.  (a)  Except as provided by Subsection (b) of this
section, Chapter 183, Health and Safety Code, as added by this Act,
applies only to an electronic health record prepared on or after the
(b)  Section 183.002, Health and Safety Code, as added by
this Act, applies to the storage of an electronic health record on
or after January 1, 2026, regardless of the date on which the
electronic health record was prepared.
SECTION 3.  This Act takes effect September 1, 2025.