Get Af 1540a 2015-2025

The AF 1540A form is essential for obtaining clinical privileges and medical staff appointments. This guide provides clear and supportive instructions to help you navigate the online completion of this important document.

Follow the steps to fill out the AF 1540A accurately

1. Press the ‘Get Form’ button to access the AF 1540A online form.
2. In Section I, provide your identification details including last name, first name, grade, middle name, social security number, alias, home phone, home address, and organization/office symbol.
3. In Section II, input additional identification information such as duty phone, duty section, email address, DAFSC, PAFSC, and corps.
4. List your licenses and certifications in Section II. Include state license, status, license number, date issued, expiration date, national certification details along with similar information for national registration.
5. In Section III, indicate any professional society memberships followed by the status of your membership.
6. In Section IV, provide references, including at least one peer reference, your most recent clinical supervisor, and the chief medical staff's name and contact information.
7. In Section V, answer the practice history questions. Be sure to explain any 'yes' responses in the remarks section on page 3.
8. Section VI requires disclosure of your health status. Again, explain any 'yes' responses in the remarks section.
9. In Section VII, select the reason for completing the form: renewal, revision of privileges, or reapplication.
10. In Section VIII, read the statement carefully before signing. Confirm your current clinical privileges, acknowledgment of off-duty employment if applicable, and ensure all information provided is true.
11. Finally, review all entries for correctness and completeness. You can then save your changes, print, download, or share the completed AF 1540A form.

Complete your AF 1540A online today for a streamlined application process.