AF Form 3930: Clinical Privileges for Air Force Dietitians

AF Form 3930: Clinical Privileges for Air Force Dietitians – AF Form 3930 is the official U.S. Air Force form used to request, verify, and document clinical privileges for dietetics providers working in military treatment facilities (MTFs). It defines the scope of practice for Registered Dietitians (RDs) and those with additional certifications, ensuring they deliver safe, competent nutritional care to service members, families, and other beneficiaries.

This form supports the credentialing and privileging process governed primarily by AFI 44-119 (Medical Quality Operations) and related Department of Defense policies. Privileges are granted based on an individual’s education, training, experience, current competence, and facility capabilities.

Who Uses AF Form 3930?

The form targets dietetics providers, including:

Registered Dietitians (RDs) or Registered Dietitian Nutritionists (RDNs)
Certified Nutrition Support Dietitians (CNSC)
Certified Diabetes Educators (now often Certified Diabetes Care and Education Specialists, CDCES)

It applies to active duty, reserve, civilian, contract, and volunteer dietitians in Air Force Medical Service (AFMS) facilities. All must complete credentialing and receive approved privileges before providing patient care.

Purpose of AF Form 3930

The principal purpose is to define the scope and limits of practice for individual dietetics providers. Privileges rest on evaluation of credentials (education, registration, certifications) and demonstrated performance.

Authority: Title 10, U.S.C. Chapter 55, Sections 1094 and 1102.
Routine Use: Information may be shared with government boards, professional societies, or civilian institutions for licensing, monitoring standards, or staff privilege applications.
Disclosure: Voluntary, but failure to provide required information may result in limitation or termination of privileges.

The form ensures alignment with the facility’s master privileges list and supports quality patient care across inpatient, outpatient, and community settings.

How to Complete AF Form 3930?

The two-page form includes clear instructions:

Part I: Requested/Verified Privileges

Applicant: Enter Code 1, 2, or 4 in each REQUESTED block for every privilege. Base this on your current capability (ignore facility limitations). Sign and date in ink, then forward to your Clinical Supervisor.
Clinical Supervisor: Enter Code 1, 2, 3, or 4 in each VERIFIED block using the facility’s master privileges list. Provide a recommendation in Part II.

Codes:

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

Part II: Clinical Supervisor’s Recommendation
The supervisor recommends approval, approval with modification (specify changes), or disapproval (specify reasons). Sign and date, then forward to the Credentials Function.

Important: Use ink for all entries. Any changes to approved privileges must follow AFI 44-119 procedures.

Download the Official Form: Access the current PDF directly from Air Force e-Publishing: AF Form 3930 PDF.

Clinical Privileges Listed on AF Form 3930

Privileges are divided into core and supplemental categories:

Section A: Registered Dietitian (Core Privileges)

Evaluation & Assessment: Nutritional assessment, diagnosis/classification of nutritional status, self-referral evaluation, referrals to programs like WIC or HAWC, medical disposition per protocol.
Procedures: Anthropometric measurements, bioelectric impedance, indirect calorimetry.
Ordering: Diets per verbal physician orders, modify consistency, add supplements/snacks, order labs/weight/height/calorie counts for nutrition therapy.
Therapies: Prenatal, geriatric, pediatric, psychiatric, gastrointestinal, lipid, diabetic, renal, weight management/behavior modification, nutrition support, modified consistency diets, and miscellaneous/test diets.
Additional privileges as specified.

Section B: Certified Nutritional Support Dietitian (Supplemental to A)

Additional ordering of indirect calorimetry studies and other specialized nutrition support privileges.

Section C: Certified Diabetic Educator (Supplemental)

Regulate insulin and nutritional therapy per protocol.
Educate on glucometer use and self-administering insulin.
Adjust physician-prescribed diabetes medications per established protocol.

Providers may request “other” privileges as needed, which require specific justification and approval.

Modern Department of Defense dietitian privilege lists (DOD MPL) expand on these to include comprehensive nutrition screening, assessment, diagnosis, intervention, monitoring, and evaluation across the lifecycle and various medical conditions (e.g., diabetes, cardiovascular disease, critical illness, eating disorders, oncology).

Minimum Qualifications for Dietitians in the Air Force

To qualify for privileges via AF Form 3930, applicants typically need:

Baccalaureate degree from an accredited institution plus completion of an ACEND-accredited didactic program in dietetics.
Successful completion of an ACEND-accredited supervised practice program (Dietetic Internship or Coordinated Program).
Current registration with the Commission on Dietetic Registration (CDR) of the Academy of Nutrition and Dietetics (AND), or eligibility to sit for the exam (with registration required within specified timelines for new graduates).
For specialized certifications (CNSC, CDCES): Proof of certification, continuing education, and recertification.

Active duty accessions must meet registration requirements before or shortly after entry. Competency is further verified through peer review, proctoring if needed, and ongoing performance monitoring.

Renewal and Reappointment of Privileges

Privileges are not indefinite. Reappointment or renewal follows AFI 44-119 and local MTF processes, typically involving:

Maintenance of RD registration.
Evidence of active practice and demonstrated proficiency (no negative trends in peer reviews).
Completion of required continuing education units (CEUs).
Current Basic Life Support (BLS) training.
Updated AF Form 3930 or electronic equivalent in systems like CCQAS (Centralized Credentials Quality Assurance System).

Specialized certifications require ongoing CE and recertification evidence.

Recent Military Health System (MHS) initiatives have streamlined privileging for providers moving between facilities, reducing administrative burden while maintaining standards.

Why Proper Completion Matters?

Accurate completion of AF Form 3930 protects patients, supports mission readiness, and ensures compliance with federal law and DoD/Air Force quality standards. Incorrect or incomplete submissions can delay privileging, affect deployment readiness, or limit a provider’s ability to deliver full-scope nutritional medicine services.

For official guidance, consult:

AFI 44-119 (Medical Quality Operations)
AFMAN 44-144 (Nutritional Medicine)
Your local MTF Credentials Office or the Air Force Medical Service Credentials Verification resources.

Note: Always use the most current official form and instructions from e-Publishing.af.mil. Policies and electronic systems (e.g., CCQAS/JCCQAS) may supplement or replace paper processes over time.

If you are a dietetics provider preparing AF Form 3930 or supporting credentialing in the U.S. Air Force, gather your supporting documentation (transcripts, registration verification, certifications, and performance evaluations) early. Contact your facility’s credentials coordinator for facility-specific master privilege lists and timelines.

This article is for informational purposes and is based on publicly available official U.S. Air Force publications as of the latest accessible data. For personalized advice, consult your chain of command or the official credentials office.