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Form Specs

Fact Name Details
Legal Authority The 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 required immunizations for school attendance in Florida.
Optional Information It includes fields for the child's Social Security number and state immunization ID, both of which are optional.
Immunization Doses The form allows for the documentation of multiple doses for various vaccines, including DTaP, Polio, MMR, and more.
Certificate Types There are three parts: Part A for complete immunizations, Part B for temporary exemptions, and Part C for permanent medical exemptions.
Expiration Date Part B requires an expiration date for temporary medical exemptions; without it, the form is considered invalid.
Physician Signature A physician or authorized clinic representative must sign the form to validate the immunization records.
Form Issuance The form must be issued by a physician or clinic, and it must include the date of issuance.
Guidelines Availability Guidelines for completing the form can be found at www.immunizeflorida.org/schoolguide.pdf.
Version and Stock Number The current version of the form is DH 680, dated July 2010, with a stock number of 5740-000-0680-6.

Dos and Don'ts

When filling out the Florida Certification of Immunization (Form 680), it's essential to approach the task carefully. Here are four key actions to take and avoid:

  • Do: Ensure all required fields are filled out completely and accurately, including the child’s name and immunization dates.
  • Do: Review the immunization records thoroughly before submission to confirm that all necessary vaccinations are documented.
  • Do: Sign and date the appropriate certificate (A, B, or C) as required to validate the form.
  • Do: Keep a copy of the completed form for your records.
  • Don't: Leave any sections blank; incomplete forms may be deemed invalid.
  • Don't: Forget to include the expiration date for any temporary medical exemptions.
  • Don't: Use outdated immunization records; always refer to the most current guidelines.
  • Don't: Submit the form without verifying that all information is accurate and legible.

Common mistakes

  1. Incomplete Information: One common mistake is failing to provide all necessary details. Individuals often overlook sections such as the child's middle initial or the parent's full name. Each part of the form must be filled out completely to avoid delays or rejections.

  2. Incorrect Dates: Entering the wrong dates for immunizations can lead to significant issues. Parents sometimes confuse the dates of doses, which can result in the child being deemed ineligible for school attendance. It's essential to double-check each date against the child's medical records.

  3. Missing Signatures: Failing to sign the form is another frequent error. The form requires a signature from a parent or guardian, as well as from a physician or authorized clinic representative. Without these signatures, the form is considered invalid.

  4. Not Following Guidelines: Ignoring the provided instructions can lead to mistakes. The form includes specific directions about how to complete it correctly. For instance, using the wrong certificate type (A, B, or C) can cause confusion and delay the processing of the immunization record.

Documents used along the form

The Florida Certification of Immunization, commonly referred to as the 680 form, is a crucial document for children attending school or daycare in Florida. However, several other forms and documents may accompany the 680 form to ensure compliance with health regulations. Below is a list of these important documents, each serving a unique purpose in the immunization process.

  • DH Form 150-615: This form provides comprehensive immunization guidelines for Florida schools, childcare facilities, and family daycare homes. It outlines the required immunizations for various age groups and offers detailed instructions for completing the 680 form.
  • Health Examination Form: Often required alongside the 680 form, this document verifies that a child has undergone a health examination by a licensed healthcare provider. It includes information about the child’s overall health and any special medical considerations that may affect their school attendance.
  • IL-941 form: Essential for reporting Illinois income taxes withheld from employees, this form is crucial for employers. To efficiently fill it out, visit https://formsillinois.com.
  • Temporary Medical Exemption Form: This form is used when a child is unable to receive certain vaccinations due to temporary medical reasons. It must specify the vaccines that are exempt and include an expiration date, ensuring that the exemption is reviewed periodically.
  • Permanent Medical Exemption Form: For children who cannot receive vaccinations due to long-term medical conditions, this form is essential. It requires documentation from a physician stating the medical reasons for the exemption and ensures that the child’s health needs are appropriately considered.

Understanding these accompanying forms can help parents and guardians navigate the immunization requirements more effectively. Ensuring that all necessary documentation is complete and accurate not only promotes the health and safety of children but also facilitates a smoother process for school enrollment and attendance.

Misconceptions

Understanding the 680 form can be crucial for parents and guardians navigating immunization requirements for school attendance in Florida. However, several misconceptions can lead to confusion. Here are four common misunderstandings:

  • The 680 form is only for K-12 students. While the form is primarily used for K-12 students, it also applies to children in daycare, preschool, and kindergarten. It's important to recognize that all children attending these facilities must meet immunization requirements.
  • All immunizations must be completed before submitting the form. This is not entirely true. The form allows for a temporary medical exemption if the child has not completed all required immunizations. Parents can submit the form even if some immunizations are still pending, as long as they indicate that a schedule is in place to complete them.
  • The 680 form is the only documentation needed for school enrollment. While the 680 form is essential, it is not the only requirement. Schools may request additional documents, such as proof of residency or a birth certificate. Always check with the specific school for their complete enrollment requirements.
  • Parents can fill out the form without a healthcare provider. This is a misconception. The 680 form must be completed and signed by a healthcare provider or authorized personnel. Their signature verifies that the immunization records are accurate and up-to-date.

By understanding these misconceptions, parents can better prepare for their child's school enrollment and ensure compliance with Florida's immunization laws.

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

Key takeaways

When filling out and using the Florida Certification of Immunization Form (680), there are several important points to keep in mind. Here are key takeaways:

  • Accurate Information is Crucial: Ensure that all details, such as the child's name, date of birth, and immunization dates, are entered correctly. Errors can lead to complications in school enrollment.
  • Documentation of Immunizations: List all appropriate vaccine doses and their corresponding dates. This documentation is essential for demonstrating compliance with school immunization requirements.
  • Understand the Certificate Sections: The form includes different parts for various situations: Part A for complete immunizations, Part B for temporary exemptions, and Part C for permanent medical exemptions. Select the appropriate section based on the child's immunization status.
  • Consult Immunization Guidelines: Refer to the Immunization Guidelines for Florida Schools and Childcare Facilities for detailed instructions on completing the form. These guidelines can provide clarity on requirements.
  • Signature Requirement: The form must be signed by a physician or authorized clinic representative. Without this signature, the form is considered invalid.

By following these key takeaways, parents and guardians can ensure that they properly complete the 680 form, facilitating their child's school enrollment and compliance with immunization laws.

Similar forms

  • Form I-693: Report of Medical Examination and Vaccination Record - This form is used by individuals applying for immigration benefits in the U.S. It documents the results of a medical examination and vaccination history, similar to how the 680 form records immunization details for school attendance.

  • CDC Vaccine Administration Record - This document serves as a personal record of vaccinations received. Like the 680 form, it tracks immunization dates and types, ensuring individuals maintain an accurate vaccination history.

  • California LLC-1 Form: This form is essential for filing Articles of Organization for an LLC in California and can be found at https://californiadocsonline.com/california-llc-1-form/, ensuring all necessary details are communicated effectively to the Secretary of State.
  • State Immunization Registry Form - Many states have their own immunization registry forms that collect vaccination data. These forms, similar to the 680 form, help manage and verify immunization records for school and healthcare purposes.

  • Form DS-3053: Statement of Consent - This form is used for passport applications involving minors. It requires parental consent, akin to how the 680 form requires a parent or guardian's signature for immunization verification.

  • School Health Assessment Form - Schools often require this form to assess a child's health status, including immunization records. It functions similarly to the 680 form by ensuring compliance with health requirements for school attendance.

  • Child Health Record - This document is maintained by parents or guardians to track a child's health history, including vaccinations. It parallels the 680 form by serving as a comprehensive record of immunizations.

  • Form 101: Immunization Record - Used in various healthcare settings, this form records a patient's immunization history. Like the 680 form, it provides essential information for health compliance and school entry.

  • Vaccine Information Statement (VIS) - This document provides information about vaccines. While it does not record immunizations, it complements the 680 form by informing parents about vaccine benefits and risks.

  • Form 1700: Certificate of Immunization - This is another state-specific form that certifies a child's immunization status. Similar to the 680 form, it is often required for school enrollment and verifies that immunizations are up to date.

  • Form 214: Medical Exemption Certificate - This form documents a child's medical exemption from vaccinations. It is akin to Part C of the 680 form, which outlines permanent medical exemptions for specific immunizations.