ANGI 40-102

angi40-102 State Air Surgeon published!!!

Thanks to all who contributed.  It was substantially revised with the assistance of many thoughtful State Air Surgeons.  A full explanation of the comments and changes is included under the State Air Surgeon heading.  The suggestions were presented to the Office of the ANG/SG in January of 2014.  The draft was presented at the SAS meeting in July 2014 with minor/editorial changes being suggested.  The regulation is undergoing final typing in the office of the ANG/SG which has been somewhat delayed due to the monumental amount of work and other tasks required of the office.  Thanks to all the docs, without whom this rewrite simply would not have happened—WWP  (and thanks to Mike Ricci for the impetus to assure that the latest version is here on the web site)

Below is the draft after the July 2014 changes.


This instruction governs the position of the State Air Surgeon (SAS) in the Air National Guard (ANG). It implements ANGPD 40-1, State Air Surgeon. This Air National Guard Instruction (ANGI) prescribes the qualifications, duties, responsibilities, and both wartime and peacetime contingency requirements of the SAS.



This document has been substantially revised and must be completely reviewed.

1. Philosophy. The SAS enhances the ability of the ANG to properly perform its state and federal mis­sions as the primary liaison between the individual medical/aeromedical evacuation units, the Adjutant General (TAG) and the Air Surgeon (NGB/SG) on force protection medical issues, medical aspects of homeland security and other medical matters. The SAS helps to ensure that the State maintains a viable and healthy force for worldwide deployment. The SAS coordinates with the State’s Army National Guard Surgeon as well as other ANG SASs within the Federal Emergency Management Agency (FEMA) region to identify military medical capabilities. The SAS coordinates appropriate use of medical assets mobilized for state or national emergencies and exercises staff oversight of ANG medical activities.  The SAS is a member of the State Headquarters Staff and should be the senior ANG medical officer.  To qualify for and maintain the position of SAS, the SAS must hold valid credentials and waiver/certification approval authority granted by the ANG/SG .


2. Nomination and Appointment of State Air Surgeon.

2.1. Candidate for the position of State Air Surgeon must hold the aeronautical rating of Air Force Flight Surgeon.

2.2. Candidate should have broad experiences as medical officer including those as an operational flight surgeon and command experience of a medical group.

2.3. Candidate must have current rank of O-6 or should be eligible for promotion to O-6.

2.4. Candidate must have eligibility to serve at least 2 years in the position and will be appointed for 4 years; TAG may reappoint the SAS for additional 4 year terms.

2.5. Candidate must be nominated to the position of State Air Surgeon by the Adjutant General of the State.

2.6 Candidate must execute a written confirmation acknowledging nomination and acceptance of the duties and responsibilities of the position of State Air Surgeon.

2.7 SAS candidate will assure that copies of the TAG Appointment Letter and SAS Appointee Acknowledgement Letter are sent to the ANG/SG.

2.8 State Air Surgeon is a member of the State Headquarters staff as the senior ANG Medical officer of the State.

2.9 ANG/SG may delegate authority to approve certain items, such as waivers or enlistment examinations after appropriate training and certification by the ANG/SG.

2.10 State Air Surgeon Credentials are granted and records thereof maintained by the ANG/SG.

2.11 The State Air Surgeon is responsible for providing such information necessary to the ANG/SG for the credentialing/recredentialing process in a timely manner.

2.12. Failure of the SAS to obtain credentials or to be granted waiver/certification authority within 180 days of appointment by the ANG/SG shall disqualify the SAS from serving in the position of SAS.


3. Qualification and Re-Qualification Training.

3.1. Within ninety (90) days of appointment, SAS shall supply all information necessary for the ANG/SG to establish a Provider Credential File (PCF).

3.2 Within 120 days of appointment, State Air Surgeon must complete a one week orientation/training program devised by the ANG/SG.  SAS will not be granted waiver/certification authority until accomplishment of such training.

3.3. SAS must complete, under the direction of the ANG/SG, a one week recertification training program (including knowledge test of 40-102) every 2 years in order to maintain waiver/certification authority.

3.4. NGB/SG shall have the authority to waive any of the above qualifications on a case by case basis.


4. Duties and Responsibilities of SAS. As the senior ANG medical officer in the State, the SAS serves as consultant to the TAG for all medical issues. The SAS also acts as the liaison between NGB/SG and all medical units within the State.

4.1. The SAS functions as the State Headquarters’ Surgeon General in addressing all ANG medical and aeromedical programs within the State. Specifically the SAS:

4.1.1. Oversees all force protection medical requirements for all ANG members of the State.

4.1.2. Ensures proper support and evaluation of Geographically Separated Units (GSUs) within the State. The SAS, after coordination with the Assistant Adjutant General – Air (AAG), will assign a host Medical Group (MDG) to all Geographically Separated Units (GSUs) within the State. The State AAG will assign host MDG to all GSUs if they are not assigned by the SAS. The SAS will notify the commanders of each GSU and host MDG of the host/GSU assignments. The SAS will send a copy of the notification letter to Medical Operations Division (NGB/ SGP) which must return a receipt of acknowledgement. Ensures that support agreements are formally established between the host MDG and assigned GSUs in accordance with AFI 25-201, Support Agreements Procedures. Evaluates medical aspects of GSU support agreements annually, serving as a catalyst for issue identification and resolution. An update letter indicating the assignment of GSU to host MDG will be forwarded to each GSU, MDG and the ANG/SG Medical Operations Division on an Annual basis and for which the ANG/SGP must acknowledge receipt. ANG/SGP Medical Operations Division shall retain copy of all such letters and shall notify the SAS if no such GSU to host MDG letter is received within the calendar year following receipt of a prior letter. If the GSU/host relationship no longer exists, SAS shall notify the ANG/SGP in writing of such. If such GSU/host relationship still exists, the SAS or, in his absence, the Commander of the State Headquarters Staff, shall immediately generate such documentation as specified above.

4.1.3. Assists line and medical leaders regarding medical personnel issues and programs. Partici­pates in an annual strategic planning process with the HP recruiting team as part of the Health Professions Recruiting/Retention Team within the State. If there is no such team, SAS assists the local Recruiters on base and in the community, coordinates the assistance of unit health professionals with unit/regional HP recruiters when requested. Advise line commanders on medical unit commander selections and provide input for medical and aeromedical commanders’ officer performance reports. May serve as a member of medical officer promotion boards.

4.1.4 Nominates members of medical organizations throughout the State for awards, decorations and promotions.

4.1.5. Advises TAG, State Headquarters and line commanders, as well as medical organization commanders, on ANG medical/health programs.

4.1.6. Ensures that support agreements are formally established between the host MDG and the squadron medical element or other unique operational groups or squadrons that have medical providers in accordance with AFI 48-149, Flight and Operational Medicine Programs, and AFI 25-201, Support Agreements Procedures.

4.1.7. Serves as the ANG medical representative in support of the State Partnership Program (SPP), or appoints another senior medical leader from within the State to fill this role.

4.1.8. Coordinates with the State Army Surgeon’s office to ensure that medical participation in the SPP is joint.

4.1.8. Serves as the focal point at State Headquarters regarding ANG medical capabilities related to Homeland Response and medical support to civil authorities. Coordinates with SASs in other states within the same FEMA region and with the State’s Army National Guard Surgeon to identify synergistic medical capabilities. Serves as liaison between the Joint Forces Headquarters (JFHQ), medical organizations for issues related to ANG medical capabilities and requirements. Works to establish bi-directional cross flow of information and capabilities awareness with State Health Departments for CBRNE events Helps integrate ANG medical representation into community National Incident Man­agement System (NIMS) and Emergency Support Function (ESF) Health and Medical Services.

4.1.9. Encourages timely, accurate reporting of Medical Readiness statistics and reviews results with medical groups, commanders, and JFHQ

4.2. SAS will maintain an awareness of issues and initiatives facing each of the medical organiza­tions to ensure that appropriate force health protection is maintained throughout the State and Region.

4.2.1. SAS will assist in the identification and resolution of problems, conflicts or other factors potentially limiting an organization’s mission readiness. Such awareness will be developed through formal site visits, either individually or as part of a headquarters’ team, or through infor­mal methods including telephonic and electronic communiqués, or a combination of both. At a minimum, formal or informal visits will be accomplished at least annually with in-person, electronic or telephonic means utilized as deemed appropriate by the SAS: Each GSU regardless of whether or not medical personnel are authorized/assigned. Each squadron with an authorized/assigned medical element (SME). Each MDG and Aeromedical Evacuation Squadron (AES) within the State. Each visit to the GSU, SME MDG and AES will be documented by a report.

4.2.2. SAS will maintain an awareness of the Medical Regional Readiness Response (MRRR) that allows MDGs to forecast and schedule long-term training and exercise requirements.

4.2.3. SAS will maintain an awareness of the allocation of existing resources, days and dollars that support and permeate the MRRR requirements in DoD FUNDS or the equivalent DoD Service information sources.

4.2.4. The SAS will encourage utilization of the self inspection process within each medical organization and will assist with leadership initiatives and resource procurement. Review the unit self inspection tools such as Management Internal Control Toolset (MICT) and the Flight Deck report at least quarterly. Follow up on identified unit program discrepancies, engage the unit leadership and develop a get well plan.

4.2.5. In conjunction with NGB/SG staff, the SAS will assess unit plans and assist as necessary to rectify issues leading to a DoD/USAF/NGB/MAJCOM inspection finding of less than satisfactory (or equivalent result) for any State ANG medical unit

4.2.6. SAS will furnish a written report to the TAG, the Assistant Adjutant General – Air (AAG), the wing commander, the visited unit’s commander, the host MDG commander and NGB/SG detail­ing issues, concerns and recommendations. When formal visits have been accomplished, this report should be submitted as soon after the visit as possible (The TAG and NGB/SG should be notified in writing if the report will not be submitted within two UTA’s of the visit). When infor­mal methods are utilized, the SAS will prepare an annual report, which may be facilitated by utilizing templates supplied by the ANG/SG and which may be located in a central repository.

4.2.7. In states with a Combat Readiness Training Center (CRTC) the SAS is responsible for oversight of the compliance with force protection medical requirements, including Individual Medical Readiness (IMR) of ANG personnel stationed or assigned to the CRTC.

4.2.8. The SAS must review and approve all “augmented” formulary items identified to fulfill unique state requirements in the CERF-P before such items are added to the formulary.

4.3. Credential must be maintained for the SAS and for MDG Commanders:

4.3.1. Medical privileges for the SAS will be awarded by the Air Surgeon (NGB/SG). The SAS’s PCF will be maintained at NGB/SG. If the SAS augments medical organizations outside of his/her state as a provider, the gaining organization must maintain a privilege “Inter-facility Credentials Transfer Brief (ICTB) with a validity period encompassing that time the SAS serves as a provider. If the SAS augments a medical organization within his/her state as a provider, the gaining organization must maintain a privilege “Inter-facility Credentials Transfer Brief (ICTB) with an indefinite period of validity not to exceed the expiration of the current credentials awarded by the ANG/SG.

4.3.2. The SAS reviews the PCF and awards clinical privileges to all MDG commanders within the State. In the event of a non-physician commander, the SAS reviews and awards clinical priv­ileges to the senior physician in the unit IAW AFI 44-119 Medical Quality Operations, Para 6.14 and 6.15. In the event that the senior physician of a CERF-P, Contingency Response Group, Special Tactics Squadron is not credentialed through a Medical Group, the SAS will award clinical privileges to the senior physician of such group.

4.4 Public Health Emergency Officer (PHEO) liaison is function of SAS.

4.4.1 SAS will act as PHEO liaison between the TAG and governmental agencies such as FEMA; SAS will not be required to uphold all PHEO requirements.

4.5 Retirement or Reassignment of SAS must be orderly.

4.5.1 Upon decision for retirement or reassignment, the current SAS should notify the TAG and ANG/SG.

4.5.2 Due to time required for appointing, credentialing, and training the incoming SAS, the selection should be at least 6 months in advance.

4.5.3 Outgoing SAS should mentor the incoming SAS during the transition period.

4.6 SAS interacts with Wing Director of Psychological Health (WDPH).

4.6.1 Since the SAS is a senior flight surgeon physician not attached to any Wing in the State, the SAS may serve as a resource, counselor for the WDPH.

4.6.2 SAS shall review quarterly and report to JFHQ aggregate quality measures such as number of contacts and referrals, average number of visits, length of time for referral, patient satisfaction, etc.

5. Medical Review, Certification, and Waiver Authority. As the senior medical officer within the State, the SAS must be aware of all medical issues in the State. As such, all medical issues that may impact medical readiness of the unit should be brought to the attention of the SAS. In addition, the SAS must mentor the less experienced medical officers in the State. To meet these goals, the SAS will:

5.1. Act as the Senior Reviewer for all Worldwide Duty (WWD) Evaluations. This will facilitate sit­uational awareness regarding the medical readiness and the quality of medical summaries within the State.

5.1.1. Ensure quality and completeness of cases prior to forwarding to higher authority.

5.1.2. Provide mentoring to constituent units on medical summaries.

5.1.3. Brief the TAG/State Headquarters as needed on medical issues.

5.2. Act as the Senior Reviewer for all Physical Examination Processing Program (PEPP) cases.

5.3. Act as the Certification Authority for cases where the SAS has been delegated Certification Authority by NGB/SG.

5.4. Act as the Waiver Authority for cases for which the SAS has been delegated Waiver Authority by NGB/SG. All flying and Special Operational duty waivers must be accomplished in Aeromedical Information Management Waiver Tracking System (AIMWTS).

5.5. Review and certify medical examinations for transfers of all individuals of Air Force and non-AF compo­nent military transfers. Cases with disqualifying/potentially disqualifying conditions must be sent to NGB/SGPA for Waiver consideration.

5.6. Review and validate Incapacitation (INCAP) pay packages requiring extensions past 6 months.

5.6.1 Review and ensure quality/com­pleteness of all Incapacitation pay extension packages before the Adjutant General’s Signature.

5.6.2 NGB/ SG, Financial Management (NGB/FM), and Manpower & Personnel (NGB/A1) will no longer review packages for completeness.

5.6.3 Packages will be forwarded directly to the Chief of Staff (COS) from the TAG for approval.

5.7 Conflict of Interest.

5.7.1 SAS or Deputy SAS many not certify physical or waiver of spouse, sibling or any other family member, nor shall the SAS or Deputy SAS act as the privileging authority for spouse, child or other family member.

5.7.2 Such waivers or physicals, must submitted to ANG/SGP or Deputy SAS for approval.


6. Support for the Duties and Responsibilities of the SAS:

6.1 Assistant to the SAS.

6.1.1 The SAS may appoint an officer or senior enlisted person from any medical organization the additional duty of assisting in the fulfillment of SAS duties and responsibilities.

6.1.2 The appointment must have the written concurrence of the member’s organization commander.

6.1.3. The assistant to the SAS is prohibited from:

6.2.4. Making credential/privilege determinations.

6.2.2. Making determinations pertaining to certification and waiver authority.

6.2.3. Other actions which require determination of a privileged provider.

6.2 Deputy SAS

6.2.1. At the discretion of the SAS and with the concurrence of the TAG, States are authorized a Deputy SAS.

6.2.2 The appointment must have the documented concurrence of the member’s organization commander.

6.2.3 Deputy State Air Surgeon shall undergo the same appointment process as the State Air Surgeon as specified in ANGI 40-102, para 2.

6.2.4 Deputy State Air Surgeon shall complete the qualification and re-qualification training as specified in ANGI 40-102, para 3.

6.2.5 Deputy SAS shall assist in the duties and responsibilities as specified in ANGI 40-102 para 5, with the SAS being ultimately responsible for assuring the accomplishment of all tasks.


7. Mobilization and Contingency Missions. During a mobilization and with consent and concurrence of TAG and NGB/SG, the SAS may augment any state medical organization, any Unit Type Code (UTC) tasking for which the SAS is otherwise qualified, or HQ NGB/SG.



Attachment 1



AFI 25-201, Support Agreements Procedures, 1 May 2005

AFI 41-106, Medical Readiness Planning and Training, 14 Apr 2008

AFI 41-115, Authorized Health Care and Health Care Benefits in the Military Health Services System (MHSS), 28 Dec 2001

AFI 41-117, Medical Service Officer Education, 23 Apr 2001

AFI 44-103, The Air Force Independent Duty Medical Technician Program and Medical Support for Mobile Medical Units/Remote Sites, 1 May 2005

AFI 44-119, Clinical Performance Improvement, 24 Sep 2007

AFI 48-101, Aerospace Medicine Operations, 19 Aug 2005

AFI 48-149 Squadron Medical Elements, 28 Feb 2003

AFI 48-123 Vol 1, Medical Examinations and Standard, Volume 1-General Provisions, 5 Jun 2006

AFI 48-123 Vol 2, Medical Examinations and Standards, Volume 2-Accession, Retention, and Administra­tion, 5 Jun 2006

AFI 48-123 Vol 3, Medical Examinations and Standards, Volume 3-Flying and Special Operational Duty, 5 Jun 2006

AFI 48-123 Vol 4, Medical Examinations and Standards, Volume 4-Special Standards and Requirements, 5 Jun 2006

AFMAN 44-158, The Air Force Independent Duty Medical Technician Medical and Dental Treatment Protocols, 1 Dec 1999

ANGI 36-2005, Appointment of Officers in the ANG of the United States and As Reserves of the Air Force, 15 Mar 2005

ANGI 40-101, Annual Training and Planning Requirements and Procedures Local, 28 Jan 1994

ANGI 40-103, Medical Support to Geographically Separated Units (GSUs), 16 Jul 1995

ANGI 41-102, Early Appointment Program for Physician, 30 Oct 1995

ANGI 41-103, Annual Training, Planning Requirements, and Procedures for ANG Aeromedical Evacua­tion Units, 22 Dec 1995

ANGPD 40-1, State Air Surgeon, 21 Oct 1994

Abbreviations and Acronyms

AAG—Assistant Adjutant for Air

AES—Aeromedical Evacuation Squadron

AFPC—Air Force Personnel Center

AGR—Active Guard Reserve

AIMWTS—Aeromedical Information Management Waiver Tracking System

AMSUS—Association of Military Surgeons of the United States

AT—Annual Training

DoD FUNDS—Department of Defense Financial Uniform Needs Development System

ESF-#8—Emergency Support Function #8 (FEMA)

FC—Flying Class

FEMA—Federal Emergency Management Agency

GSU—Geographically Separated Unit

HMDS—Host Medical Squadron

HSM—Health Services Management

IPEB—Informal Physical Evaluation Board

LoD—Line of Duty

MDG—Medical Group

MEB—Medical Evaluation Boards

NIMS—National Incident Management System

PCF—Provider Credential File

PEPP—Physical Examination Processing Program

SAS—State Air Surgeon

SAV—Staff Assistance Visit

SME—Squadron Medical Element

SPP—State Partnership Program

STARC—State Area Command

TAG—The Adjutant General

UTA—Unit Training Assembly

UTC—Unit Type Code

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