Medical Verification Form - Ball State University 2026

1. Click ‘Get Form’ to open the Medical Verification Form in the editor.
2. Begin by entering the student's name in the designated fields. Ensure you include the first, middle, and last names clearly.
3. Input the BSU ID number accurately to help identify the student’s records.
4. In the diagnosis section, provide a clear description of the medical condition that necessitates an air conditioner.
5. Fill out the prognosis and any restrictions related to the condition. This information is crucial for understanding the student's needs.
6. Detail any functional nature of the condition and expected date restrictions will be lifted, if applicable.
7. Describe clinical evidence supporting the condition, such as physical findings or test results.
8. Ensure that the physician signs and prints their name, along with providing their address and daytime phone number for verification purposes.
9. Finally, select whether to return the completed form directly to the student or mark it confidential for mailing or faxing to Housing and Residence Life.

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