AF Form 2816: Clinical Privileges Family Practice (2026) – AF Form 2816: Clinical Privileges – Family Practice and Primary Care Physicians is the official U.S. Air Force form used to request, verify, and grant clinical privileges to family practice and primary care physicians serving in Air Force medical treatment facilities (MTFs).
This document ensures that providers practice within their demonstrated competence, training, and the capabilities of the specific facility, while maintaining high standards of patient safety and quality care across the Air Force Medical Service.
What Is AF Form 2816?
AF Form 2816, titled Clinical Privileges – Family Practice and Primary Care Physicians, was issued on 20030707 (July 7, 2003) as an Electronic Form Version 1 (EF-V1). It falls under the authority of Title 10, U.S.C. Chapter 55, Sections 1094 and 1102.
The principal purpose of the form is to define the scope and limits of practice for individual providers. Privileges are granted based on a thorough evaluation of the physician’s credentials, education, training, experience, and demonstrated performance.
Routine uses include sharing information with government boards, professional societies for licensing or monitoring, and civilian medical institutions when the provider seeks staff privileges after separating from the Air Force. Disclosure is voluntary, but failure to provide required information may result in limitation or termination of clinical privileges.
Download the official form here: AF Form 2816 PDF
Who Uses AF Form 2816?
- Applicants: Family Practice and Primary Care Physicians (MDs/DOs) applying for or renewing clinical privileges in Air Force MTFs.
- Clinical Supervisors: Senior physicians who review and verify the requested privileges against the facility’s master privileges list.
- Credentials Function: The office responsible for processing, verifying, and maintaining provider credentials and privileging files.
The form supports both initial granting of privileges and periodic re-privileging, which aligns with Air Force Instruction (AFI) 44-119 and related Department of Defense policies on medical staff credentials and privileging.
Structure of AF Form 2816
The form has two main parts:
Part I: List of Clinical Privileges
Physicians indicate their requested level of privilege using specific codes. The clinical supervisor then enters verified codes based on the facility’s master privileges list and the provider’s qualifications.
Codes for Requested Privileges (Applicant):
- 1 = Fully competent within defined scope of practice
- 2 = Requires clinical oversight/supervision
- 4 = Not requested (or not applicable)
Codes for Verified Privileges (Supervisor):
Include 1, 2, 3 (not approved due to lack of facility support), or 4.
Privileges are divided into:
A. Core Privileges
These represent the standard expected capabilities for a family practice/primary care physician in an Air Force setting.
1. Outpatient Privileges include:
- Pediatrics: Well-child care and office pediatric problems
- Obstetrics: Uncomplicated prenatal care, threatened abortion, and complicated/high-risk prenatal care (with appropriate consultation)
- Gynecology: Office gynecologic care
- Internal Medicine: Office adult internal medicine, neurologic problems, dermatologic problems (with specified exclusions), and uncomplicated psoriasis/actinic keratosis
- Surgery/Surgical Subspecialties: Office orthopedic, otorhinolaryngologic (ENT), and ophthalmologic problems (excluding iritis and glaucoma)
- Behavioral Health: Office behavioral problems, crisis intervention, and short-term individual, family, and marital counseling
2. Inpatient Privileges cover:
- Pediatrics: Uncomplicated inpatient problems, routine newborn care, and complicated cases with consultation (e.g., meningitis, pneumonia, neonatal issues, status asthmaticus)
- Obstetrics: Routine uncomplicated labor and complicated cases (e.g., preeclampsia, premature labor, postpartum hemorrhage) with consultation
- Gynecology: Complicated inpatient problems with consultation
- Internal Medicine: Uncomplicated adult cases (no ICU/CCU) and complicated cases (e.g., acute MI without serious decompensation, CHF, DKA, serious infections) with consultation
- Surgery: Uncomplicated musculoskeletal and urologic problems, management of spontaneous pneumothorax (with consultation), and first-assist at major surgical procedures
3. Procedures (extensive list):
- Emergency: BLS, ACLS, cricothyroidotomy, tube thoracostomy, endotracheal intubation, central lines, arterial lines, cardioversion
- Dermatology: Punch biopsy, simple laceration repair, I&D of abscess, excision of benign and certain malignant skin lesions
- Internal Medicine: Lumbar puncture, thoracentesis, flexible sigmoidoscopy with biopsy, bone marrow aspiration/biopsy, stress ECG
- Pediatrics: Suprapubic bladder aspiration, neonatal circumcision, umbilical catheterizations, intubation
- Surgical: Bladder catheterization, removal of ocular/nasal foreign bodies, vasectomy, arthrocentesis, closed reduction of simple fractures/dislocations
- Obstetrics: Routine vaginal delivery, manual placenta extraction, outlet vacuum delivery, induction of labor, limited obstetric ultrasound
- Gynecology: Pap smears, endometrial and cervical biopsy, IUD insertion/removal
B. Supplemental Privileges
These include additional or advanced procedures (e.g., multi-layer laceration repair, colposcopy, low forceps delivery, paracentesis, colonoscopy) that may be requested on a case-by-case basis when supported by training and facility resources.
C. Other Privileges
Space to specify up to four additional privileges not listed elsewhere.
Part II: Clinical Supervisor’s Recommendation
The supervisor recommends approval, approval with modifications, or disapproval, then signs and dates the form before forwarding it to the Credentials Function.
How to Complete AF Form 2816?
- Applicant — Complete personal information (name, facility) and enter requested codes (1, 2, or 4) for each privilege. Sign and date, then forward to your clinical supervisor.
- Clinical Supervisor — Review using the facility’s master privileges list and enter verified codes. Provide recommendation in Part II, sign, and forward to the Credentials Function.
- All entries must be made in ink.
Important: Requested privileges should reflect your current capability without considering facility limitations. The verification process accounts for both your competence and local resources.
Why Clinical Privileges Matter in the Air Force?
Proper privileging protects patients, supports mission readiness, and ensures providers deliver care aligned with their expertise. It also facilitates smooth transitions to civilian practice by documenting demonstrated competencies. Family medicine physicians in the Air Force often serve as the primary point of care for service members, families, and retirees, handling a broad spectrum from pediatrics and obstetrics to acute and chronic adult conditions.
For the most current guidance on credentials and privileging processes, refer to official Air Force publications such as AFI 44-119 (Medical Quality Operations) and consult your local MTF Credentials Office.
Note: Forms and policies can be updated. Always download the latest version directly from the official e-Publishing site and verify current procedures with your facility’s credentials personnel.
Keywords: AF Form 2816, Air Force clinical privileges, family practice privileges, primary care physician Air Force, AF medical credentials, download AF Form 2816, Air Force MTF privileging.
This article is for informational purposes only and is based on the official form and publicly available U.S. Air Force resources as of the latest accessible data. For official use, consult your chain of command and the most recent publications.