Medical Verification for Air Conditioner Request - Ball State 2026

1. Click ‘Get Form’ to open the Medical Verification for Air Conditioner Request in the editor.
2. Begin by entering the student's name in the designated fields: First, Middle, and Last. Ensure accuracy as this information is crucial for identification.
3. Input the BSU ID number in the specified field to link the request to the correct student record.
4. In the Diagnosis section, provide a clear description of the medical condition that necessitates an air conditioner.
5. Fill out the Prognosis field with relevant details about the expected outcome of the condition.
6. List any Restrictions that may affect daily activities due to the medical condition.
7. Describe the Functional nature of the condition, detailing how it impacts daily life.
8. Indicate any Expected date restrictions will be lifted, if applicable, to inform future accommodations.
9. Provide clinical evidence of the condition in detail, including physical findings and any relevant tests like x-rays or lab results.
10. Ensure that your physician signs and prints their name at the bottom of the form. Include their address and daytime phone number for verification purposes.
11. Finally, return completed forms either directly to the student or mark it confidential and send it via mail or fax to Housing and Residence Life at Ball State University.

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