Get 680 Form

Get 680 Form

The Florida Certification of Immunization, commonly known as the 680 form, serves as a critical document for parents and guardians seeking to confirm that a child has received the necessary vaccinations for school attendance. It includes essential information such as immunization dates and personal identification details. Understanding how to accurately fill out this form is vital to ensure compliance with state regulations.

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Outline

The Florida Certification of Immunization, commonly known as the 680 form, serves as a crucial document for families and educational institutions in the state. This form, governed by various sections of the Florida Statutes and the Florida Administrative Code, reflects a child’s immunization status necessary for school attendance, daycare, and other educational settings. It includes sections for personal information such as the child's name, date of birth, and parent or guardian details, alongside optional identifiers such as the child’s Social Security number. The form requires parents or guardians to document specific vaccinations, including DTaP, MMR, and Hepatitis B, along with the corresponding dates for each dose received. There are three main parts to the form: Part A certifies complete immunization for K-12 students, Part B allows for temporary exemptions for children not fully vaccinated, and Part C provides a space for permanent medical exemptions. Signing the form validates that immunization records have been accurately reviewed, confirming compliance with state regulations. For additional guidance, resources are available through the Florida Department of Health, which outlines the completion requirements and associated vaccination schedules. Proper understanding and utilization of the 680 form are essential for ensuring that children meet the health and safety standards set by Florida's educational policies.

680 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

Document Data

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 document certifies that a child has received the required immunizations for school attendance in Florida.
Optional Information The form allows for optional entries such as the child's Social Security Number and State Immunization ID Number.
Immunization Documentation Parents or guardians must enter all appropriate doses and dates of immunizations in the designated sections of the form.
Signatures Required The form must be signed and dated by an authorized healthcare provider, confirming the immunization information is accurate.
Temporary Exemption A temporary medical exemption can be requested; it must include an expiration date to be valid.
Permanent Exemption A permanent medical exemption may be granted for valid clinical reasons, which need to be documented on the form.
Guidelines for Completion Additional immunization guidelines can be found in DH Form 150-615, available at www.immunizeflorida.org/schoolguide.pdf.
Form Version This is the DH 680 form as of July 2010, with the stock number 5740-000-0680-6.

How to Use 680

Filling out the 680 form promptly and accurately is crucial for ensuring compliance with immunization requirements. Follow these steps to complete the form correctly.

  1. Obtain the form: Get a copy of the 680 form. You can usually find it online or request it from your child's school or healthcare provider.
  2. Fill in child’s details: Enter the child's LAST NAME, FIRST NAME, and MI (middle initial). Include the child's DOB (date of birth) using the format MM/DD/YY.
  3. Parent or guardian section: Write the name of the PARENT OR GUARDIAN as required.
  4. Child’s SSN: If you choose, provide the child’s SS# (Social Security Number). This step is optional.
  5. State Immunization ID: If applicable, enter the child’s STATE IMMUNIZATION ID#. This is also optional.
  6. Immunization details: For each vaccine listed, input the doses and corresponding dates in the designated spaces. Follow the instructions carefully for each vaccine.
  7. Select appropriate certifying box: Decide which certificate to sign (A, B, or C). Mark the corresponding DOE CODE that reflects the child's immunization status.
  8. Sign and date: The authorized person must sign the form and provide the date of signing.
  9. Physician or clinic information: If applicable, include the Physician or Clinic Name and the Authorized Signature.
  10. Review and submit: Double-check all entries for accuracy, then submit the form to the necessary school or daycare facility.

Ensure all information is complete and correct. An incomplete form can delay the enrollment process or cause issues with compliance. If you have questions about specific vaccine requirements, consult healthcare providers or refer to the provided immunization guidelines.

Key Facts about 680

What is the purpose of the Florida Certification of Immunization Form 680?

The Florida Certification of Immunization Form 680, commonly referred to as the 680 form, serves as documentation to verify that a child is up to date on their immunizations as required for school attendance. Schools and childcare facilities need this form to ensure that children have received the necessary vaccinations to protect them and their peers from contagious diseases. This is particularly important for K-12 students and those in daycare and preschool settings.

Who is responsible for completing the Form 680?

The responsibility for completing the Form 680 lies primarily with the child's parent or guardian. They must provide accurate immunization details, including dates and doses of vaccines received. Once the form is filled out, it needs to be signed by an authorized healthcare provider who can certify the immunization records. It’s important for the parent or guardian to ensure that all information is entered correctly to avoid any delays or complications with school enrollment.

What vaccines must be documented on the 680 form?

The form requires documentation for several key vaccines, including DTaP, Polio, Hib, MMR, Hepatitis B, Varicella, and Pneumococcal conjugate. Each vaccine should list the specific doses received along with the dates administered. For middle school students, additional doses may be necessary. The form also includes options for temporary or permanent medical exemptions, allowing for flexibility based on individual health needs.

What should I do if my child has not completed all required immunizations?

If your child has not completed all required immunizations, you should fill out Part B of the form, which addresses temporary medical exemptions. You will need to indicate which immunizations your child has received and outline a schedule to complete them. It’s crucial to consult with your child's healthcare provider to understand the immunization timeline and make sure that your child is on track to receive all necessary doses before school starts.

How can I obtain the necessary immunization guidelines?

The necessary immunization guidelines can be found in the DH Form 150-615, Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes. These guidelines are accessible online at www.immunizeflorida.org/schoolguide.pdf. This resource will provide you with important information on the required vaccinations, dosing schedules, and any updates regarding immunization requirements for school attendance.

Is the Social Security Number (SS#) required on the Form 680?

While the child’s Social Security Number is requested on the Form 680, it is marked as optional. Parents may choose to leave this section blank if they are uncomfortable providing their child's SS#. However, including this number may assist in accurately maintaining immunization records within the state’s health system. Still, the absence of an SS# will not prevent the form from being accepted by schools or childcare providers.

Common mistakes

Filling out the Florida Certification of Immunization Form 680 can seem straightforward, but many people often make mistakes that could lead to delays in processing. Understanding these common errors can help ensure that the form is completed correctly and efficiently.

One frequent mistake is failing to provide complete personal information. It's essential to include the child's last name, first name, middle initial, and date of birth as specified. Omitting the child's name or date of birth can cause confusion and may necessitate a return of the form for corrections.

Another common issue arises from incorrect documentation of immunization doses. Parents or guardians must accurately enter the dates for each vaccine dose received. The failure to enter these dates, or providing incorrect dates, could lead to the child being marked as not fully immunized, despite having received the necessary shots.

Additionally, people sometimes ignore the instructions on signing the form. It is crucial to ensure that the appropriate certificate is signed and dated. Not signing the form correctly can invalidate the entire document, meaning that the child’s immunization records will not be officially recognized.

A fourth mistake involves not indicating the correct DOE Code. This code designates whether the vaccinations are complete or if the child qualifies for a medical exemption. Misclassifying the vaccination status can cause complications regarding school enrollment.

Lastly, leaving out necessary medical exemption details can be problematic. For those seeking a permanent medical exemption, it's important to clearly state the reasons for the exemption and provide supporting documentation. Without the necessary details, the request for an exemption may be denied, resulting in mandatory vaccinations that may not be feasible for the child.

By being aware of these common pitfalls, individuals can better prepare to complete the Form 680 accurately and avoid unnecessary complications.

Documents used along the form

The Florida Certification of Immunization (Form 680) is a crucial document for confirming that a child’s immunizations are in order for school attendance. Along with this form, other documents may be required to support a child's enrollment. Here is a list of common forms and documents that are often used in conjunction with the 680 form, along with brief descriptions of each one.

  • DH Form 150-615: This form provides guidelines for completing the immunization forms for Florida schools, childcare facilities, and family daycare homes. It outlines the necessary immunizations required for children, along with instructions for parents and guardians.
  • Certificate of Medical Exemption: This certificate can be issued by a licensed physician to indicate that a child has a valid medical reason for not receiving certain immunizations. The exemption should detail the medical contraindication.
  • Florida Immunization Registry Verification: This document serves as verification from the Florida Immunization Information System that a child's immunization records are up to date. It can be helpful to confirm the completion of immunizations.
  • Permission Slip for Immunizations: Parents may need to fill out permission slips that authorize schools or healthcare providers to administer immunizations. These slips include vital information regarding the child and the specific vaccines to be administered.
  • Transfer Records: When transferring to a new school, parents should request transfer records, which include the child's immunization history from their previous school or healthcare provider. This ensures that schools have complete records for all incoming students.
  • Individualized Education Plan (IEP): For children requiring special education services, an IEP may be necessary to outline the accommodations needed regarding immunization requirements due to specific health conditions.
  • Affidavit of Religious Objection: Parents who wish to exempt their child from immunization for religious reasons may be required to submit an affidavit. This document must clearly express the family's objections to immunizations based on their religious beliefs.

Collecting and organizing these documents can streamline the enrollment process for children in Florida schools. It is essential to ensure that all required forms are completed accurately to avoid delays or issues with school attendance.

Similar forms

  • Form I-693, Report of Medical Examination and Vaccination Record: Like the 680 form, this document certifies the immunization status of an individual. It is primarily used in immigration processes but also requires detailed immunization information.

  • Vaccine Administration Record (VAR): This document provides a comprehensive record of all vaccines given. Similar to the 680 form, it includes specific dates and types of vaccines administered.

  • School Vaccination Records: Many schools require this document to verify that a child has met vaccination requirements. It parallels the 680 form in maintaining a record of immunizations necessary for school attendance.

  • Child Health Assessment: This assessment may include vaccination records as part of the overall health evaluation, sharing similarities with the 680 form in documenting a child’s health and immunization needs.

  • Immunization History Records: These records detail a person’s vaccination history and are essential for enrollment in schools or daycare, much like the 680 form provides for K-12 education.

  • Immunization Exemption Forms: These forms certify that a child is exempt from certain immunizations. They serve a similar purpose as Parts B and C of the 680 form in providing alternate options for vaccinations.

  • Florida Immunization Registry (FIR): This state registry maintains records of vaccinations for all children in Florida. It operates in a manner akin to the 680 form, ensuring that immunization data is properly documented and accessible.

  • Healthcare Provider Immunization Records: These records maintained by doctors provide details about immunizations received and are similar to the 680 form in function; both serve to document immunization compliance.

Dos and Don'ts

When filling out the Florida Certification of Immunization Form (680), here are some dos and don'ts to keep in mind:

  • Do use the child's full legal name, including the last name, first name, and middle initial.
  • Do include the correct date of birth in the specified format (MM/DD/YY).
  • Do list all required immunizations along with the appropriate doses and dates.
  • Do double-check all entries for accuracy before submitting the form.
  • Don't leave any blank spaces for required information; fill them out as needed.
  • Don't forget to sign and date the appropriate section before submission.
  • Don't include Social Security numbers unless absolutely necessary; it's optional.
  • Don't ignore the expiration date for any exemptions; it must be included.

Misconceptions

Many parents and guardians find themselves confused when it comes to the Florida Certification of Immunization, commonly referred to as the 680 form. Misunderstandings about this form can lead to significant challenges in school enrollment and compliance. Here are some common misconceptions:

  • Misconception 1: The 680 form is only needed for kindergarten enrollment.
  • While the form is crucial for children entering kindergarten, it is also required for students starting in grades 1 through 12. Ensuring that all immunization records are complete is essential for continuous attendance.

  • Misconception 2: The immunization requirements are the same for all grades.
  • This is not true. Different grades have specific immunization requirements. For example, 7th graders have additional vaccination requirements that must be met before entry.

  • Misconception 3: Parents can fill out the form without any medical records.
  • It is necessary to provide accurate immunization records when completing the 680 form. Generic or incomplete records may lead to delays or issues with school registration.

  • Misconception 4: The 680 form does not need to be signed by a physician.
  • A signature from a licensed healthcare provider is crucial to validate the document. An unsigned form may not be accepted by the school.

  • Misconception 5: The 680 form is only for vaccinations that a child has already received.
  • The form can also indicate which vaccinations a child is scheduled to receive in the future, particularly in cases of incomplete immunization records.

  • Misconception 6: All immunizations must be completed by the time the form is submitted.
  • Children can have temporary medical exemptions or be on a schedule to complete their required vaccinations under specific circumstances. This is documented in Part B of the form.

  • Misconception 7: A child's Social Security number is mandatory on the form.
  • The form states that the child’s Social Security number is optional. Providing it can be helpful, but it is not a requirement.

  • Misconception 8: Once a child has completed vaccinations, no further documentation is needed.
  • Parents must continue to monitor and update immunization records as new vaccines become necessary, especially as children enter new school levels.

Understanding these misconceptions can empower parents to ensure their children are adequately prepared for school enrollment, aligning with Florida's immunization laws.

Key takeaways

Understanding and correctly filling out the Florida Certification of Immunization Form 680 is essential for ensuring that children meet immunization requirements for school attendance. Here are seven key takeaways:

  • Personal Information is Required: The form requires accurate entry of the child’s name, date of birth, and optionally the Social Security number and state immunization ID.
  • Immunization Records: Ensure all appropriate vaccine doses and dates are entered correctly. Double-check for completeness.
  • Signature is Mandatory: A parent or guardian must sign and date the certificate in the designated areas, certifying the provided information.
  • Different Certificates: The form includes parts A, B, and C, serving different needs like complete immunization, temporary medical exemptions, or permanent medical exemptions.
  • Temporary Exemption Requirements: For a temporary medical exemption, an expiration date must be provided; without it, the exemption is invalid.
  • Seek Guidance: The form references DH Form 150-615 for detailed guidelines. Review this for additional information on completing the form accurately.
  • Record Keeping: Once filled, retain a copy of the completed form for personal records, as schools may require proof of immunization at various points.

Filling out the form accurately not only ensures compliance with state regulations but also protects the health and safety of children in educational environments.