Homepage Free 680 Template
Jump Links

The Florida Certification of Immunization, commonly referred to as the 680 form, plays a crucial role in ensuring that children meet the immunization requirements necessary for school attendance. This form is not just a simple document; it encapsulates important legal mandates outlined in Florida Statutes and Administrative Codes, specifically sections 1003.22 and 402.305. Parents or guardians fill out the form, providing essential information such as the child's name, date of birth, and immunization history. The form includes sections for various vaccines, allowing for the documentation of multiple doses across different types of immunizations, including DTaP, MMR, and Hepatitis B. Additionally, the 680 form accommodates exemptions, whether temporary or permanent, ensuring that those with valid medical reasons can still navigate the school system. Understanding how to complete this form correctly is vital, as it not only affects a child's eligibility for school but also contributes to public health efforts aimed at preventing outbreaks of vaccine-preventable diseases. Resources and guidelines for completing the form are readily available, making it easier for families to comply with immunization requirements while safeguarding the health of their children and the community.

Key takeaways

When filling out the Florida Certification of Immunization (Form 680), it is essential to follow specific guidelines to ensure accuracy and compliance. Here are key takeaways to consider:

  • Understand the Purpose: The 680 form is required for children attending K-12 schools and certain childcare facilities in Florida to document their immunization status.
  • Collect Necessary Information: Gather all relevant details, including the child's full name, date of birth, and immunization records before starting the form.
  • Complete the Vaccine Section: Clearly enter the dates for each vaccine dose in the appropriate boxes. Make sure to include all required doses as specified for each vaccine.
  • Choose the Correct Certificate: Sign and date the appropriate certificate (A, B, or C) based on the child's immunization status. Each certificate serves a different purpose.
  • Temporary Exemptions: If a child is not fully immunized, use Part B to document a temporary medical exemption. Remember to include an expiration date for validity.
  • Permanent Exemptions: For children with permanent medical exemptions, Part C must be filled out. Provide a valid clinical reason for each exemption listed.
  • Consult the Guidelines: Refer to the Immunization Guidelines available at the provided link for detailed instructions on completing the form accurately.
  • Check for Accuracy: Review all entries on the form for completeness and correctness before submission. Errors can lead to delays in school enrollment.
  • Keep Copies: Always keep a copy of the completed form for your records. This can be useful for future school registrations or medical needs.

By following these takeaways, you can ensure that the 680 form is filled out correctly and efficiently, helping to facilitate a smooth enrollment process for your child.

Dos and Don'ts

When filling out the Florida Certification of Immunization Form (680), there are several important dos and don'ts to keep in mind. These guidelines will help ensure that the process goes smoothly and that your child's immunization records are accurately documented.

  • Do double-check all entries for accuracy before submitting the form.
  • Do include all relevant immunization dates and doses as required.
  • Do ensure that the form is signed by an authorized physician or clinic representative.
  • Do refer to the Immunization Guidelines available at the provided website for additional instructions.
  • Don’t leave any sections blank; fill in all necessary information, even optional fields if possible.
  • Don’t submit the form without verifying that it meets the requirements for your child’s grade level.
  • Don’t forget to include the expiration date for any temporary medical exemptions.

Following these guidelines will help ensure that your child's immunization documentation is complete and compliant with Florida regulations.

Documents used along the form

The Florida Certification of Immunization Form 680 is essential for documenting a child's immunization history, particularly for school attendance. Along with this form, several other documents may be required or helpful in ensuring compliance with immunization requirements. Below is a list of these documents, each described briefly for clarity.

  • DH Form 150-615: This document provides detailed immunization guidelines for Florida schools, childcare facilities, and family daycare homes. It outlines the necessary immunizations and the procedures for completing the 680 form.
  • Immunization Records: These are official records from healthcare providers that detail a child's vaccination history. They serve as proof that the required immunizations have been administered.
  • New York Boat Bill of Sale: To ensure a smooth and legally compliant transfer of ownership, utilizing a document like the Fast PDF Templates can greatly assist buyers and sellers in capturing all necessary details about the transaction.
  • Temporary Medical Exemption Form: This form is used when a child cannot receive certain vaccinations due to medical reasons. It must include an expiration date and must be signed by a licensed physician.
  • Permanent Medical Exemption Form: This document is for children who are permanently exempt from vaccinations due to specific medical contraindications. It requires clinical reasoning and must be validated by a healthcare provider.
  • School Health Forms: Many schools require additional health forms that may include health history, allergies, and other medical conditions. These forms help schools provide appropriate care and accommodations.
  • Consent Forms: These forms are necessary for parents or guardians to authorize vaccinations for their children. They typically include information about the vaccines being administered and any potential side effects.
  • Insurance Information: Some schools or clinics may request proof of insurance to cover vaccination costs. This documentation can help ensure that families receive necessary immunizations without financial barriers.
  • School Registration Forms: When enrolling a child in school, parents often need to complete registration forms that may require immunization information, ensuring compliance with state laws.
  • Health Care Provider Statements: In some cases, a statement from a healthcare provider may be required to confirm a child’s immunization status or to clarify any medical exemptions.

Understanding the various documents associated with the Florida Certification of Immunization Form 680 can help streamline the process of ensuring that children are adequately vaccinated. Parents and guardians should gather these documents to facilitate a smooth enrollment experience in schools and childcare settings.

Things to Know About This Form

What is the purpose of the Florida 680 form?

The Florida 680 form, also known as the Certification of Immunization, serves as an official record of a child's immunizations. It is required for school enrollment in Florida, ensuring that children are up-to-date on necessary vaccines. The form helps schools verify that students meet the immunization requirements set by state law, which is crucial for maintaining public health and preventing the spread of infectious diseases.

Who needs to complete the 680 form?

Parents or guardians of children entering K-12 schools, daycare centers, or preschool programs in Florida must complete the 680 form. It is particularly important for those enrolling in the 7th grade, as additional immunization requirements apply at this educational level. The form can also be used for children who have received temporary or permanent medical exemptions from certain vaccinations.

How do I fill out the 680 form correctly?

Filling out the 680 form involves several steps:

  1. Enter the child's personal information, including last name, first name, middle initial, date of birth, and Social Security number (optional).
  2. Document all required immunizations by entering the vaccine type and the corresponding dates for each dose.
  3. Choose the appropriate certificate section (A, B, or C) based on the child's immunization status and any medical exemptions.
  4. Sign and date the form to certify that the information provided is accurate.

For detailed instructions, refer to the Immunization Guidelines available at www.immunizeflorida.org/schoolguide.pdf.

What if my child has a medical exemption?

If your child cannot receive certain vaccinations due to medical reasons, you can indicate this on the 680 form. There are two types of exemptions: temporary and permanent. For a temporary medical exemption, you must provide an expiration date. For a permanent exemption, specific clinical reasons must be documented. A physician or authorized clinic must sign the form to validate the exemption.

Where can I obtain the 680 form?

The Florida 680 form can be obtained from several sources. Parents can request it from their child's healthcare provider or download it directly from the Florida Department of Health's website. Additionally, schools and childcare facilities often have copies available for parents to complete. It’s essential to ensure that the most recent version of the form is used, as guidelines and requirements may change over time.

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

Document Specifics

Fact Name Description
Legal Authority The form is governed by Sections 1003.22, 402.305, 402.313 of the Florida Statutes and Rule 64D-3.046 of the Florida Administrative Code.
Purpose This form certifies that a child has received the necessary immunizations required for school attendance in Florida.
Optional Information Parents or guardians may provide the child's Social Security number and state immunization ID number, although these fields are optional.
Completion Guidelines Instructions for completing the form are available in DH Form 150-615, which outlines immunization guidelines for Florida schools and childcare facilities.
Expiration of Exemptions Temporary medical exemptions must include an expiration date to be considered valid.

How to Fill Out 680

Completing the Florida Certification of Immunization Form 680 is essential for ensuring that your child meets the immunization requirements for school attendance. This form collects important information about your child's immunization history and requires signatures from a physician or authorized clinic. Following the steps below will help you accurately fill out the form.

  1. Begin by entering your child's last name, first name, and middle initial in the designated fields.
  2. Input your child's date of birth in the format MM/DD/YY.
  3. Provide the name of the parent or guardian in the next section.
  4. If applicable, include your child's Social Security number (this is optional).
  5. Enter the state immunization ID number if you have it (this is also optional).
  6. In the vaccine section, fill out the doses and dates for each vaccine your child has received. Use the appropriate codes for each vaccine listed, such as DTaP/DTP, Polio, MMR, etc.
  7. Make sure to sign and date the certificate in the appropriate section (A, B, or C) based on your child's immunization status.
  8. If your child has a temporary medical exemption, fill out Part B and provide the expiration date.
  9. For a permanent medical exemption, complete Part C by listing each vaccine and the clinical reasoning for the exemption.
  10. Finally, ensure that the form is signed by a physician or authorized clinic representative and include the date of issuance.