Homepage Fill a Valid 680 Form
Contents

The Florida Certification of Immunization, commonly referred to as the 680 form, plays a crucial role in ensuring that children receive the necessary vaccinations required for school attendance. This form is mandated by various sections of Florida Statutes and is designed to provide a comprehensive record of a child's immunization history. Parents or guardians are required to fill out essential details, including the child's name, date of birth, and immunization information. The form accommodates multiple vaccines, allowing for the documentation of various doses and dates. Additionally, it offers options for certifying complete immunization, temporary medical exemptions, or permanent medical exemptions, ensuring that all children have access to education while considering individual health needs. Guidelines for completing the form can be found in the Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes. For those seeking further assistance, resources are readily available online. Understanding the 680 form is vital for parents, guardians, and healthcare providers alike, as it serves as a key component in safeguarding public health and facilitating a safe learning environment for all students.

Similar forms

The FLORIDA CERTIFICATION OF IMMUNIZATION (Form 680) serves a crucial role in documenting a child's immunization status. Several other documents are similar in purpose and function, providing essential information regarding health and vaccination records. Below is a list of seven documents that share similarities with Form 680:

  • CDC Vaccine Administration Record (VAR): This document tracks the vaccines a person has received, including dates and types, similar to how Form 680 records immunization details for school attendance.
  • State Immunization Registry Record: This official state record compiles immunization data for individuals, much like Form 680 does for children in Florida, ensuring that vaccination history is easily accessible.
  • School Health Record: Often maintained by schools, this document includes a student's health history, including immunizations, paralleling the purpose of Form 680 in confirming vaccination compliance for school entry.
  • Immunization Exemption Form: This form allows parents to document medical or religious exemptions from vaccinations, akin to the exemption sections in Form 680 that address temporary and permanent medical exemptions.
  • Ohio BMV Application Form - A necessary document for establishing vehicle ownership, requiring information about the vehicle and owner; for more details, visit All Ohio Forms.

  • Personal Health Record (PHR): A PHR is a document that individuals maintain to track their health information, including immunizations, similar to the personal tracking aspect of Form 680.
  • Health Insurance Portability and Accountability Act (HIPAA) Authorization Form: This form allows for the sharing of health information, including immunization records, reflecting the importance of maintaining accurate health documentation as seen in Form 680.
  • Child's Health Assessment Form: This form is often required for school enrollment and includes immunization status, similar to how Form 680 certifies a child's immunizations for school attendance.

Document Example

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

Form Specs

Fact Name Description
Legal Authority The 680 form is governed by Sections 1003.22, 402.305, and 402.313 of the Florida Statutes, as well as 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.
Immunization Records Parents or guardians must enter all appropriate vaccine doses and dates on the form. Accurate documentation is crucial for compliance.
Exemption Options The form provides options for temporary and permanent medical exemptions from immunizations, requiring valid clinical reasoning for each exemption.
Submission Guidelines After completion, the form must be signed and dated by an authorized physician or clinic representative before submission.

Crucial Questions on This Form

What is the purpose of the 680 form?

The 680 form, also known as the Florida Certification of Immunization, serves to document a child's immunization status. This form is essential for school attendance in Florida, ensuring that children are up-to-date on required vaccinations. It provides a clear record for schools, childcare facilities, and family daycare homes.

Who needs to fill out the 680 form?

Parents or guardians of children entering K-12 schools, daycare, preschool, or kindergarten in Florida must complete the 680 form. It is necessary for children who are either beginning school or transitioning to a new educational setting.

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 each vaccine administered, including doses and dates

What are the different parts of the 680 form?

The 680 form consists of three main parts:

  1. Part A: For children who have completed all required immunizations for K-12.
  2. Part B: For children who are in the process of completing their immunizations but have not yet finished.
  3. Part C: For children who have a permanent medical exemption from certain vaccines, requiring documentation of the medical reason.

How do I obtain the 680 form?

The 680 form can be obtained from various sources, including your child's healthcare provider, local health departments, or online through the Florida Department of Health's website. It is important to ensure you have the most current version of the form.

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 part requires you to list each vaccine for which the exemption is requested and provide valid clinical reasoning or evidence from a physician or clinic supporting the exemption.

Is there a deadline for submitting the 680 form?

Yes, the 680 form should be submitted before the start of the school year or when enrolling in a new childcare facility. Each school or childcare provider may have specific deadlines, so it's essential to check with them to ensure compliance.

What happens if I do not submit the 680 form?

If the 680 form is not submitted, your child may be denied entry to school or childcare facilities. Schools require proof of immunization to protect the health and safety of all students, so timely submission is crucial.

Where can I find more information about immunization requirements?

For more detailed information about immunization requirements in Florida, visit the Florida Department of Health's website or refer to the Immunization Guidelines for Florida Schools and Childcare Facilities. These resources provide comprehensive guidance on vaccine requirements and the completion of the 680 form.

Documents used along the form

The Florida Certification of Immunization Form 680 is essential for documenting a child's immunization status for school entry. Alongside this form, several other documents may be required or helpful in ensuring compliance with state regulations. Below is a list of commonly used forms and documents that complement the 680 form.

  • DH Form 150-615: This document provides detailed immunization guidelines for Florida schools, childcare facilities, and family daycare homes. It outlines the required vaccinations and schedules, ensuring parents understand what is necessary for their child's enrollment.
  • Certificate of Medical Exemption: This certificate is issued when a child is medically unable to receive certain vaccinations. It must be signed by a licensed physician and should clearly state the medical reasons for the exemption.
  • School Health Assessment Form: This form is often required by schools to assess a child's overall health and wellbeing. It may include information on physical exams, vision and hearing screenings, and other health-related assessments.
  • Immunization Record: A personal immunization record details all vaccines a child has received. It is crucial for parents to keep this record updated and readily available, as schools may request it for verification.
  • Georgia Trailer Bill of Sale: This form is essential for the purchase and sale of trailers in Georgia, ensuring proper ownership transfer. For easy access, you can download an editable document to simplify the process.
  • Temporary Medical Exemption Form: This form is similar to the permanent exemption but is used for children who cannot receive vaccines for a limited time due to medical reasons. It also requires a physician's signature and an expiration date.
  • Health Insurance Information: Schools may request health insurance information to facilitate access to vaccinations. This document helps ensure that children receive necessary immunizations without financial barriers.

Understanding these documents and their purposes can streamline the process of meeting immunization requirements for school entry. Parents should gather all necessary paperwork to avoid delays in their child's enrollment.

Misconceptions

Here are four common misconceptions about the Florida 680 form, which is used for certifying immunizations:

  • Misconception 1: The 680 form is only for K-12 students.
  • This form is not limited to K-12 students. It also applies to children in daycare, preschool, and kindergarten. It is essential for documenting immunizations for various age groups.

  • Misconception 2: Completing the form guarantees school enrollment.
  • While the 680 form is necessary for enrollment, it does not automatically guarantee a spot in school. Schools may have additional requirements beyond immunization documentation.

  • Misconception 3: All immunizations must be completed before submitting the form.
  • The form allows for temporary exemptions. If a child has not completed all immunizations, parents can indicate this on the form and provide a schedule for completing them.

  • Misconception 4: A physician's signature is not required.
  • A physician or authorized clinic must sign the form for it to be valid. This signature confirms that the child has received the necessary immunizations or has a valid medical exemption.