To help the Student Health Office prepare for each student’s health and safety needs, required health forms should be completed and submitted by August 1 of each school calendar year. Parents/Guardians should also provide updated information whenever there is a significant change in their student’s health, medications, or health care needs.

Forms Required for All Students

Every student attending Perpich Arts High School must have a current Annual Student Health Information Form on file with the Student Health Office.

This form provides the Student Health Office with important information about your student’s health history, medical conditions, allergies, medications, and other health needs. A new form should be completed each school year and whenever there is a significant change in your student’s health.

Authorization for Medication Administration Form

This form is required if your student needs medication to be administered, stored, or managed through the School or Dorm Health Office.

A new or updated medication authorization may be required if there is a change in the medication, dosage, administration instructions, or health care provider’s orders.

Vaccination Record or Vaccination Exemption Form

Minnesota law requires students to have documentation of required vaccinations or a valid notarized exemption on file. Please provide updated vaccination records when your student receives additional required vaccines.

Forms for Students with Specific Health Conditions

Students with a medical condition that may require treatment, emergency care, medication, or accommodations at school or in the dorm may need an additional health care plan.

Depending on your student’s health needs, their health care provider may provide forms such as:

• Allergy/Anaphylaxis Emergency Action Plan
• Asthma Action Plan
• Diabetes Medical Management Plan
• Seizure Action Plan
• Other individualized emergency or health care plans requested by the school or dorm Health Office

Not sure which form your student needs? Please contact the School’s or Dorm Health Office for assistance.

Specialized Health Services

If your student requires a specialized health procedure during the school day or while living in the dorm, additional medical orders, authorization, and an individualized health plan may be required.

Specialized health services may include:

• Tube feeding
• Nebulizer treatments
• Tracheostomy care
• Specialized respiratory treatments
• Health-related mobility assistance
• Other health procedures requiring nursing care or supervision

Please contact the School’s or Dorm Health Office before the start of the school year, or as soon as a new health need develops. This allows enough time to obtain necessary medical orders and authorizations and to develop a safe plan for your student’s care.

Changes in Your Student’s Health

Please notify the School’s or Dorm Health Office during the school year if there is a significant change in your student’s:

• Medical condition or diagnosis
• Medication or dosage
• Allergies or emergency medications
• Physical activity restrictions
• Mental or behavioral health needs that may affect care at school
• Emergency action plan
• Health care provider recommendations

Keeping your student’s health information current helps the Student Health Office provide safe and appropriate care while your student is at school and, when applicable, living in the dorm.

Additional Health Forms and Resources

Special Diet Statement: Complete this form when a student requires a special diet or meal accommodation related to a medical or dietary need.

Free and Reduced-Cost Vaccination Resources: Information for families who may need assistance locating free or reduced-cost vaccination services.