Premier Medical Group - Multispeciality Practice in Clarksville, Tennessee

Notice of Privacy Practices

Notice of Privacy Practices
Premier Medical Group, P.C. (“Premier”)

Updated: August 2022


This Notice describes how Premier may use or disclose your individually identifiable health information (protected health information or PHI). Premier is required by law to maintain the privacy of your PHI, to provide you with notice of our legal duties and privacy practices with respect to PHI, and to notify affected individuals following a breach of unsecured PHI. PHI is information about you, including medical information, billing information and basic demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related healthcare services.  PHI may include records of testing or treatment for drug or alcohol abuse, mental health, HIV/AIDs, if applicable. 

This Notice of Privacy Practices (“Notice”) describes the privacy practices of Premier and describes your rights with respect to your PHI. We are required to abide by terms of this Notice. We reserve the right to revise or change this Notice and to make any such change applicable to all PHI that we maintain (including PHI obtained before the change).  The terms of this notice apply to your entire PHI created or maintained by Premier. We may revise or amend this Notice as necessary. Any revisions or amendments to the Notice will be effective for all records created or maintained by Premier whether past, present or future. A copy of our current Notice can be found on the website at

  1. How We May Use and Disclose Your PHI (without an authorization)

This section discusses how your PHI may be used or disclosed without an authorization. Not every use or disclosure in a category will be listed. Your PHI may be stored in paper, electronic or other form and may be disclosed electronically and by other methods.

• Treatment –We will use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. For example, we may disclose your PHI to other physicians, professionals and health care providers that are treating you or involved in your care. If you participate in a virtual visit, your information will be shared electronically via secure means. If you require language translation assistance for your visit, the necessary information will be securely shared with the translation service. 

• Payment –We will use and disclose your PHI for purposes of receiving payment for treatment and services that you receive. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as: making a determination of eligibility for benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.  For example, we may disclose your PHI to your health plan to obtain approval for a hospital stay.  We may release all applicable medical information to all applicable insurance carriers, other third party payer’s, Social Security Administration, disability or Workers’ Compensation, or for other payment purposes. We may provide PHI to entities that help us submit bills and collect amounts owed, such as collection agencies.

• Healthcare Operations –We may use and disclose your PHI in performing a variety of business activities defined as “healthcare operations.” For example we may use and disclose your PHI to: evaluate the skills and performance of healthcare providers and employees involved in your care;  provide training; cooperate with outside organizations that evaluate, accredit, license or certify healthcare providers, staff or facilities, resolve complaints and establish process improvements within Premier,  arrange for legal services, budgeting and financial reporting and conduct quality or patient safety activities, population health based activities, case management and care coordination . We may also contact you to provide appointment reminders, leave messages or requests for a return on your voicemail or answering machine or through other methods. We may make incidental disclosures of limited PHI, such as by using sign-in sheets in our waiting rooms or calling out names in our waiting rooms when calling back patients for their appointments.

• Health Information Exchanges – We may participate in one or more Health Information Exchanges (HIEs) and may electronically share your PHI for treatment, payment and permitted healthcare operations purposes with other participants in the HIE, including disclosing your PHI to other providers who participate in an HIE program called Patient Record Sharing. Patient Record Sharing allows the exchange of PHI among providers that use compatible electronic health records. HIEs allow your health care providers to efficiently access and use your PHI as necessary for treatment and other lawful purposes. We recognize the right to choose not to participate in HIE. If you should choose not to participate please notify our practice in writing to opt out. 

• Others Involved in Your Care –Unless you object, we may disclose relevant PHI about you to a relative, close personal friend or any other person you identify if that person is involved in your care. If the patient is a minor, we may disclose medical information about the minor to a parent, guardian or other person responsible for the minor. If the patient is a minor, we may or may not be able to agree to your request for PHI. We may also disclose your PHI to disaster relief agencies to assist them in notifying those involved in your care of your location and general condition. If you are not present, you are incapacitated, or there is an emergency, we may, using our professional judgment, determine that it is in your best interests for us to disclose PHI that is directly relevant to the person’s involvement with your care.  

• Required by Law – We may use and disclose PHI about you as required by law. For example, we may disclose PHI about you to the U.S. Department of Health and Human Services if it requests such information to determine that we are complying with federal privacy law.

• Public Health – We may use and disclose for public health activities, such as controlling disease, injury or disability, disclosures to the State of Tennessee Immunization Registry (past & current immunizations) , disclosures to the Food and Drug Administration in connection with post-market surveillance and other FDA functions, and disclosing PHI to a person who may have been exposed to communicable disease consistent with applicable law. Tennessee State Law also authorizes the release of immunization information to other healthcare professionals, pharmacists, as well as to schools and daycare facilities requiring prof for participation and/or enrollment.

• Business Associates – We may disclose your PHI to individuals and entities that perform various jobs on our behalf (“Business Associates”), such as our billing company. Business Associates are required to safeguard your PHI.

• Health Oversight – We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections in connection with their oversight of the health care system, government benefit programs, other government regulatory programs and civil rights laws.

• Abuse or Neglect – We may use or disclose your PHI to the appropriate government authorities if we believe that abuse, neglect or domestic violence has occurred. We will inform the individual that we have made such a report, unless we believe that doing so would place the individual at serious risk of harm. We will make such reports only as required or authorized by law, or if the individual agrees.

• Legal Proceedings – We may use and disclose PHI in the course of any judicial or administrative proceeding, in response to a court order, a subpoena, a discovery request or other lawful process.

• Coroners, Funeral Directors, and Organ Donation – We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose PHI to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties.  PHI also may be used and disclosed for cardiac organ, eye or tissue donation purposes. We may disclose such PHI following or in reasonable anticipation of death.

• Law Enforcements/ Health and Safety – Consistent with applicable laws, we may disclose your PHI if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose PHI if it is necessary for law enforcement authorities to identify or apprehend an individual, to investigate a crime or for other law enforcement purposes permitted by law.

• Military Active and National Security Program – We may disclose PHI for specialized government functions, such as when requested by the armed forces for enlisted personnel, veterans, foreign military personnel, and national security and intelligence.

• Workers’ Compensation and Occupational Medicine –  We may release PHI about you to your employer if we provide health care services to you at the request of your employer, and the health care services are provided either to conduct an evaluation relating to work placement/employment or to evaluate whether you have a work-related illness or injury.  We may disclose your PHI to the extent necessary to comply with laws relating to Workers Compensation.

• Inmates – We may disclose PHI in certain circumstances for inmates in custody, as necessary for your health and the health and safety of other individuals.

• Research – We may use your PHI for research or disclose your PHI to researchers to assist in the preparation of a research study or when the research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.

• Minors – We may disclose your PHI to your parent or guardian unless otherwise prohibited by law.

2. Uses and Disclosures  with an Authorization

Except for uses and disclosures described above, we will only use and disclose your PHI with your written authorization. Subject to compliance with limited exceptions, we will not use or disclose psychotherapy notes, use or disclose your PHI for  marketing purposes or sell your PHI, unless you have signed an authorization. You may revoke an authorization by notifying us in writing. However, your decision to revoke the authorization will not affect or undo any use or disclosure of PHI that occurred before you notified us of your decision to revoke your authorization.

3. Your Rights with Respect to PHI about You 

To exercise any of the following rights, please contact our Privacy Officer in writing at the address or fax number at the top of this Notice. You have the right to:

• Request a restriction on certain uses and disclosures of your health information by delivering the request to our Privacy Officer. We are not required to grant the request, except for disclosures to a health plan when you have paid in full out-of-pocket for your care. You may also request to opt out of participation in HIEs and Patient Record Sharing (see description of HIEs Section 1 of this Notice). 

• Obtain a paper copy of the current Notice of Privacy Practices for Protected Health Information (Notice) by submitting the request to our Privacy Officer (even if you have previously agreed to receive this Notice electronically). 

• Inspect and obtain a copy of your PHI that we maintain or direct us to send a copy of your PHI to another person designated by you in writing. In most cases, we will provide this access to you or the person you designate within 30 days of your request. This right applies to PHI used to make decisions about you or payment for your care, subject to limited exceptions. We may charge you a reasonable, cost-based fee for labor, supplies and/or postage consistent with applicable laws.

• Request that your health care record be amended to correct incomplete or incorrect information. We may deny your request if the PHI is already correct or for certain other reasons permitted by law, but we will tell you why within 60 days of receiving your request. 

• Request that communication of your health information be made by alternative means or at an alternative location. We will accommodate reasonable requests.

• Obtain an accounting of disclosures (that have been made within the last 6 years) of your PHI that is documented in our system as required.  An accounting will not include disclosures we are not required by law to record such as disclosures made pursuant to an authorization. The first list you request within a 12-month period is free, but we may charge a fee for any additional lists that you request. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.

If you have given another individual a medical power of attorney, if another individual is appointed as your legal guardian or if another individual is authorized by law to make health care decisions for you (known as a “personal representative”), that individual may exercise any of the above rights listed for you. 

4. Additional Information

• Sensitive Health Information: There are additional State and Federal laws protecting information such as psychotherapy notes, substance use disorders and treatment, mental health, AIDS/HIV, abortion and reproductive health and other communicable diseases which may limit how we may use and disclose the information. Premier Medical Group will ask for specific authorization relating to the release of the above mentioned health information.

• Incidental Disclosures: Premier Medical Group will make every effort to protect your privacy. At times, we may use or disclosure information where complete privacy cannot reasonably be prevent but is limited in nature that may result in an incidental disclosure. These disclosures are not considered a breach.

5. You  May File a Complaint 

If you have any questions about this Notice or would like to file a complaint, please contact: 

Privacy Officer 
Premier Medical Group 
P.O. Box 3799 Clarksville, TN 37043 
Phone: (931) 245-7000 Fax: (931) 245-7069 

You can file directly with the U.S. Department of Health and Human Services Office for Civil Rights

U.S. Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201
Phone: (877) 696-6775




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