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This paper presents findings of a Master of Philosophy Degree in Information Sciences undertaken to assess medical records management (MRM) in support of evidence-based medical practices at Kisii Teaching and Referral Hospital (KTRH) with a view of proposing strategies to improve MRM in the hospital. Data was collected through interviews conducted with health records management officers, a system administrator, admission clerks, doctors, clinical officers, and nurses drawn from four departments that create; use; and manage medical records (MR). Findings indicated that KTRH faced several challenges in MRM that impact the provision of health care based on reliable evidence. These challenges included an absence of comprehensive MRM policies and procedural frameworks, and a scarcity of MRM knowledge and skill at the hospital. Although KTRH has adopted the use of information and communication technology (ICT), MRM processes were partially automated. The study concluded that the general status of MRM at KTRH was inadequately positioned to manage MR as a strategic evidence resource in a continuum from creation to disposition, and therefore requires urgent attention. The study recommends that for the MRM at KTRH to succeed, the hospital needs to integrate MRM functional, structural and infrastructural aspects into the hospital’s health information system and continuously manage MR in line with the Records Continuum Model and best-practice strategies proposed by this study. The hospital should also develop operational MRM policies and procedural frameworks, build MRM capacity and provide MRM knowledge and skill to staff; improve on its ICT infrastructure and integrate MRM functionalities.