Campus in the fall


Minnesota state statute 121A.221 states:
In a school district that employs a school nurse or provides school nursing services under another arrangement, the school nurse or other appropriate party must assess the student’s knowledge and skills to safely possess and use an asthma inhaler in a school setting and put a plan to implement safe possession and use of asthma inhalers in the student’s school health records.


Perpich Arts High School requires that an incoming student who has been diagnosed with asthma and his/her family must complete both a parent/guardian asthma questionnaire and a student breathing/asthma questionnaire.

Perpich has devised a procedure in which a family’s healthcare provider, along with the parent/guardian, student and school nurse can jointly agree that self-administration of asthma medication is appropriate. A consent to self-carry must be completed by the family’s prescribing healthcare provider and sent to the school nurse before school begins.

Orders must be reviewed annually or whenever medication, dosage or other details of the order change.


The parent/guardian must provide the school health office with:

  • A written order by a healthcare provider (signed asthma action plan, medication consent form and/or the Perpich form)
  • Written authorization from the parent/guardian (signed asthma action plan, medication consent form and/or Perpich parent questionnaire)
  • The inhaler and/or other medication in a container appropriately labeled by a pharmacist or the health care provider

The student must:

  • Complete the Perpich student breathing questionnaire
  • Demonstrate competency in taking his/her medication safely
  • Demonstrate appropriate asthma self-management and self-care skills
  • Appropriately complete and sign the self-care/self-administer student agreement
  • Follow up as indicated in the student agreement

The school nurse must:

  • Determine asthma severity level from the student breathing questionnaire, if not indicated on an asthma action plan, and assess level of asthma control
  • Insure the student understands what asthma is, early and late warning signs/symptoms, peak flow usage as appropriate, how to prevent/relieve symptoms, the concept of good control, asthma management steps, how to use the asthma action plan, the difference between controller and reliever medication, appropriate self-care skills and can demonstrate appropriate medication technique/competency, including how to tell time and decide when to take medications

The school nurse must also work with older students in preparation for currently or in the near future being able to self-manage their own disease and assess whether students know and understand:

  • Their primary health care provider’s name and clinic
  • Importance of choosing and building a relationship with a primary health care provider
  • How and when to make one’s own asthma appointments
  • The need for preventive “well asthma care” at least every six months
  • Location of one’s pharmacy
  • How to get prescriptions filled and refilled
  • Intervene on the student’s behalf by communicating with the student’s parent/guardian and health care provider as needed to promote better asthma control and mastery of asthma self-care skills

Required Asthma Forms

All medical forms are located on the “Medical Forms” page. Click the link below to view the forms and download the ones you need.