AF Form 3928: Clinical Privileges – Audiologist

AF Form 3928: Clinical Privileges – Audiologist – AF Form 3928 is the official U.S. Air Force document used to request, verify, and grant clinical privileges for audiologists practicing in military treatment facilities (MTFs). It defines the scope of practice for audiologists, ensuring they can safely and competently provide hearing healthcare services to active duty members, dependents, and retirees.

This form is part of the Air Force Medical Service (AFMS) credentials and privileging process governed primarily by AFI 44-119 (Medical Quality Operations) and related Department of Defense instructions. It helps standardize the evaluation of an audiologist’s education, training, experience, and demonstrated competency before granting independent or supervised practice rights.

Who Needs AF Form 3928?

  • Active Duty Air Force audiologists (Biomedical Sciences Corps – BSC)
  • Air National Guard and Air Force Reserve audiologists
  • Civilian and contract audiologists seeking privileges in Air Force facilities
  • Newly graduated or transitioning audiologists completing training

The form is typically submitted alongside DHA Form 367 (or equivalent credentialing documents) during initial appointment, renewal (usually every 2 years), or when requesting additional privileges.

Purpose of AF Form 3928

The principal purpose of AF Form 3928 is to define the scope and limits of clinical practice for individual audiologists. Privileges are granted based on:

  • Verified credentials (education, licensure, certifications)
  • Training and experience
  • Demonstrated current competence
  • Facility needs and available resources

It protects patients by ensuring only qualified providers perform specific audiology procedures while supporting the mission of the Air Force Medical Service.

Key Qualifications for Air Force Audiologists

To qualify for full clinical privileges, audiologists generally need:

  • Doctoral degree in Audiology (Au.D. or Ph.D.)
  • Current unrestricted state license to practice audiology
  • Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association (ASHA) or Board Certification from the American Board of Audiology (ABA)
  • Completion of any required supervised clinical experience or residency/externship
  • Compliance with AFMS continuing education and performance standards

For those still in training (e.g., 4th-year Au.D. externs), updated privilege lists must be submitted no more than 45 days before program completion.

What Privileges Does AF Form 3928 Cover?

While the exact checkboxes and privilege categories appear on the official form, audiologist clinical privileges typically include evaluation, diagnosis, treatment, and consultation for patients of all ages with hearing and balance disorders. Common areas include:

  • Comprehensive audiologic evaluations (pure-tone, speech, immittance testing)
  • Pediatric and infant hearing assessments (including newborn screening follow-up)
  • Hearing aid selection, fitting, and verification
  • Cochlear implant mapping and follow-up (often with additional training)
  • Vestibular/balance assessments and rehabilitation
  • Tinnitus evaluation and management
  • Auditory processing disorder testing
  • Electrophysiologic testing (ABR, OAE, etc.)
  • Industrial hearing conservation programs and occupational audiology
  • Consultation and interprofessional collaboration with ENT, speech pathology, and primary care

Privileges are often divided into core privileges (routine procedures all qualified audiologists may request) and special or advanced privileges that may require additional documentation of training, proctoring, or case logs.

On the form, applicants mark privileges as:

  • Requested
  • Verified (by the credentials committee)
  • With codes indicating level (e.g., 1 = fully qualified/independent; 2 = requires supervision)

Supervision requirements, if any, are clearly documented.

How to Complete and Submit AF Form 3928?

  1. Download the latest version — Official PDF is available through the Air Force e-Publishing site: AF Form 3928 PDF.
  2. Complete Part I – List of Clinical Privileges — Indicate requested privileges.
  3. Provide supporting documentation — License, certifications, training logs, letters of recommendation, and procedure logs where required.
  4. Part II – Applicant’s Certification — Sign and date, attesting to the accuracy of information.
  5. Facility credentials committee/review process — Includes primary source verification and approval by the Medical Staff Executive Committee or equivalent.
  6. Renewal — Privileges are time-limited and must be renewed periodically with evidence of ongoing competency.

Important tip for applicants: Civilian training graduates should follow the Clinical Privilege List Instructions from the Air Force Credentials Verification Office (AFCCVO) rather than relying solely on any general instructions printed on the form itself. This prevents delays or returns.

  • DHA Form 367 — Often used in conjunction for allied health professionals.
  • AFI 44-119 — The governing instruction for medical quality, credentials, and privileging.
  • MPL Audiology (Medical Privilege List) — The 2022 version outlines the detailed scope for audiology in the Air Force.
  • Similar forms exist for related fields, such as AF Form 3929 (Speech Pathologist).

Why Proper Privileging Matters in the Air Force?

Accurate completion of AF Form 3928 ensures audiologists can fully support the readiness mission — from conserving hearing in high-noise environments (aviation, maintenance, range operations) to providing rehabilitative care for service members with hearing loss or tinnitus. It also facilitates smooth transitions for providers moving between bases or status (active duty, Guard, Reserve, civilian).

Download AF Form 3928 here:
Official AF Form 3928 PDF

Need Help with Air Force Audiology Careers or Privileging?

If you are a licensed audiologist interested in serving in the U.S. Air Force, contact an Air Force Health Professions recruiter or visit the official Air Force Medicine Credentials Verification Office resources. Requirements and processes can evolve, so always verify with current .mil sources or your local MTF credentials office.

Keywords: AF Form 3928, clinical privileges audiologist, Air Force audiologist, AFMS privileging, military audiology credentials, AuD Air Force, hearing conservation Air Force.

This article is for informational purposes only and is based on publicly available U.S. Air Force and Department of Defense resources as of 2026. Official guidance should always come directly from the Air Force e-Publishing site, AFCCVO, or your servicing credentials office.