Fill Out a Valid 680 Form

Fill Out a Valid 680 Form

The 680 form, officially known as the Florida Certification of Immunization, is a crucial document that verifies a child's immunization status for school enrollment. Required by Florida law, it ensures that children are adequately vaccinated against preventable diseases. Understanding how to properly complete this form is essential for parents and guardians to ensure their child's compliance with school health regulations.

Access This 680 Now

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 mandated by various Florida statutes and administrative rules, which outline the legal framework for immunization documentation. Parents or guardians must provide essential details, including the child's name, date of birth, and optional identification numbers. The form requires the listing of specific vaccines and their corresponding administration dates, ensuring that children receive the appropriate doses at the right times. It includes different sections for completing immunization records, temporary medical exemptions, and permanent medical exemptions, allowing for flexibility based on individual health circumstances. The completion of the 680 form is vital for school enrollment, and adherence to the guidelines set forth by the Florida Department of Health is essential. For further assistance, parents can refer to the Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes, which provides comprehensive instructions for accurate form completion.

Dos and Don'ts

When filling out the Florida Certification of Immunization form (Form 680), it's important to follow certain guidelines to ensure accuracy and compliance. Here are ten things you should and shouldn't do:

  • Do double-check the child's full name, including last name, first name, and middle initial, to ensure it matches official documents.
  • Don't leave any sections blank. If a particular section does not apply, indicate that with "N/A" instead of leaving it empty.
  • Do use the correct format for dates, following the MM/DD/YY structure as specified in the instructions.
  • Don't forget to include the child’s immunization history. Be thorough and accurate when listing each vaccine and its corresponding date.
  • Do sign and date the appropriate certificate (A, B, or C) at the end of the form to validate the information provided.
  • Don't use correction fluid or tape on the form. If a mistake is made, it’s best to cross it out neatly and write the correct information next to it.
  • Do review the guidelines available at www.immunizeflorida.org/schoolguide.pdf for additional instructions and details.
  • Don't submit the form without checking for any additional requirements specific to the school or daycare facility the child will be attending.
  • Do ensure that any exemptions, if applicable, are clearly documented and supported with valid clinical reasoning.
  • Don't forget to keep a copy of the completed form for your records, as it may be needed for future reference.

Key takeaways

Filling out the 680 form is an essential step in ensuring that children are properly immunized for school attendance in Florida. Here are some key takeaways to keep in mind:

  • Accuracy is Crucial: Ensure that all information, such as names, dates, and immunization records, is entered accurately to avoid delays or issues with school enrollment.
  • Know the Requirements: Familiarize yourself with the immunization requirements for different grades, especially for K-12 and 7th grade, to ensure compliance.
  • Use the Right Certificate: Depending on the child's immunization status, select the appropriate certificate (Part A, B, or C) to document their immunization status correctly.
  • Temporary Exemptions: If applicable, note that temporary medical exemptions must include an expiration date to remain valid.
  • Permanent Exemptions: For permanent medical exemptions, provide detailed clinical reasoning or evidence to support the exemption request.
  • Review Guidelines: Refer to the Immunization Guidelines for Florida Schools, available online, for comprehensive instructions on filling out the form.
  • Signature Matters: Ensure that the form is signed by an authorized physician or clinic representative, as this validates the immunization records provided.

By keeping these points in mind, you can navigate the process of completing the 680 form with confidence and ensure that your child's immunization records are in order.

Find Common Documents

Example - 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

Misconceptions

Here are five common misconceptions about the Florida Certification of Immunization, also known as the 680 form, along with clarifications for each:

  • Misconception 1: The 680 form is only for children entering kindergarten.
  • This is not true. The 680 form is required for children in daycare, preschool, kindergarten, and grades 1 through 12. It documents immunization status for school attendance across multiple grade levels.

  • Misconception 2: Parents can fill out the form without any medical documentation.
  • Parents must provide accurate immunization records when completing the 680 form. It is essential to include all appropriate doses and dates of immunizations received by the child.

  • Misconception 3: A child can attend school without submitting the 680 form.
  • Submission of the 680 form is mandatory for school attendance in Florida. Schools require this documentation to ensure that students meet immunization requirements.

  • Misconception 4: The 680 form can be submitted at any time during the school year.
  • While the form can be submitted at various points, it is best to provide it before the start of the school year. This ensures that the child's immunization status is verified and any necessary follow-ups can be addressed promptly.

  • Misconception 5: The 680 form is the same as a medical exemption form.
  • The 680 form includes sections for temporary and permanent medical exemptions, but it is not solely a medical exemption form. It also serves to certify completed immunizations for school attendance.

Similar forms

  • Form 680 - Florida Certification of Immunization: This document serves as proof of a child's immunization status, specifically for school attendance in Florida. It requires details about the child's vaccines, dates administered, and exemptions if applicable.

  • CDC Vaccine Administration Record: Similar to the 680 form, this record documents the administration of vaccines, including dates and types. It is used nationwide and may be required for school enrollment.

  • State Immunization Registry Records: These records track immunizations for individuals within a state. Like the 680 form, they provide a comprehensive history of vaccinations and can be used for school and healthcare purposes.

  • School Health Records: Schools often maintain health records that include immunization status. These records, akin to the 680 form, are essential for ensuring compliance with state health regulations.

  • Child Health Assessment Form: This form includes immunization information and health evaluations. It parallels the 680 form by providing a holistic view of a child's health status.

  • Vaccine Information Statements (VIS): These documents inform parents about the benefits and risks of vaccines. While not a record of immunization, they are related to the educational aspect of vaccinations.

  • Temporary Medical Exemption Form: Similar to Part B of the 680 form, this document allows parents to exempt their child from certain vaccinations for medical reasons, detailing the exemption's validity.

  • Permanent Medical Exemption Form: This form aligns with Part C of the 680 form, providing documentation for children who cannot receive vaccinations due to medical contraindications.

  • Immunization Waiver Form: This document allows parents to opt out of vaccinations for personal beliefs. It serves a similar purpose to the exemptions noted in the 680 form.

  • Health Insurance Portability and Accountability Act (HIPAA) Authorization Form: While primarily focused on privacy, this form may include immunization records, similar to how the 680 form documents vaccination history.