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Fill Out a Valid 680 Template

The 680 form, officially known as the Florida Certification of Immunization, serves as a crucial document for verifying a child's immunization status in compliance with state regulations. This form is essential for school enrollment and childcare facilities, ensuring that children are protected against preventable diseases. Understanding its requirements and proper completion is vital for parents and guardians to facilitate their child's educational journey.

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The Florida Certification of Immunization, commonly known as the 680 form, is an essential document for parents and guardians navigating the school enrollment process for their children. This form is rooted in various Florida statutes and administrative rules, ensuring that children meet the necessary immunization requirements before attending school or daycare. It requires parents to provide specific details, such as the child’s name, date of birth, and immunization history, including dates for each vaccine received. The form also offers sections for different scenarios: a complete immunization record, a temporary medical exemption, or a permanent medical exemption. Each section has its own certification codes, making it easier for healthcare providers and schools to understand a child's immunization status. Completing this form accurately is crucial, as it directly impacts a child's eligibility for school attendance. For additional guidance, parents can refer to the Immunization Guidelines available online, which provide further instructions on how to fill out the 680 form correctly.

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Misconceptions

  • Misconception 1: The 680 form is only for children entering kindergarten.
  • This is not accurate. The 680 form is required for all students attending K-12 schools in Florida, including those in daycare, preschool, and even those entering the 7th grade. It documents a child's immunization history, ensuring they meet the necessary health requirements for school attendance.

  • Misconception 2: Parents can submit the form without any immunization records.
  • This is incorrect. The 680 form must be filled out with accurate immunization dates and doses. Parents need to provide documentation of their child's vaccinations. Without this information, the form is incomplete and cannot be accepted.

  • Misconception 3: The 680 form is the same as the health examination form.
  • These are two different forms. While the 680 form focuses on immunizations, the health examination form addresses a child's overall health status. Both are important for school enrollment, but they serve distinct purposes.

  • Misconception 4: Once submitted, the 680 form never needs to be updated.
  • This is misleading. Parents should update the form whenever their child receives new vaccinations. Keeping the form current is essential for compliance with school health regulations.

  • Misconception 5: A temporary medical exemption means the child is fully exempt from vaccinations.
  • This is not true. A temporary medical exemption allows a child to attend school while they are in the process of completing their immunizations. It does not provide a permanent exemption, and parents must ensure that the child receives the required vaccinations within the specified time frame.

  • Misconception 6: All vaccines must be completed before the 680 form can be submitted.
  • This is partially incorrect. The form allows for a temporary exemption if a child has started the vaccination schedule but has not yet completed all doses. Parents can submit the form to document the vaccinations that have been received and outline a plan for completing the immunization schedule.

Key takeaways

When filling out the Florida Certification of Immunization form (680 form), there are several important points to keep in mind:

  • Accurate Information: Ensure that all personal details, including the child's name, date of birth, and parent or guardian information, are filled out accurately.
  • Immunization Records: Enter all appropriate doses and dates for each vaccine in the designated sections. This is crucial for verifying the child's immunization status.
  • Certificate Selection: 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 applicable, include the expiration date for temporary medical exemptions in Part B. This section is essential for children who are not fully immunized.
  • Permanently Exempt: For children with permanent medical exemptions, detail the clinical reasoning in Part C. This documentation must be thorough and valid.
  • Consult Guidelines: Refer to the Immunization Guidelines provided in DH Form 150-615 for detailed instructions on completing the form. This ensures compliance with state requirements.
  • Online Resources: Utilize the online resources available at www.immunizeflorida.org/schoolguide.pdf for additional information and support regarding immunization requirements.
  • Keep Copies: After completing the form, retain a copy for your records. This can be helpful for future school enrollments or health-related inquiries.

By following these key takeaways, you can ensure that the 680 form is completed correctly and that your child's immunization records are properly documented.

Dos and Don'ts

When completing the Florida Certification of Immunization (Form 680), it is important to follow certain guidelines to ensure accuracy and compliance. Below is a list of recommended actions and those to avoid.

  • Do enter the child's full name, including last name, first name, and middle initial.
  • Do provide the correct date of birth in the specified format (MM/DD/YY).
  • Do list all appropriate vaccine doses and dates accurately in the designated sections.
  • Do sign and date the appropriate certificate (A, B, or C) at the bottom of the form.
  • Don't leave any sections blank; ensure all required information is filled out.
  • Don't submit the form without reviewing it for errors or omissions.

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