AF Form 3922: Adult Preventive Care Flow Sheet Download – AF Form 3922: Adult Preventive Care Flow Sheet (DD Form 2005 Privacy Act Statement Serves) is an official U.S. Air Force form used to document and track preventive health services for adult patients in military treatment facilities.
Healthcare providers in Air Force clinics rely on this flow sheet to maintain a clear, chronological record of recommended screenings, immunizations, counseling, and other preventive measures. It supports proactive health management, helps meet readiness requirements, and ensures continuity of care for active duty members, retirees, and their families under the Military Health System (MHS) and TRICARE.
What Is AF Form 3922?
AF Form 3922, titled Adult Preventive Care – Flow Sheet, serves as a dedicated tool for logging preventive care activities over time. The form explicitly notes that the DD Form 2005 (Privacy Act Statement – Health Care Records) serves with it, fulfilling privacy notice requirements for collecting and using personal health information in DoD facilities.
Key purposes include:
- Tracking dates and results of age-appropriate preventive services.
- Supporting Preventive Health Assessments (PHA) and periodic health visits required for Air Force personnel.
- Providing a quick visual summary (flow sheet format) of completed services versus those still due.
- Aiding compliance with clinical guidelines from the U.S. Preventive Services Task Force (USPSTF), Advisory Committee on Immunization Practices (ACIP), and Air Force/MHS standards.
This form pairs with its counterpart, AF Form 3923 (Child Preventive Care Flow Sheet), and relates to the electronic or paper DD Form 2766 (Adult Preventive and Chronic Care Flowsheet), which many clinics now use for similar documentation.
Who Uses AF Form 3922?
- Air Force Medical Service (AFMS) providers, nurses, and medical technicians in military treatment facilities (MTFs).
- Active duty Air Force members during annual or periodic health assessments.
- Other eligible beneficiaries (dependents, retirees) receiving care in Air Force clinics.
- Personnel preparing for deployments, PCS moves, or separation/retirement to ensure medical readiness.
The form helps document services that contribute to individual medical readiness and overall force health protection.
Key Sections and What It Tracks
Although the exact layout is a multi-column flow sheet (typically with patient demographics at the top and year/age-based columns for entries), AF Form 3922 generally includes areas to record:
- Patient Information: Name, DOB, allergies, and other identifiers.
- Health Counseling Topics: Smoking cessation, alcohol/drug use, diet/exercise, injury prevention, sexual health, domestic violence screening, and other behavioral counseling.
- Screenings and Exams: Blood pressure, cholesterol/lipids, blood glucose/diabetes screening, cancer screenings (e.g., colorectal, breast, cervical, prostate), osteoporosis, depression/anxiety, and others based on age, sex, and risk factors.
- Immunizations: Tetanus/diphtheria/pertussis (Tdap/Td), influenza, pneumococcal, shingles, hepatitis, COVID-19, and service-specific requirements.
- Laboratory and Diagnostic Tests: Dates and results for relevant preventive labs or procedures.
- Other Preventive Services: Aspirin prophylaxis (when indicated), dental/oral health referrals, vision/hearing, and advance directives discussion.
Providers mark completion dates, results, or notes in the appropriate columns, creating an at-a-glance history. The form is not exhaustive; it aligns with current evidence-based guidelines and may be supplemented by electronic health record (EHR) entries in systems like MHS GENESIS.
Note: Always follow the most current version available from official Air Force e-Publishing sources, as forms are periodically updated.
How to Access and Download AF Form 3922?
You can download the current AF Form 3922 PDF directly from the official Air Force e-Publishing site:
This is the authoritative source for the fillable or printable form. Do not use unofficial copies for official medical records.
Related forms:
- DD Form 2005: Privacy Act Statement for health care records (acknowledges collection of information for treatment, benefits, and readiness).
- DD Form 2766: Broader Adult Preventive and Chronic Care Flowsheet used across DoD.
- AF Form 3923: Child version.
Why Preventive Care Documentation Matters in the Air Force?
The U.S. Air Force emphasizes prevention to maintain a ready force. Completing services tracked on AF Form 3922 supports:
- Annual Preventive Health Assessment (PHA) requirements.
- Deployment and worldwide qualification standards.
- TRICARE-covered preventive services with no or low cost-sharing for many screenings and immunizations.
- Long-term health by catching issues early (e.g., hypertension, diabetes risk, cancers).
TRICARE beneficiaries should discuss their preventive care needs during Health Promotion visits or annual exams. Many services follow USPSTF “A” and “B” recommendations, which are typically covered without copays when criteria are met.
Tips for Patients and Providers
For patients (Air Force members and beneficiaries):
- Bring your immunization records and any outside preventive care documentation to appointments.
- Ask your provider to review your flow sheet and discuss what’s due based on your age, gender, and risk factors.
- Schedule preventive visits proactively—many MTFs offer dedicated wellness appointments.
For providers:
- Use the flow sheet to guide age- and risk-appropriate care.
- Document clearly and transcribe information consistently when moving between paper and electronic records.
- Stay updated with Air Force Instructions (e.g., AFI 44-170 for Preventive Health) and national guidelines.
Stay Current with Preventive Health Guidelines
Preventive recommendations evolve. Refer to:
- U.S. Preventive Services Task Force (USPSTF) A & B Recommendations.
- CDC/ACIP immunization schedules.
- Air Force Medical Service policies and your local MTF guidelines.
For the latest official form and instructions, always visit the Air Force e-Publishing website or consult your healthcare team.
Keywords: AF Form 3922, Adult Preventive Care Flow Sheet, Air Force preventive health form, DD Form 2005, Air Force medical forms, TRICARE preventive care, military health flow sheet, PHA documentation.
This article is for informational purposes only and is not a substitute for official guidance. Always consult your military treatment facility or current Air Force instructions for policy and form usage.
Official Download: AF Form 3922 PDF