AF Form 3899M: PCA/PNB Epidural Hand-Off Patient Record

AF Form 3899M: PCA/PNB Epidural Hand-Off Patient Record – The AF Form 3899M, officially titled Patient Movement Record PCA/PNB/Epidural Hand-Off, is a specialized U.S. Air Force form used in aeromedical evacuation (AE) and patient movement operations. It ensures safe, standardized hand-off and documentation for patients receiving Patient-Controlled Analgesia (PCA), Peripheral Nerve Block (PNB), or epidural analgesia during transport between medical treatment facilities (MTFs), staging areas, or en route care.

This form supports the broader AF Form 3899 series used in the Air Force aeromedical evacuation system and belongs to the en route care documentation tools governed by Department of the Air Force Instruction (DAFI) 48-107V3, En Route Care Documentation.

Why the AF Form 3899M Matters in Patient Movement?

Patient movement in the U.S. Air Force, including aeromedical evacuation, requires meticulous documentation to maintain continuity of care, ensure patient safety, and meet regulatory standards. The 3899M specifically addresses the unique challenges of managing advanced pain control modalities—PCA pumps, continuous peripheral nerve blocks, and epidurals—during transfers where responsibility shifts between sending and receiving teams (e.g., from ground MTF staff to Aeromedical Evacuation Crew Members or CCATT teams).

Key purposes include:

  • Verifying privileged provider orders and pump programming.
  • Documenting physical verification of tubing, connections, and pump security (locked status).
  • Recording infusion history (volume infused, boluses delivered/attempted).
  • Capturing required patient assessments and teaching.
  • Providing a permanent part of the medical record with mandatory drug accountability.

Proper use of the form helps prevent medication errors, ensures compliance with pain management protocols, and supports high-reliability hand-offs in dynamic environments like aircraft or staging facilities.

When and How the AF Form 3899M Is Used?

Medical personnel use the AF Form 3899M whenever a patient with an active PCA, PNB, or epidural requires movement. This includes:

  • Transfers between MTFs.
  • Hand-offs to aeromedical evacuation teams.
  • En route care during flight or ground transport.
  • Staging in En Route Patient Staging Systems (ERPSS).

It works alongside the primary AF Form 3899 (Aeromedical Evacuation Patient Record) and may pair with AF Form 3899N (Patient Movement Pain Adjunct Flow Sheet) for ongoing q2h assessments.

Minimum documentation frequency: Assess and document at least every 2 hours while the infusion is active. This includes:

  • Baseline pain score.
  • Vital signs with pulse oximetry.
  • Motor Activity Assessment Scale (MAAS) or sedation level.
  • Medication side effects.

Specific requirements:

  • Epidural: Document dermatome levels.
  • PNB: Assess and document sensation and circulation distal to the catheter insertion site.

Key Sections and Fields on AF Form 3899M

The two-sided form includes structured sections for identification, initial setup/verification, and multiple hand-off opportunities.

Patient Identification:

  • Name (Last, First, Middle Initial)
  • Date of Birth
  • Service/Status, CITE # / Patient ID
  • Allergies (Food, Drug, and Latex)

Initial Physician Order Verification and Pump Set-Up:

  • Verification that the privileged provider order for the PCA/PNB/Epidural pump, pain management, and any sedation/treatment medications is confirmed (RN #1 & #2 initials).
  • Medication details (e.g., Morphine 1 mg/mL or Dilaudid 0.2 mg/mL; alternate concentration if needed).
  • Pump programming: Program #, Basal Flow Rate, Bolus Dose, Lock Out Interval, Volume to be infused.
  • Confirmation that the pump is Locked, tubing connections are correct, tubing is labeled, and patient teaching completed (initials required).

Patient Care Hand-Off Sections (multiple blocks, typically #1–#4): Each hand-off requires dual verification (sending and receiving personnel):

  • Privileged provider order and pump program verified per order.
  • Pump locked status.
  • Correct tubing connections confirmed.
  • Infusion history: Total volume infused, number of boluses delivered and attempted, elapsed time.
  • History cleared? (Y/N)
  • IV/pump site assessed.
  • Tubing labeled.
  • Patient/family teaching completed.
  • Signatures and initials of both sending and receiving clinicians.

Back of the Form: Serves as a flow sheet for continued assessments and progress notes.

Drug Accountability: Mandatory per referenced instructions (historically AFI 41-307, now aligned with current DAFI guidance).

All entries become part of the permanent medical record and are protected by the Privacy Act of 1974.

Best Practices for Completing the AF Form 3899M

  1. Use two RNs (or qualified clinicians) for initial setup and critical verifications to enhance safety through independent double-checks.
  2. Perform read-back verification for orders and pump settings.
  3. Clear pump history at appropriate hand-off points and document it.
  4. Ensure pump is locked after programming or changes.
  5. Document allergies clearly and verify no contraindications (e.g., latex).
  6. Combine with I-SBAR or similar hand-off communication tools for verbal report.
  7. File or attach the completed form to the primary patient movement record for continuity.

Failure to complete required fields or verifications can compromise patient safety and regulatory compliance during aeromedical evacuation.

Download the Official AF Form 3899M

The current version (AFFORM3899M, 20140813) is available as a fillable PDF directly from the official U.S. Air Force e-Publishing site:

→ Download AF Form 3899M PDF

Always use the most recent version from e-Publishing.af.mil and consult your local medical treatment facility or Aeromedical Evacuation Squadron policies, as electronic health record (EHR) equivalents may supplement or replace paper forms when available.

  • DAFI 48-107V3 – En Route Care Documentation
  • AF Form 3899 series (including 3899, 3899L for critical care, 3899N for pain adjuncts)
  • TRAC2ES system for Patient Movement Requests (PMR)
  • Aeromedical Evacuation training and competencies (e.g., patient hand-off using I-SBAR)

For questions on proper use, contact your unit’s Aeromedical Evacuation or En Route Care experts, or refer to current Department of the Air Force publications.

This guide is for informational purposes and is based on publicly available official U.S. Air Force forms and instructions. Always follow the latest guidance from Air Force e-Publishing and your chain of command.