AF Form 2820-1: Clinical Privileges Certified Nurse Midwife

AF Form 2820-1: Clinical Privileges Certified Nurse Midwife – Certified Nurse Midwives (CNMs) play a vital role in the Air Force Medical Service (AFMS), delivering comprehensive women’s healthcare with a strong emphasis on pregnancy, childbirth, and reproductive health. AF Form 2820-1, titled CLINICAL PRIVILEGES – CERTIFIED NURSE MIDWIFE, is the official document used to request, verify, and grant specific clinical privileges to qualified CNMs working in Air Force medical treatment facilities (MTFs).

This form ensures that each CNM practices within a defined scope based on their education, training, certification, experience, and demonstrated competence, while aligning with Air Force standards for quality and patient safety.

What Is AF Form 2820-1 and Why Is It Important?

AF Form 2820-1 (also referred to as AF IMT 2820-1, dated 20020505 V1) formally documents the scope and limits of practice for individual Certified Nurse Midwives. Privileges are granted after a thorough evaluation of the provider’s credentials and performance, in accordance with Title 10 U.S.C. §§ 1094 and 1102, and governed primarily by AFI 44-119, Medical Quality Operations (which covers credentials, privileging, clinical oversight, and performance improvement).

The principal purpose of the form is to:

  • Define requested and verified clinical privileges.
  • Ensure safe, competent care for active duty members, dependents, and other beneficiaries.
  • Support medical staff appointment and re-privileging processes at Air Force MTFs.

Information from the form may be shared with licensing boards, professional organizations, or civilian institutions (e.g., during transition to civilian practice). Disclosure is voluntary, but incomplete information can result in limited or denied privileges.

Download the official form here: AF Form 2820-1 PDF.

Who Uses AF Form 2820-1?

This form is primarily for:

  • Active Duty, Reserve, or Guard Certified Nurse Midwives seeking initial or renewed clinical privileges in Air Force facilities.
  • CNMs applying for or updating privileges as part of the credentials verification and medical staff appointment process.
  • Clinical supervisors and credentials committees responsible for verification and recommendation.

It is used alongside other documents, such as DHA Form 367 (for certain applicants) and the Department of Defense Medical Privilege List (DODMPL) for Certified Nurse Midwife, which outlines broader scope expectations.

Structure of AF Form 2820-1

The form is divided into two main parts and uses a standardized coding system:

Coding System (entered in “Requested” and “Verified” columns):

  • 1 — Fully competent within defined scope of practice.
  • 2 — Supervision required (per facility master privileges list).
  • 3 — Not approved due to lack of facility support.
  • 4 — Not requested/not approved (due to lack of expertise, proficiency, or physical limitation).

Part I: Applicant Information and List of Clinical Privileges

  • Applicant name and medical facility.
  • Separate columns for Requested (by the CNM, reflecting personal capability, ignoring facility limits) and Verified (by the clinical supervisor using the facility’s master list).

Core Privileges (common foundational abilities for many advanced practice providers):

  • Health histories, physical exams, ordering labs/imaging, specimen collection (including Pap smears), data analysis and treatment planning, consultations, diagnosis/treatment of acute/chronic illness in women, patient counseling, prescribing (including controlled substances), temporary profiles, short-term admissions/discharges, and assisting physicians.

Certified Nurse Midwife-Specific Privileges (Section B): These focus on reproductive health across the maternity cycle:

  • Primary healthcare for women, especially reproductive health.
  • Independent management of normal maternity cycles (prenatal, labor, delivery, postpartum).
  • Admission and discharge of patients meeting nurse midwifery criteria.
  • Consultation/referral for complications.
  • Fetal well-being assessments (non-stress tests, contraction stress tests, amniotic fluid index).
  • Labor management, including amniotomy and fetal monitoring.
  • Vaginal deliveries and immediate newborn care (including resuscitation).
  • Collaborative management for deviations from normal (e.g., use of oxytocics, tocolytics).
  • Unwanted pregnancy counseling, initial infertility evaluations, family planning counseling, and education on pregnancy, childbirth, newborn care, and menopause.

Procedures (Section C):

  • Local/pudendal anesthesia.
  • Episiotomy and repair.
  • Laceration repairs (including 3rd/4th degree).
  • First surgical assistant for Cesarean sections.
  • Limited ultrasound (fetal viability, amniotic fluid index, placental location, fetal lie).
  • Neonatal resuscitation and ACLS protocols.
  • Contraceptive device insertion/removal (diaphragm, IUD, implants, rings, caps).
  • Endometrial biopsy, endocervical curettage, lesion destruction, wound care.

Advanced Procedures (Section D):

  • Outlet vacuum-assisted deliveries.
  • First-trimester dating ultrasound, biophysical profile.
  • Colposcopy, cervical biopsy, lesion excision, incision and drainage, punch biopsy, circumcision, cryotherapy.

Other Privileges: Space for up to four additional facility-specific or individualized privileges.

Part II: Clinical Supervisor’s Recommendation The supervisor recommends approval, approval with modifications, or disapproval, provides rationale, signs, and forwards the form to the credentials function. All entries must be in ink.

How to Complete AF Form 2820-1?

For the Applicant (CNM):

  1. Enter your name and facility.
  2. For each privilege, enter Code 1, 2, or 4 in the Requested column based on your current competence (do not factor in facility limitations).
  3. Sign and date the form.
  4. Forward to your clinical supervisor.

For the Clinical Supervisor:

  1. Review using the facility’s master privileges list.
  2. Enter Codes 1–4 in the Verified column.
  3. Complete Part II with your recommendation.
  4. Sign, date, and forward to the Credentials Function.

Changes to approved privileges must follow AFI 44-119 procedures. Clinical oversight requirements for allied health providers are also defined in that instruction.

Tip for Air Force applicants: Civilian training graduates should consult current Clinical Privilege List Instructions from the Air Force Credentials Verification Office rather than relying solely on older form instructions to avoid processing delays.

  • CNMs must maintain national certification (e.g., through the American Midwifery Certification Board) and state licensure where applicable.
  • Privileging aligns with broader DoD and Air Force policies on scope of practice for Certified Nurse Midwives, emphasizing collaborative care with physicians when cases deviate from normal.
  • Re-privileging typically occurs on a periodic basis as part of ongoing credentials review.
  • Providers must demonstrate ongoing competence through performance evaluations, continuing education, and quality assurance activities under AFI 44-119.

For the most current guidance on credentials and privileging, refer to official Air Force Medicine resources, including the Air Force Medical Service Credentials Verification Office and the latest version of AFI 44-119.

Why Proper Completion Matters?

Accurate completion of AF Form 2820-1 directly affects a CNM’s ability to provide full-scope midwifery care, including independent management of low-risk pregnancies, deliveries, and women’s health services in military facilities. It protects both the provider and patients by ensuring privileges match demonstrated skills and facility capabilities.

Whether you are a new CNM joining the Air Force, preparing for re-privileging, or transitioning between MTFs, understanding this form is essential for a smooth credentials process.

Official Download: AF Form 2820-1 – Clinical Privileges – Certified Nurse Midwife

For additional support, contact your local MTF Credentials Function or visit the Air Force Medical Service website for the latest forms, DODMPL documents, and privileging instructions.

This guide is for informational purposes and is based on the official form and publicly available Air Force medical policy references. Always consult current official publications and your chain of command for authoritative guidance, as policies and forms can be updated.