AF Form 2819-1: CRNA Clinical Privileges Guide (Download) – Certified Registered Nurse Anesthetists (CRNAs) play a vital role in the U.S. Air Force Medical Service, delivering safe, high-quality anesthesia care in military treatment facilities (MTFs) worldwide. To practice, Air Force CRNAs must request and receive formal clinical privileges through a standardized credentialing process. One key document in this process is AF Form 2819-1, officially titled Clinical Privileges – Certified Registered Nurse Anesthetist.
This article explains what AF Form 2819-1 is, its purpose, how to complete it, the specific privileges it covers for CRNAs, and why it matters for Air Force healthcare providers and those transitioning to or from civilian practice.
What Is AF Form 2819-1?
AF Form 2819-1 is an official U.S. Air Force form used to delineate and document the specific clinical privileges granted to individual Certified Registered Nurse Anesthetists working in Air Force medical facilities. It defines the scope of practice based on the provider’s education, training, experience, current competence, and facility capabilities.
The form is part of the broader Air Force credentialing and privileging system governed primarily by AFI 44-119 (Clinical Performance Improvement and Risk Management) and related Department of Defense and Defense Health Agency (DHA) policies. It ensures that every CRNA practices only within their verified level of expertise while maintaining patient safety standards.
Download the current official form here: AF Form 2819-1 PDF
Purpose of AF Form 2819-1
According to the form itself, its principal purpose is “to define the scope and limits of practice for individual providers. Privileges are based on evaluation of the individual’s credentials and performance.”
Key legal authority comes from Title 10, U.S.C. Chapter 55, Sections 1094 and 1102. Information collected may be shared with licensing boards, professional societies, or civilian institutions when providers separate from service or seek new privileges.
Disclosure is voluntary, but failure to provide required information can result in limitation or termination of clinical privileges.
Who Uses AF Form 2819-1?
- CRNA Applicant — The Certified Registered Nurse Anesthetist requesting privileges.
- Clinical Supervisor — Typically a supervising anesthesiologist or senior CRNA who verifies and recommends approval.
- Credentials Function / Credentials Committee — Processes the form as part of initial appointment, renewal, or modification of privileges at the military treatment facility.
The form supports both active duty, reserve, and civilian CRNAs working in Air Force facilities.
Structure of AF Form 2819-1
The two-page form includes:
Page 1:
- Header: Applicant name and name of medical facility.
- Part I: List of Clinical Privileges – Certified Registered Nurse Anesthetist
It uses a coding system where the applicant marks Requested privileges and the supervisor marks Verified privileges.
Coding System (used throughout):
- 1 — Fully competent within defined scope of practice.
- 2 — Supervision required (e.g., lacks current relevant experience).
- 3 — Not approved due to lack of facility support (per master privileges list).
- 4 — Not requested / not approved due to lack of expertise, proficiency, or physical limitation.
Page 2:
- Part II: Clinical Supervisor’s Recommendation — Recommend approval, approval with modification, or disapproval.
- Signature blocks for the applicant and clinical supervisor.
All entries must be made in ink.
Specific Clinical Privileges Listed on AF Form 2819-1
The form organizes privileges under Section A. TECHNIQUES and allows additional Section B. OTHER (Specify) privileges (up to 5).
Core Techniques for CRNAs include:
- Perform preoperative medical evaluations and history of allergies and intolerance to anesthesia (requires counter-signature by surgeon or anesthesiologist).
- Plan and order preoperative medications, including sedatives, analgesics, and anticholinergics.
- Administer anesthesia; inhalation and intravenous.
- Administer drugs commonly used as adjuncts to anesthesia (muscle relaxants, vasopressors, antiemetics, etc.).
- Cannulate arteries and veins for patient monitoring.
- Perform and/or supervise post-anesthetic management, especially until level of consciousness and cardiorespiratory function return to normal.
- Perform post-anesthetic visits, patient evaluation (emphasizing complications of anesthesia), and record progress notes.
- Perform routine and emergency intubation and ventilatory support and instruction in these techniques.
- Induce and manage various types of regional anesthesia, including management of untoward reactions:
- Local infiltration anesthesia
- Peripheral nerve block anesthesia
- Intravenous regional anesthesia
- Axillary brachial plexus block
- Interscalene brachial plexus block
- Spinal anesthesia
- Lumbar epidural anesthesia
- Caudal anesthesia
- Supraclavicular brachial plexus block
These privileges encompass the full spectrum of pre-, intra-, and post-anesthesia care for surgical, obstetric, and procedural patients. Additional privileges (e.g., specific pain management techniques or advanced procedures) can be requested in the “Other” section and must be justified with supporting documentation.
Note: Modern DHA-generated privilege lists may include expanded language on providing all levels of sedation and anesthesia for pediatric and adult patients, pain management, and consultation capabilities, but the core AF Form 2819-1 remains the primary delineation tool for Air Force use.
How to Complete AF Form 2819-1?
For the CRNA Applicant:
- Enter Code 1, 2, or 4 in each “Requested” column based on your current capability (do not consider facility limitations here).
- Sign and date the form.
- Forward to your Clinical Supervisor.
For the Clinical Supervisor:
- Using the facility’s Master Clinical Privileges List, enter Code 1, 2, 3, or 4 in each “Verified” column.
- Check the appropriate recommendation in Part II (Approval / Approval with Modification / Disapproval).
- Sign and date, then forward to the Credentials Function.
Any changes to approved privileges must follow AFI 44-119 procedures.
Why Clinical Privileges Matter for Air Force CRNAs?
Proper privileging protects patients, supports quality care, and ensures compliance with Joint Commission, DHA, and Air Force standards. For CRNAs, it confirms competency in critical skills such as airway management, regional anesthesia techniques, and perioperative patient optimization.
Military CRNAs often work in austere or deployed environments where they may function with a high degree of autonomy under collaborative agreements. Accurate documentation on AF Form 2819-1 (and related forms) becomes especially important when transitioning to civilian healthcare systems, as it provides a clear record of granted privileges and experience.
Related Resources
- Official form: AF Form 2819-1 PDF
- AFI 44-119 – Clinical Performance Improvement and Risk Management
- Air Force Medicine CRNA career information
- DHA Medical Privileging Lists (DODMPL) for CRNAs
Conclusion
AF Form 2819-1 is the foundational document that allows Certified Registered Nurse Anesthetists to deliver anesthesia care safely and legally within the U.S. Air Force. Understanding its structure, the specific privileges it covers, and the proper completion process helps CRNAs, supervisors, and credentials staff ensure high standards of perioperative care for service members, families, and retirees.
Whether you are applying for initial privileges, requesting renewal, or preparing documentation for a career transition, always use the most current version of the form available on the official Air Force e-Publishing site and consult your local credentials office for facility-specific guidance.
This information is based on the official AF Form 2819-1 (20030707) and supporting Air Force and DHA references as of the latest available data. Always verify with current e-Publishing sources and your MTF credentials committee for the most up-to-date requirements.