AF Form 2828: Clinical Privileges for Occupational Therapist

AF Form 2828: Clinical Privileges for Occupational Therapist – If you are an Occupational Therapist (OT) serving in the United States Air Force or applying for a position within the Air Force Medical Service (AFMS), you will likely need to complete AF Form 2828. This official form defines and requests your clinical privileges, ensuring you can practice safely and effectively within military treatment facilities (MTFs).

What Is AF Form 2828?

AF Form 2828, titled Clinical Privileges – Occupational Therapist, is an official Air Force form used to document and approve the scope of practice for occupational therapists. Its principal purpose is to define the scope and limits of practice for individual providers based on an evaluation of their credentials, training, experience, and demonstrated performance.

The form is governed by Title 10, U.S.C. Chapter 55, Sections 1094 and 1102, and aligns with AFI 44-119 (Medical Quality Operations), which outlines credentials, privileging, and clinical performance improvement processes across the AFMS.

Key users include:

  • The applicant (Occupational Therapist)
  • The clinical supervisor
  • The credentials function at the medical facility

Download the official form here: AF Form 2828 PDF

Note: The current version is dated 20020505 (V1). Always verify you are using the latest edition through official Air Force e-Publishing channels.

Why Clinical Privileges Matter in the Air Force?

In military healthcare, clinical privileges ensure that every provider — including allied health professionals like occupational therapists — practices only within their verified competency. This protects patients, maintains high standards, and complies with Joint Commission and DoD requirements.

Privileges for OTs focus on rehabilitation, functional restoration, and supporting warfighter readiness, including recovery from injuries, management of neuromuscular and musculoskeletal conditions, psychosocial support, and adaptive equipment training.

How to Complete AF Form 2828: Step-by-Step?

The form has two main parts:

Part I: List of Clinical Privileges – Occupational Therapist

You (the applicant) indicate which privileges you are requesting by entering a code in the “Requested” column:

  • Code 1: Fully competent within the defined scope of practice.
  • Code 2: Supervision required.
  • Code 4: Not requested / not approved due to lack of expertise or proficiency.

Your clinical supervisor then verifies using the facility’s master privileges list and enters codes in the “Verified” column (adding Code 3: Not approved due to lack of facility support).

Core Privileges (Section A) typically include:

  • Patient examination, evaluation, treatment, consultation, education, and discharge planning for individuals with neuromuscular, skeletal, psychosocial, or cognitive dysfunction.
  • Assessments of strength, coordination, endurance, cognition (orientation, memory, problem-solving), and activities of daily living (ADLs).
  • Therapeutic exercise and modalities (e.g., hot/cold packs, fluidotherapy, paraffin).
  • Burn and wound care, including debridement and dressing changes.
  • Fabrication of customized splints.
  • Ordering, adjusting, and instructing patients on braces, wheelchairs, prostheses, and assistive devices.
  • Psychosocial interventions, including work and combat stress management, and group therapy.
  • Hand therapy.
  • Referral of patients to specialty clinics.

Supplemental / Special Privileges (Section B) may include:

  • Ordering diagnostic imaging (interpreted by radiologist/physician) or laboratory studies.
  • Prescribing select medications from the MTF formulary (aspirin, acetaminophen, NSAIDs, designated muscle relaxants).
  • Pediatric/neurodevelopmental therapy (including neonatal, early intervention, and school-based services).
  • Oral-motor assessment, treatment, and assistance with swallow studies.
  • Critical incident stress debriefing (CISD) and neuropsychiatric triage support.
  • Work site/ergonomic evaluations, functional capacity evaluations, and work therapy (up to 72 hours).
  • Administering temporary profiles and assigning quarters (when specified).

Additional blank fields allow for facility-specific or other requested privileges.

Part II: Clinical Supervisor’s Recommendation

The supervisor recommends approval, approval with modifications, or disapproval, then signs and dates the form. The completed form goes to the credentials function for final processing.

Important Instructions:

  • Complete all entries in ink.
  • Base your “Requested” codes on your current capability — do not factor in facility limitations.
  • Any changes to approved privileges must follow AFI 44-119 procedures.
  • Clinical oversight requirements for allied health providers are detailed in AFI 44-119.

Who Needs AF Form 2828?

  • Active Duty, Reserve, and Air National Guard occupational therapists.
  • Civilian and contract OTs seeking privileges in Air Force MTFs.
  • New graduates or those transitioning into AFMS roles (often submitted with DHA Form 367 and other credentialing documents).

For new accessions or recent graduates, privilege lists should generally be completed no more than 45 days prior to training completion.

To qualify for clinical privileges, OTs typically need:

  • Graduation from an accredited occupational therapy program (entry-level master’s or higher).
  • Current state licensure/registration as an occupational therapist.
  • Relevant supervised clinical experience (often a minimum of 24 months for certain AFSC levels).
  • Compliance with AFMS credentialing standards under AFI 44-119.

Additional guidance comes from the American Occupational Therapy Association (AOTA) standards and facility-specific master privilege lists.

Tips for a Smooth Privileging Process

  1. Review the latest Master Privilege List (MPL) for Occupational Therapy available through your MTF or the Air Force Credentials Verification Office.
  2. Gather supporting documentation: license, certifications, training records, and performance evaluations.
  3. Coordinate closely with your clinical supervisor early in the process.
  4. Be accurate and honest when assigning requested codes — over-requesting without supporting experience can delay approval.
  5. Understand that privileges are facility-specific and may vary based on mission needs and resources.

Conclusion

AF Form 2828 is a critical document that formalizes your ability to deliver high-quality occupational therapy services to service members, their families, and other beneficiaries in the Air Force healthcare system. Properly completing and processing this form helps ensure you can contribute fully to rehabilitation, readiness, and patient-centered care.

For the most current instructions, always refer to official sources:

  • AF Form 2828 PDF
  • AFI 44-119 on e-Publishing
  • Your local MTF Credentials Office or the Air Force Medical Service Credentials Verification resources

If you are preparing to submit AF Form 2828 or need assistance understanding specific privileges, consult your supervisor or the credentials function for facility-specific guidance. Accurate privileging supports both your professional practice and the overall mission of Air Force medicine.

This article is for informational purposes and is based on publicly available official U.S. Air Force documents. Policies can be updated; verify all information through official military channels.