In Texas, when I used to manage information at a pediatric hospital, I kept 
the records on the shelf as long as possible.  However, when a record became 
inactive for one reason or another, I would calculate the patient's 21'st 
birthday and compare it to a retention period of 10 years after the date of 
the last visit....whichever was the longer of the two....and group purges by 
the date that calculated as the longer of the two retention periods.  That 
way, all of the records in the box aged out at the same time.

In some states, I believe that the cut-off is age 20, but we always used age 
21...it was recommended by our legal team at the time.  You can use an excel 
spreadsheet to calculate or you can simply enter a patients birthdate and 
have a little SQL routine calculate both dates simultaneously.  Select the 
date for the longer of the two retention periods and group them 
accordiningly in a box either by month/year, quarter/year, or by 
year...depending on how often you shred records. 

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