Fill in Your 680 Template Get Document Here

Fill in Your 680 Template

The Florida Certification of Immunization (Form 680) is a crucial document that verifies a child's immunization status for school attendance in Florida. It outlines the required vaccines and allows parents or guardians to certify that their child has received the necessary immunizations. Completing this form is essential for ensuring compliance with state health regulations; click the button below to fill it out.

Get Document Here

Key takeaways

Understanding the Florida Certification of Immunization (680 form) is essential for parents and guardians. Here are some key takeaways regarding its completion and use:

  • Accurate Information is Crucial: Ensure that all personal details, including the child's name, date of birth, and immunization dates, are entered correctly. Mistakes can lead to delays in school enrollment.
  • Choose the Correct Certificate: Depending on the child's immunization status, select the appropriate certificate (A, B, or C) to indicate whether the child is fully immunized, has a temporary exemption, or has a permanent medical exemption.
  • Documentation is Required: Keep records of all immunizations received. This information must be documented on the form, as it serves as proof for school attendance requirements.
  • Consult the Guidelines: For detailed instructions on completing the form, refer to the Immunization Guidelines available at the provided website. This resource offers valuable insights into the immunization process and requirements.

Dos and Don'ts

When filling out the Florida Certification of Immunization (Form 680), there are important steps to follow. Here’s a helpful list of things to do and avoid.

  • Do read the instructions carefully before starting.
  • Do fill in all required fields completely.
  • Do use the correct dates for each vaccine dose.
  • Do check for any additional requirements specific to your child’s school.
  • Do keep a copy of the completed form for your records.
  • Don't leave any sections blank unless instructed.
  • Don't forget to sign and date the form where required.

Following these guidelines can help ensure a smoother process when submitting the form. It's always best to double-check your work before submission.

Form Overview

Fact Name Details
Legal Authority This form is governed by Sections 1003.22, 402.305, and 402.313 of the Florida Statutes, along with Rule 64D-3.046 of the Florida Administrative Code.
Purpose The Florida Certification of Immunization (Form DH 680) is used to document a child's immunization status for school attendance.
Immunization Records Parents or guardians must enter all appropriate vaccine doses and dates on the form, ensuring accurate documentation for school requirements.
Exemptions The form allows for temporary and permanent medical exemptions from immunizations, requiring appropriate documentation and signatures from a physician or clinic.

Common mistakes

  1. Incomplete Personal Information: Failing to fill out the child's full name, date of birth, or the parent's or guardian's name can lead to delays. It is essential that all personal details are complete and accurate.

  2. Missing Immunization Dates: Not entering the dates for each vaccine dose is a common mistake. Each dose must have a corresponding date to ensure that the immunization schedule is clear and complete.

  3. Incorrect Vaccine Codes: Using the wrong codes for vaccines can cause confusion. Each vaccine has a specific code that must be used to avoid errors in the immunization record.

  4. Not Signing the Form: Omitting a signature can invalidate the form. It is crucial to sign and date the appropriate certificate to confirm that the information provided is accurate and complete.

  5. Ignoring Expiration Dates for Exemptions: When applying for a temporary medical exemption, failing to include an expiration date renders the exemption invalid. Always ensure that this date is clearly stated.

  6. Overlooking Additional Immunization Requirements: Some parents may forget to check for additional immunizations required for specific grades, particularly for 7th grade. It is important to review the requirements thoroughly.

  7. Neglecting to Review Records: Not reviewing the child's immunization records before filling out the form can lead to inaccuracies. It is advisable to verify all information to ensure it reflects the child's true immunization history.

Similar forms

The Florida Certification of Immunization, commonly known as the DH 680 form, shares similarities with the CDC's Certificate of Immunization. Both documents serve to verify that an individual has received the necessary vaccinations. They include sections for listing vaccine types and dates administered. The CDC form is widely recognized across states, just as the DH 680 is essential for school enrollment in Florida. Both forms help ensure that children are protected against preventable diseases, promoting public health and safety.

Another similar document is the State Immunization Registry record. This record is maintained by health departments and tracks immunizations for individuals. Like the DH 680, it includes detailed information about each vaccine received, including dates and types. The registry serves as an official record, much like the DH 680, which parents can present to schools or childcare facilities to prove compliance with immunization requirements.

The Universal Child Health Record is another document that resembles the DH 680. This form is used by healthcare providers to document a child's health history, including immunizations. It provides a comprehensive overview of a child's health status and vaccination history, similar to the DH 680. Parents can use this document to ensure that their child meets school immunization requirements, thus facilitating school enrollment.

The School Health Record is also comparable to the DH 680. This document is used by schools to maintain health information about students, including immunization status. It ensures that schools have up-to-date records on each student’s vaccinations, just as the DH 680 does. Both documents are vital for safeguarding the health of the student population and preventing outbreaks of vaccine-preventable diseases.

The Immunization Exemption Form is another document that aligns with the DH 680. This form is used by parents to formally request an exemption from immunization requirements for medical, religious, or philosophical reasons. Like the DH 680, it requires documentation and signatures from healthcare providers. Both forms are essential in managing the balance between public health requirements and individual rights.

The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule allows individuals to access their health records, including immunization records. While not a vaccination form itself, it provides the legal framework for individuals to obtain their DH 680 or similar documents. This access ensures that individuals can verify their immunization status and share it with schools or employers when necessary.

The Certificate of Medical Exemption is similar to the DH 680 in that it documents a child's exemption from certain vaccinations due to medical reasons. This certificate, like the DH 680, must be signed by a licensed healthcare provider. Both documents help clarify a child's vaccination status and ensure compliance with school health policies.

The Vaccination Record Card, often provided by healthcare providers, is another document that mirrors the DH 680. It serves as a personal record of vaccinations received by an individual. Parents can use this card to track their child's immunizations over time, similar to how the DH 680 is used for school enrollment. Both documents are crucial for maintaining accurate vaccination histories.

Creating an essential guide for your Operating Agreement can help you establish clear operational procedures and management structures for your LLC, ensuring all members understand their roles and responsibilities. This document is integral to maintaining organization and preventing potential conflicts as your business grows.

Lastly, the Immunization Assessment Form is comparable to the DH 680. This form is used by healthcare providers to assess and document a child's immunization status. It includes sections for listing vaccines and their administration dates, much like the DH 680. Both forms play a critical role in ensuring that children receive appropriate vaccinations to protect their health and the health of those around them.

Other PDF Forms

Your Questions, Answered

What is the purpose of the Florida 680 form?

The Florida 680 form serves as a Certification of Immunization. It documents the immunization status of children attending K-12 schools, daycare facilities, and family daycare homes in Florida. This form ensures compliance with state immunization requirements, which are essential for the health and safety of all students.

Who needs to fill out the 680 form?

The 680 form must be completed for children who are entering or attending K-12 schools, daycare centers, or family daycare homes in Florida. Parents or guardians should provide this form to verify that their child has received the necessary immunizations as mandated by state law.

What information is required on the 680 form?

The form requires the following information:

  • Child's last name, first name, and middle initial
  • Date of birth
  • Parent or guardian's name
  • Child's Social Security number (optional)
  • State immunization ID number (optional)
  • Details of all immunization doses and dates

Additionally, the form includes sections for certifying the completion of immunizations, temporary medical exemptions, and permanent medical exemptions.

What are the different parts of the 680 form?

The 680 form consists of three main parts:

  1. Part A: Certification of complete immunizations for K-12 students.
  2. Part B: Temporary certification for children who are in the process of completing their immunizations.
  3. Part C: Permanent medical exemption for children who cannot receive certain vaccines due to medical reasons.

How can I obtain the 680 form?

The 680 form can be obtained from various sources, including healthcare providers, schools, and online resources. It is also available through the Florida Department of Health's website. Parents and guardians should ensure they have the most current version of the form to meet state requirements.

What should I do if my child has a medical exemption?

If your child has a medical exemption, you must complete Part C of the 680 form. This section requires a physician or clinic's signature, along with a valid clinical reasoning or evidence for the exemption. It is important to include an expiration date for the exemption to ensure compliance with school policies.

Are there any deadlines for submitting the 680 form?

While specific deadlines may vary by school or daycare facility, it is generally recommended to submit the 680 form before the start of the school year or upon enrollment. Parents should check with their child’s school or daycare for any specific submission timelines to avoid complications.

Where can I find more information about immunization requirements?

For additional information regarding immunization requirements and guidelines, parents and guardians can visit the Florida Department of Health’s website. The site provides resources, including the Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes.

Form Preview

FLORIDA CERTIFICATION OF IMMUNIZATION

Legal Authority: Sections 1003.22, 402.305, 402.313, Florida Statutes; Rule 64D-3.046, Florida Administrative Code

 

 

 

 

 

 

 

 

 

 

LAST NAME

 

FIRST NAME

 

MI

 

DOB (MM/DD/YY)

 

 

 

 

 

 

 

 

 

 

PARENT OR GUARDIAN

 

CHILD’S SS# (optional)

 

STATE IMMUNIZATION ID# (optional)

 

 

 

 

 

 

 

 

 

 

Directions:

Enter all appropriate doses and dates below.

Sign and date appropriate certificate (A, B,or C) on form.

See DH Form 150-615, Immunization Guidelines - Florida Schools, Childcare Facilities and Family Daycare Homes (July 2010) for information and instructions on form completion. Guidelines are available at: www.immunizeflorida.org/schoolguide.pdf.

VACCINE

DOE

Dose 1

 

Dose 2

 

Dose 3

 

Dose 4

 

Dose 5

 

CODE

MM/DD/YY

 

MM/DD/YY

 

MM/DD/YY

 

MM/DD/YY

 

MM/DD/YY

DTaP/DTP

A

 

 

 

 

 

 

 

 

 

DT

B

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tdap

P

 

 

 

 

 

 

 

 

 

Td

Q

 

 

 

 

 

 

 

 

 

Polio

D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hib

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MMR (Combined)

F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Separate)

G, H

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Measles (dose 1)

 

Measles (dose 2)

 

Mumps (dose 1)

 

Mumps (dose 2)

 

 

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rubella (dose 1)

 

Rubella (dose 2)

 

 

 

 

 

 

Hepatitis B

J

 

 

 

 

 

 

 

 

 

Varicella

K

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Varicella Disease

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Year

PneumoConju N

Select appropriatebox(es)

Certificate of Immunization forK-12

Part A-Complete

DOE Code 1: Immunizations are complete K-12 (Excluding 7th grade/middle school requirements)

DOE Code 8: Immunizationsare complete for 7th grade

I have reviewed the records available,and to the best of my knowledge, the above named child has adequately been immunized for school attendance, as documented above.

Temporary Medical Exemption

Expiration date: _____________

Part B-Temporary

 

Part B (For children in daycare, family daycare homes, preschool, kindergarten and grades 1 through 12 who are incomplete for immunizations in Part A) Invalid without expiration date. DOE Code 2

I certify that the above named child has received the immunizations documented above and has commenced a schedule to complete the required immunization. Additional immunizations are not medically indicated at this time.

Permanent Medical Exemption

Part C-Permanent

Part C (For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption.) DOE Code 3 ________________________________________________________________________________________

I certify the physical condition of this child is such that immunizations as indicated in Part C above are medically contraindicated.

Physician or Clinic Name:

Physician or

_________________________________________________

Authorized Signature: ____________________________________

_________________________________________________

Issued By:_____________________________________________

_________________________________________________

Date: _________________________________________________

DH 680 (Jul 2010) Stock Number: 5740-000-0680-6