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The Florida Certification of Immunization, commonly referred to as the 680 form, plays a crucial role in ensuring that children meet the necessary immunization requirements for school attendance. This form is guided by various legal authorities, including specific sections of Florida Statutes and the Florida Administrative Code, which outline the immunization obligations for children in educational settings. Parents or guardians must provide essential information such as the child's name, date of birth, and optional identifiers like the child’s Social Security number. The form requires documentation of all administered vaccine doses, including dates for each, helping to verify that children have received the appropriate immunizations. There are specific sections within the form for different circumstances, such as complete immunization records, temporary medical exemptions, and permanent medical exemptions. Each section is clearly marked, and proper completion is essential for compliance with state regulations. Additionally, resources are available to guide users through the process, ensuring that all necessary information is accurately captured. Understanding the 680 form is vital for parents and guardians as it not only facilitates school enrollment but also contributes to the overall health and safety of the community.

Common mistakes

  1. Incomplete Personal Information: Failing to provide the child's full name, date of birth, or parent/guardian details can lead to processing delays.

  2. Incorrect Vaccine Codes: Using incorrect codes for vaccines can result in the form being rejected. Each vaccine has a specific code that must be accurately filled out.

  3. Missing Dates: Not entering the dates for each vaccine dose can render the form incomplete. All doses must have corresponding dates.

  4. Omitting Optional Information: While the child's Social Security Number and State Immunization ID are optional, providing them can help streamline the process.

  5. Failure to Sign: Not signing the certification section can lead to rejection of the form. A signature is necessary to validate the information provided.

  6. Incorrect Certificate Selection: Choosing the wrong certificate (A, B, or C) can cause confusion regarding the child's immunization status.

  7. Ignoring Expiration Dates: For temporary medical exemptions, failing to include an expiration date can invalidate the exemption.

  8. Not Reviewing Records: Not reviewing the child's immunization records before completion can lead to inaccuracies in the information submitted.

  9. Incomplete Clinical Reasoning: For permanent medical exemptions, failing to provide valid clinical reasoning or evidence can lead to rejection of the exemption request.

Preview - 680 Form

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

Documents used along the form

The Florida Certification of Immunization, commonly referred to as the 680 form, is essential for ensuring that children meet the immunization requirements for school attendance. In conjunction with this form, several other documents may be required or beneficial. Below is a list of these forms, each accompanied by a brief description.

  • DH Form 150-615: This form provides detailed immunization guidelines for schools, childcare facilities, and family daycare homes in Florida. It outlines the necessary immunizations and the procedures for completing the 680 form.
  • Certificate of Medical Exemption: This document is issued when a child is unable to receive certain vaccinations due to medical reasons. It must be signed by a licensed physician and includes specific details about the medical contraindications.
  • School Enrollment Form: Schools often require this form to gather essential information about the student, including contact details, emergency contacts, and health history, which may influence immunization requirements.
  • Non-disclosure Agreement Form: For protecting sensitive information in business transactions, refer to our detailed Non-disclosure Agreement guidelines to ensure confidentiality and compliance.
  • Health Records Release Form: This form allows parents or guardians to authorize the release of their child's health records to the school. It is often necessary for verifying immunization status.
  • Immunization Records: These records provide a detailed history of the vaccinations a child has received. They are crucial for completing the 680 form accurately and may be requested by schools or childcare facilities.
  • Physical Examination Form: Some schools require a physical examination form that confirms a child’s overall health status. This form may also include information about immunizations.
  • Emergency Contact Form: This document lists individuals to contact in case of an emergency. While not directly related to immunizations, it is often required during school enrollment.
  • Consent for Treatment Form: This form gives permission for medical treatment in case of emergencies. Schools may require this to ensure that they can act swiftly if a child needs medical attention.
  • Allergy Action Plan: For children with known allergies, this plan outlines the necessary steps to take in case of an allergic reaction. It is important for the safety of the child during school hours.

Understanding the various forms associated with the 680 form can facilitate a smoother enrollment process for children in Florida. Ensuring that all necessary documents are completed and submitted can help avoid delays in school attendance and promote a safe environment for students.

Similar forms

The Florida Certificate of Immunization (Form 680) shares similarities with the CDC's Immunization Record. Both documents serve to track a person's vaccination history. The CDC record includes details about the vaccines received, similar to how the 680 form lists immunizations for school attendance. Each document requires accurate dates and types of vaccines, ensuring that individuals have met necessary health requirements for school or travel.

Another comparable document is the School Health Examination form. This form assesses a child's overall health and readiness for school. Like the 680 form, it collects essential health information, including immunization status. Both documents are often required for enrollment in educational settings, helping schools maintain a safe environment for all students.

The International Certificate of Vaccination or Prophylaxis (ICVP) is also similar. This document is used for international travel and confirms that a traveler has received necessary vaccinations. The ICVP, like the Florida 680 form, specifies which vaccines have been administered, providing proof of immunization to authorities in different countries.

The Certificate of Medical Exemption is another related document. This certificate is issued when a child cannot receive certain vaccinations due to medical reasons. It parallels the 680 form's exemption sections, which allow for temporary or permanent medical exemptions from immunizations, ensuring that children with health concerns are not unfairly excluded from school.

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The Personal Immunization Record is a document that families maintain to track their child's vaccinations. Similar to the 680 form, it includes details about each vaccine, such as dates and types. This personal record can be presented to schools or healthcare providers as proof of immunization, reinforcing the importance of keeping accurate health records.

The Health History form is also relevant. This form collects comprehensive information about a child's health, including immunization history. Like the 680 form, it helps healthcare providers understand a child's health background, ensuring they receive appropriate care and vaccinations.

The Child Health Assessment form is similar as well. It evaluates a child's health status and includes immunization records. Both documents are used to ensure children are healthy and up-to-date with vaccinations, which is crucial for school readiness and public health.

The Vaccine Administration Record is another document that parallels the 680 form. This record is completed by healthcare providers when administering vaccines. It documents the specific vaccines given, similar to how the 680 form tracks immunization details for school attendance, ensuring accurate health records are maintained.

The Immunization History Report from a healthcare provider is also comparable. This report provides a detailed account of all vaccinations a person has received. Like the Florida 680 form, it serves as an official record, ensuring that individuals can prove their immunization status for school or work requirements.

Lastly, the State Immunization Registry is relevant to the discussion. This electronic database collects immunization records for residents within a state. Similar to the 680 form, it aims to maintain accurate vaccination records, helping public health officials monitor immunization rates and outbreaks of vaccine-preventable diseases.

Dos and Don'ts

When filling out the Florida Certification of Immunization (Form 680), it is essential to follow specific guidelines to ensure accuracy and compliance. Below are nine important do's and don'ts to consider:

  • Do enter the child's full name, including last name, first name, and middle initial.
  • Do provide the date of birth in the correct format (MM/DD/YY).
  • Do include the parent or guardian's information accurately.
  • Do list all appropriate vaccine doses and their corresponding dates.
  • Do sign and date the appropriate certificate section (A, B, or C).
  • Don't leave any sections blank; ensure all required fields are completed.
  • Don't use abbreviations or shorthand that may cause confusion.
  • Don't forget to check for the expiration date if claiming a temporary medical exemption.
  • Don't submit the form without reviewing it for accuracy and completeness.

Following these guidelines will help facilitate the immunization process for the child and ensure compliance with state requirements.

Key takeaways

  • The 680 form is essential for documenting a child's immunization status in Florida.

  • It is required for school attendance, particularly for K-12 students and those in daycare or preschool settings.

  • Parents or guardians must provide the child's full name, date of birth, and optionally, the Social Security number.

  • Each vaccine dose must be recorded with the corresponding date to ensure compliance with state requirements.

  • There are three parts to the form: Part A for complete immunizations, Part B for temporary exemptions, and Part C for permanent exemptions.

  • Temporary medical exemptions require an expiration date to be valid.

  • For permanent exemptions, a physician must provide clinical reasoning or evidence for each vaccine listed.

  • After filling out the form, it must be signed and dated by an authorized physician or clinic.

  • Additional resources and guidelines for completing the form can be found at www.immunizeflorida.org/schoolguide.pdf.

How to Use 680

Completing the Florida Certification of Immunization Form 680 is essential for ensuring that a child meets immunization requirements for school attendance. Follow these steps carefully to fill out the form accurately.

  1. Begin by entering the child’s last name, first name, and middle initial in the designated fields.
  2. Input the child’s date of birth in the format MM/DD/YY.
  3. Fill in the parent or guardian’s name.
  4. Optionally, provide the child’s Social Security number and state immunization ID number.
  5. For each vaccine listed, enter the date of administration for each dose in the appropriate boxes.
  6. Select the appropriate certificate type (A, B, or C) based on the child's immunization status.
  7. For Part A, check the box indicating whether immunizations are complete for K-12 or 7th grade.
  8. If applicable, complete Part B for a temporary medical exemption, including the expiration date.
  9. For a permanent medical exemption, fill out Part C, listing each vaccine and the reason for exemption.
  10. Sign and date the form where indicated, and include the physician or clinic’s name and authorized signature.
  11. Ensure all information is accurate before submitting the form.

After filling out the form, it should be submitted to the appropriate school or childcare facility. Ensure that all necessary documentation is attached to avoid delays in enrollment or attendance. Keep a copy for your records as well.