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Get 680 Form in PDF

The 680 form is a vital document known as the Florida Certification of Immunization. It serves to confirm that a child has received the necessary immunizations required for school attendance in Florida. Understanding how to properly complete this form is essential for parents and guardians to ensure their child’s compliance with state health regulations.

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What to Know About This Form

  1. What is the purpose of the Florida Certification of Immunization (Form 680)?

    The Florida Certification of Immunization, commonly referred to as Form 680, serves as an official record of a child's immunizations. It is required for school attendance in Florida. This form ensures that children are vaccinated against certain diseases, thereby protecting their health and the health of those around them.

  2. Who needs to complete Form 680?

    Form 680 must be completed for children who are entering K-12 schools in Florida, including those in daycare, preschool, and kindergarten. It is essential for children transitioning into 7th grade as well, as they have additional immunization requirements.

  3. What information is required on Form 680?

    The form requires several key pieces of information, including:

    • Child's full name (last name, first name, middle initial)
    • Date of birth
    • Parent or guardian's name
    • Child’s Social Security number (optional)
    • State immunization ID number (optional)
    • Dates of vaccinations received for various diseases
  4. What are the different parts of Form 680?

    Form 680 consists of three main parts:

    • Part A: Certifies that the child has received all required immunizations for school attendance.
    • Part B: Temporary certification for children who are in the process of receiving their immunizations but have not yet completed the schedule.
    • Part C: Permanent medical exemption for children who cannot receive certain vaccines due to medical reasons.
  5. How can I obtain Form 680?

    Form 680 can be obtained from various sources, including healthcare providers, schools, and the Florida Department of Health's website. It is important to ensure that the form is the most current version to meet state requirements.

  6. What should I do if my child has a medical exemption?

    If your child has a medical condition that prevents them from receiving certain vaccinations, you will need to complete Part C of Form 680. This part requires a physician's signature and a detailed explanation of the medical reasons for the exemption.

  7. Is there a deadline for submitting Form 680?

    Yes, there are deadlines for submitting Form 680, particularly before the start of the school year. Parents should check with their child's school for specific deadlines to ensure compliance and avoid any issues with enrollment.

  8. Where can I find more information about immunization requirements in Florida?

    For more information about immunization requirements, parents can visit the Florida Department of Health's website or access the Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes. The guidelines provide detailed instructions and resources for completing Form 680.

Misconceptions

Understanding the 680 form can be challenging, and several misconceptions may lead to confusion. Here are four common misunderstandings:

  • Misconception 1: The 680 form is only for children entering kindergarten.
  • This is not true. The 680 form is required for all K-12 students, including those in daycare, preschool, and grades 1 through 12. It ensures that all students meet the necessary immunization requirements for school attendance.

  • Misconception 2: Parents can fill out the form without any medical records.
  • In reality, accurate medical records are essential. Parents must provide documentation of their child's immunizations. This ensures that the information is reliable and meets the state’s requirements.

  • Misconception 3: A temporary medical exemption means no immunizations are needed.
  • This is misleading. A temporary medical exemption allows a child to attend school while they are in the process of receiving their immunizations. However, it does not eliminate the requirement for completing the immunization schedule.

  • Misconception 4: The 680 form can be submitted without a physician’s signature.
  • This is incorrect. The form must be signed by a physician or authorized clinic representative. This signature verifies that the immunization records are accurate and that the child is compliant with state laws.

Form Breakdown

Fact Name Description
Legal Authority The Florida Certification of Immunization is governed by Sections 1003.22, 402.305, and 402.313 of the Florida Statutes, along with Rule 64D-3.046 of the Florida Administrative Code.
Form Purpose This form certifies that a child has received the required immunizations for school attendance in Florida.
Completion Requirements Parents or guardians must enter all appropriate doses and dates of immunizations on the form.
Optional Information Parents can provide the child's Social Security number and state immunization ID number, but these are optional.
Certificate Types The form includes three parts: Part A for complete immunizations, Part B for temporary exemptions, and Part C for permanent medical exemptions.
Expiration Date For temporary medical exemptions, an expiration date must be included for the exemption to be valid.
Documentation Parents or guardians must sign and date the appropriate certificate on the form to validate the information provided.
Guidelines Access Additional information and instructions for completing the form can be found in DH Form 150-615, available at www.immunizeflorida.org/schoolguide.pdf.

Common mistakes

  1. Incomplete Information: One common mistake is failing to fill out all required fields, such as the child's last name, first name, or date of birth. Each section is crucial for proper identification and processing.

  2. Incorrect Dates: Entering the wrong dates for immunizations can lead to confusion. Ensure that all vaccine doses are documented with the correct MM/DD/YY format.

  3. Missing Signatures: The form must be signed by the parent or guardian. Omitting this step can invalidate the entire form.

  4. Choosing the Wrong Certificate: Selecting the incorrect certificate (A, B, or C) can result in processing delays. Make sure to choose the certificate that corresponds to the child's immunization status.

  5. Ignoring Guidelines: Not following the guidelines provided in the DH Form 150-615 can lead to errors. Familiarize yourself with these instructions before completing the form.

  6. Failing to Document Exemptions: If a medical exemption applies, it must be clearly documented. Not providing the necessary details can lead to complications.

  7. Neglecting Optional Information: While the child's Social Security number and state immunization ID are optional, providing them can facilitate smoother processing. Omitting this information may slow down the verification process.

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