AF Form 2816-1: Family & Adult Nurse Practitioner Privileges – AF Form 2816-1: Clinical Privileges – Family and Primary Care/Adult Nurse Practitioners is the official U.S. Air Force form used to request, verify, and grant clinical privileges to Family Nurse Practitioners (FNPs) and Adult/Primary Care Nurse Practitioners practicing in Air Force Medical Treatment Facilities (MTFs).
This form ensures that advanced practice registered nurses (APRNs) operate within a defined scope of practice based on their education, training, experience, and demonstrated competency, in compliance with Air Force Instructions and federal regulations (Title 10, U.S.C. Chapter 55, Sections 1094 and 1102).
What Is AF Form 2816-1 Used For?
The principal purpose of AF IMT 2816-1 (dated 20020505, V1) is to document the scope and limits of clinical practice for individual nurse practitioners. Privileges are not automatic; they are granted only after a thorough evaluation of the provider’s credentials and performance.
- Applicants (the nurse practitioners) use the form to request specific privileges.
- Clinical Supervisors review and recommend approval, approval with modifications, or disapproval.
- The form is then forwarded to the facility’s Credentials Function for final processing.
Note: While the form itself is from 2002, the privileging process in the Air Force Medical Service (AFMS) continues to follow similar structured frameworks. Modern Department of Defense (DoD) Master Privilege Lists (MPLs) for Family Nurse Practitioners provide updated guidance and are used alongside or in place of legacy forms in many MTFs.
Who Needs to Complete AF Form 2816-1?
This form applies to:
- Family Nurse Practitioners (FNPs)
- Adult Nurse Practitioners
- Primary Care Nurse Practitioners working in Air Force clinics, hospitals, or other medical facilities
It helps standardize care across the Air Force while allowing facilities to tailor privileges based on local capabilities and patient populations (from infants to geriatrics for FNPs, or young adults to geriatrics for Adult/Primary Care NPs).
Structure of AF Form 2816-1
The two-page form is divided into two main parts:
Part I – List of Clinical Privileges
- The applicant enters a code in the REQUESTED column for each privilege (reflecting current capability, ignoring known facility limitations).
- The Clinical Supervisor or verifier enters a code in the VERIFIED column using the facility’s master privileges list.
Part II – Clinical Supervisor’s Recommendation
- The supervisor recommends Approval, Approval with Modification, or Disapproval, then signs and dates the form.
All entries must be made in ink.
Privilege Codes Used on the Form
| Code | Meaning |
|---|---|
| 1 | Fully competent within defined scope of practice |
| 2 | Supervision required (per facility master list) |
| 3 | Not approved due to lack of facility support |
| 4 | Not requested / not approved (due to lack of expertise, proficiency, or physical limitation) |
Core Privileges (Section A)
All applicants typically request these foundational privileges:
- Take, evaluate, and record comprehensive health histories.
- Perform comprehensive physical examinations.
- Order, conduct, and interpret screening studies, tests, and diagnostic procedures.
- Initiate consultations and collaborate with specialists.
- Diagnose, treat, and manage acute episodic and chronic illnesses, minor traumas, and behavioral/psychological problems.
- Provide patient and family education, counseling, and health promotion/disease prevention.
- Prescribe nonpharmacological therapies and pharmacological agents, including Schedule II-V controlled substances within the scope of primary care NP practice.
- Rotate after-duty hours as primary care manager (PCM) call.
Family Nurse Practitioner Specific Privileges (Section B)
FNPs manage patients across the lifespan (infants to geriatrics) and often include:
- Management of acute and chronic conditions, including behavioral/psychosocial issues and crisis intervention.
- Well-child care and immunizations.
- Prenatal care for low-risk pregnancies and common gynecological/obstetrical problems.
- Family planning counseling and procedures (oral contraceptives, diaphragm fitting, IUD and Norplant insertion/removal).
- Counseling on pregnancy, childbirth, child-rearing, unwanted pregnancy, and aging.
Primary Care/Adult Nurse Practitioner Privileges (Section C)
These focus on young adults through geriatrics and include similar management of medical, behavioral, and gynecological issues, plus family planning and health education.
Procedures (Section D)
The form lists numerous procedures that may be requested, including (but not limited to):
- Life support certifications (ACLS, PALS – Family only; NRP)
- Local and peripheral nerve block anesthesia
- Wound care, debridement, laceration repair, abscess I&D
- Biopsies (punch, excisional, shave), joint injections/aspirations, cryotherapy
- Gynecological procedures: Pap smear, colposcopy, endometrial biopsy, IUD insertion/removal, Bartholin’s cyst I&D
- Other advanced procedures: anoscopy, sigmoidoscopy, lumbar puncture, thoracentesis, foreign body removal, emergency airway procedures, and more.
Additional custom privileges can be specified in Section E.
How to Complete and Submit AF Form 2816-1?
- Applicant — Fills out requested privileges in Part I and forwards to the Clinical Supervisor.
- Clinical Supervisor — Verifies privileges and provides recommendation in Part II.
- Credentials Function — Reviews and processes per AFI 44-119 (Medical Quality Operations) and current DoD/AFMS privileging policies.
Important: Changes to approved privileges must follow official credentialing and privileging procedures. Disclosure of information is voluntary, but failure to provide required details may result in limitation or termination of privileges.
Download the Official Form
You can download the current version of AF Form 2816-1 directly from the Air Force e-Publishing site:
https://static.e-publishing.af.mil/production/1/af_sg/form/af2816-1/af2816-1.pdf
For the most up-to-date guidance on Family Nurse Practitioner privileges, check the Air Force Medical Service Credentials Verification Office resources or the latest DoD Master Privilege Lists for FNPs.
Why Proper Privileging Matters?
Accurate completion of AF Form 2816-1 protects patients, supports high-quality care in military treatment facilities, ensures compliance with regulatory standards, and allows qualified Nurse Practitioners to practice to the full extent of their training and state licensure (where applicable).
Air Force Nurse Practitioners play a vital role in delivering accessible primary and family care to service members, families, and retirees. Understanding and correctly using this form is essential for both new and experienced providers navigating the military healthcare system.
Keywords: AF Form 2816-1, Air Force Nurse Practitioner privileges, Family Nurse Practitioner clinical privileges, Adult Primary Care NP Air Force, AFMS privileging process, military nurse practitioner credentials.
This article is for informational purposes only and is based on the official form and related Air Force Medical Service policies. Always consult your local MTF Credentials Office or current AFI/DoD guidance for the latest requirements.