AF Form 244: Clinical Privileges – Dentist (Download)

AF Form 244: Clinical Privileges – Dentist (Download) – AF Form 244, officially titled Clinical Privileges – Dentist, is the official US Air Force form used to request, verify, and document the scope of clinical practice for dentists serving in Air Force Medical Treatment Facilities (MTFs). It ensures that every dentist practices only within the limits of their verified training, experience, and demonstrated competence, while maintaining the highest standards of patient safety and care for service members, families, and beneficiaries.

What Is AF Form 244 Used For?

The primary purpose of AF Form 244 is to define the scope and limits of practice for individual dental providers. Privileges are granted based on a thorough evaluation of the dentist’s credentials, education, training, and ongoing performance.

Key aspects include:

  • Requesting core and non-core dental procedures.
  • Documenting competency levels using standardized codes.
  • Obtaining recommendations from clinical supervisors and final approval from the Dental Commander/Chief or appropriate authority.
  • Supporting credentialing and privileging processes governed by AFI 44-119 (Medical Quality Operations) and related Department of Defense policies.

This form applies to active duty, reserve, and certain civilian dentists working in Air Force facilities. It is part of a broader Military Health System (MHS) effort to streamline credentialing while upholding rigorous quality assurance standards.

Download the official AF Form 244 here: https://static.e-publishing.af.mil/production/1/af_sg/form/af244/af244_rev.pdf

Structure of AF Form 244

The form is divided into clear sections:

Part I: List of Clinical Privileges – Dentist

  • Section A: Core Privileges — Foundational procedures that all dental AFSCs typically request. Asterisked items require a Code 1 or 2 request.
  • Section B: Non-Core Privileges — Advanced or specialized procedures that require additional justification (e.g., specific training title and completion date).

Part II: Clinical Supervisor’s Recommendation

  • The supervisor reviews the request against the facility’s master privileges list and recommends approval, approval with modification, or disapproval.

Additional sections document forwarding to the Credentials Function, approvals, remarks, and biennial review requirements.

Understanding the Privilege Codes

Dentists and supervisors use these codes:

  • Code 1: Fully competent within the defined scope of practice.
  • Code 2: Supervision required (e.g., due to limited recent experience or certification status).
  • Code 3: Not approved due to lack of facility support (used by the Credentials Function).
  • Code 4: Not requested or not approved due to lack of expertise, proficiency, physical limitation, or other factors.

Applicant instructions: When requesting privileges, enter Code 1, 2, or 4 in the REQUESTED column based on your current capability—do not factor in facility limitations. The clinical supervisor then enters the VERIFIED code using the local master privileges list.

Core vs. Non-Core Privileges for Dentists

Core Privileges (typically requested by general dentists) include essential procedures such as:

  • Oral diagnosis and evaluation (clinical exams, oral cancer screening, radiographs).
  • Preventive dentistry (prophylaxis, fluoride applications).
  • Restorative dentistry.
  • Basic endodontics (e.g., pulpectomy, root canal therapy).
  • Periodontics (scaling and root planing).
  • Prosthodontics (e.g., complete and partial dentures).
  • Oral surgery (simple extractions, suturing).
  • Emergency orthodontic care.
  • Pediatric dentistry basics.
  • Local anesthesia and palliative/emergency pain management.

Non-Core Privileges require justification and may include advanced procedures like:

  • Surgical placement of dental implants.
  • Comprehensive orthodontic treatment.
  • Gingivectomy or osseous surgery.
  • Intravenous sedation or nitrous oxide anxiolysis.
  • Surgical removal of impacted teeth.
  • Maxillofacial prosthetics or advanced diagnostic imaging (e.g., sialography).
  • Hospital admission privileges or operating room procedures.

Specialties such as Oral and Maxillofacial Surgery, Comprehensive Dentistry, Prosthodontics, or Orofacial Pain often require additional privilege lists in conjunction with AF Form 244 and may involve DHA Form 367.

How to Complete AF Form 244 (Step-by-Step for Dentists)?

  1. Prepare your documentation — Gather proof of training, continuing education, and recent clinical experience.
  2. Fill Part I — Request privileges using the appropriate codes. For non-core items, provide training details in the justification column.
  3. Sign and date — Acknowledge understanding of Air Force Dental Clinical Practice Guidelines.
  4. Forward to Clinical Supervisor — They verify against the facility master list and provide a recommendation in Part II.
  5. Credentials review — The form goes to the Credentials Function and ultimately receives approval (or modification) from the Medical/Dental Commander.
  6. Biennial review — Privileges are typically reviewed every two years or as required by policy.

Tip for new or transitioning dentists: Civilian graduates and those completing training programs should follow the specific Clinical Privilege List Instructions from the Air Force Medical Service Credentials Verification Office rather than relying solely on the form’s built-in instructions to avoid delays.

Recent Context in Air Force and MHS Dental Credentialing

The Defense Health Agency (DHA) has implemented streamlined privileging processes across the Military Health System. As of late 2025, approved providers can more easily retain privileges when moving between facilities, reducing administrative burden while preserving safety standards. Dentists should check with their local Credentials Office for the most current integration of these policies with AF Form 244.

Why Proper Use of AF Form 244 Matters

Accurate completion of this form protects patients, supports mission readiness, and ensures compliance with federal regulations (Title 10, U.S.C. §§ 1094 and 1102). Information from the form may be shared with licensing boards, professional societies, or civilian institutions when needed for credentialing or monitoring.

Failure to provide required information can result in limitation or termination of privileges. All entries must be made in ink, and previous editions of the form are obsolete.

Need Help with AF Form 244 or Dental Privileging?

  • Visit the official Air Force Medical Service Credentials Verification Office page for dentists: airforcemedicine.af.mil.
  • Consult your local MTF Credentials Office or Dental Commander for facility-specific master privilege lists and guidance.
  • Review AFI 44-119 and related DoD instructions for full policy details.

Keywords: AF Form 244, clinical privileges dentist Air Force, USAF dental credentialing, dentist privileges request, Air Force dentist form 244, core dental privileges, military dentist privileging process.

This article is for informational purposes only and is based on official Air Force publications and forms. Always refer to the current version of the form and consult your chain of command or Credentials Office for official guidance, as processes may evolve.

For the most current PDF, use the direct link provided above from e-Publishing.af.mil.