In addition to my statee laws and guidance on their HHS site, I found these
"While federal law strongly encourages the use of EHR systems, it doesn't mandate it across all healthcare providers in the United States. The HITECH Act, ARRA, and 21st Century Cures Act have incentivized and supported EHR adoption, particularly among providers participating in Medicaid and Medicare. However, the decision to implement an EHR system ultimately rests with individual healthcare providers, based on their specific circumstances and needs."
and this from a HC law firm
"To be clear, the Cures Act does not require you to adopt an EMR or EHR system at your practice. Additionally, at this time, there is no federal ban prohibiting the use of paper records as part of your practice operations. The Cures Act requirements only apply to electronic patient health information. In other words, if you are using paper records, the Cures Act’s final rulemaking process does not apply to you."