Documentation retention: what HIPAA requires you to keep (and for how long)

HIPAA compliance breaks down when you can't produce records on demand.

Even strong technical controls can become legally weak if documentation is missing, scattered, or overwritten without history.

This article explains what you should retain, why retention must include versioning and audit trails, and how clinic owners can implement a defensible approach.

Why retention matters

HIPAA requires that documentation be retained for a minimum period—commonly six years from the date of creation or last effective date (whichever is later).

But retention is not just about storage. It is about:

• proof of existence at a specific point in time
• retrievability when requested
• version history to show how policies evolved
• integrity (proving records were not altered after the fact)

What you should retain

1. Policies and procedures

All HIPAA policies (Security, Privacy, Breach, Access Control, Risk Management, Training, BAA Management, Sanctions, Audit Logs, etc.) must be retained for six years.

When policies are revised, keep the old version. Never overwrite.

2. Risk analysis and risk management plans

Your security risk analysis and the remediation plan must be documented, dated, and retained. If auditors ask "show me your 2024 risk analysis," you need to produce it.

3. Training records

Keep workforce training records for at least six years, including:

• who trained
• when trained
• what content
• completion evidence (attestation or certificate)
• training materials (for defensibility)

4. Business Associate Agreements (BAAs)

Retain executed BAAs and amendments for six years after the relationship ends.

If you switch EHR vendors, keep the old BAA.

5. Audit logs and activity records

Retain system audit logs and compliance activity logs for six years. If you cannot show access logs from previous years, you may have a compliance gap.

6. Incident and breach records

Keep all incident documentation indefinitely—especially breach risk assessments, notification records, and corrective action plans.

7. Evidence and supporting documents

Evidence files (screenshots, vendor security confirmations, attestations, encryption settings) should also be retained to support policy statements.

Best practices for defensible retention

1. Do not overwrite

Version old documents instead of deleting. When you update a policy, save the new one as a new version and keep the prior version.

2. Timestamp everything

Every document, policy approval, training completion, and evidence upload should be timestamped and linked to a responsible party.

3. Centralize and organize

Avoid scattering documentation across email, shared drives, and personal folders. Keep compliance documentation in a structured system.

4. Automate where possible

If you can build in automatic retention rules (e.g., "retain training records for 7 years"), do it. Reduces manual error and missed expirations.

5. Track retention expiration

Know when documents are eligible for disposal and log the disposal decision.

What clinic owners should do next

1. Audit your current documentation—what do you have and where is it?
2. Build a retention schedule for each document type.
3. Ensure policies are versioned, not overwritten.
4. Add timestamps to training records, evidence uploads, and approvals.
5. Centralize retention in a compliance system (not email or scattered drives).

This is how compliance becomes defensible over time.