AF Form 2130B: Health Record – Dental (Gray) | USAF MTF

AF Form 2130B: Health Record – Dental (Gray) | USAF MTF – If you’re a U.S. Air Force service member, dental professional, or administrator working in a USAF Medical Treatment Facility (MTF), you may need the AF Form 2130B, officially titled Health Record – Dental (Gray). This specialized form serves as the outer jacket for organizing and storing dental health records. It is authorized exclusively for use by USAF Medical Treatment Facilities.

This article explains what AF Form 2130B is, its purpose, how it fits into the broader AF Form 2100B series of dental health record jackets, filing procedures, and where to access the official download. Information is drawn from current Air Force e-Publishing references and training materials as of the latest available guidance.

What Is AF Form 2130B?

AF Form 2130B is a colored folder (gray) used as the physical jacket for a patient’s Service Treatment Record (STR) dental portion. It helps standardize the storage and retrieval of dental documentation within USAF dental clinics.

  • Full Title: Health Record – Dental (Gray)
  • Color: Gray
  • Restriction: For use by USAF Medical Treatment Facilities ONLY
  • Part of Series: AF Form 2100B–2190B dental health record jackets

These jackets follow a terminal digit filing system based on the last two digits of the patient’s Social Security Number (SSN). The gray jacket (AF Form 2130B) corresponds specifically to patients whose SSN ends in 30-39.

Color-Coded AF Form 2100B Series for Dental Health Records

The Air Force uses a color-coded system to streamline filing and reduce errors in dental record management:

  • 00-09: Orange (AF Form 2100B)
  • 10-19: Green (AF Form 2110B)
  • 20-29: Yellow (AF Form 2120B)
  • 30-39: Gray (AF Form 2130B)
  • 40-49: Tan (AF Form 2140B)

(Additional colors and forms continue the series for higher terminal digits.)

This system is detailed in USAF dental assistant training materials, such as the Qualified Training Package (QTP) for the Dental Assistant Specialty, which covers patient administration, record creation, and filing procedures.

Dental staff select the appropriate colored jacket when initiating or updating a patient’s dental health record. Inside the jacket, providers file treatment notes, radiographs, examination results, and other dental documentation.

Purpose and Usage in USAF Dental Clinics

AF Form 2130B supports key functions in Air Force dental services:

  • Organizing Service Treatment Records (STR): It serves as the durable outer folder for long-term storage of dental health information.
  • Patient Administration: Used during in-processing, routine dental exams, treatment visits, and readiness tracking under the Air Force Dental Assurance and Readiness Program.
  • Compliance with Standards: Helps meet requirements for accurate record-keeping as outlined in Air Force dental policies and related instructions like DAFMAN 48-123 (Medical Examinations and Standards) and AFI 47-101 (Managing Air Force Dental Services).

Important Note: This form is not for general public or civilian use. It is restricted to authorized USAF MTF personnel. Civilians or non-USAF facilities should not request or use it.

How to Properly Use and File AF Form 2130B?

According to dental assistant training guidelines:

  1. Verify patient identification using their ID card.
  2. Confirm eligibility in DEERS (Defense Enrollment Eligibility Reporting System) for non-active duty patients if applicable.
  3. Have the patient complete required forms (e.g., AF Form 696, DD Form 2005, and any Notice of Privacy Practices acknowledgment).
  4. Select the correct colored jacket based on the terminal digits of the SSN (Gray for 30-39).
  5. File dental treatment documentation inside the jacket using standardized procedures.
  6. Maintain the record in accordance with Air Force records management policies.

Supervisors certify training and performance related to these procedures in the member’s Air Force Training Record (AFTR).

Proper use ensures quick retrieval, supports dental readiness tracking, and maintains compliance with privacy and records disposition rules.

Where to Download AF Form 2130B?

The official sources for Air Force forms are hosted on the Department of the Air Force e-Publishing website (e-publishing.af.mil). However, the provided direct links point to the physical record jacket files:

Recommended Steps:

  • Visit the official Air Force e-Publishing site at https://www.e-publishing.af.mil/ for the most current versions and related publications.
  • Search for AF Form 2130B or browse the forms catalog under Medical or Dental categories.
  • Always verify you are using the latest revision, as forms can be updated.

For Authorized Personnel Only: Access may require CAC (Common Access Card) or appropriate credentials when downloading from official .mil domains. Unauthorized distribution or use is not permitted.

  • DAFMAN 48-123: Medical Examinations and Standards – Covers broader medical and dental record requirements.
  • AFI 47-101: Managing Air Force Dental Services – Details operational procedures for dental clinics.
  • QTP 4Y0X1-5: Dental Assistant Specialty Patient Administration training module – Provides hands-on guidance on using the AF Form 2100B series jackets.

These publications emphasize accurate documentation to support mission readiness, deployment eligibility, and long-term health tracking for Airmen.

Who Needs AF Form 2130B?

  • USAF dental technicians and assistants
  • Dentists and oral health providers in MTFs
  • Patient administration staff managing Service Treatment Records
  • Supervisors training personnel on dental record procedures

If you are a U.S. Air Force member seeking your own dental records, contact your local MTF dental clinic or the Patient Administration office. Requests for copies of records typically use forms like DD Form 2870 (Authorization for Disclosure of Medical or Dental Information).

Final Tips for USAF Personnel

  • Always use the correct color-coded jacket to avoid filing errors.
  • Follow terminal digit filing rules consistently.
  • Keep records secure and compliant with HIPAA-equivalent DoD privacy standards.
  • For training or questions, refer to your base dental clinic or the latest Qualified Training Packages.

Download Links (Official):

For the most up-to-date information, always start at the official Air Force e-Publishing portal.

This article is for informational purposes and references publicly available USAF training and publications. Policies and forms can change; verify with official sources or your MTF for current requirements.