The 680 form, also known as the Florida Certification of Immunization, is a crucial document that verifies a child's immunization status for school attendance. This form ensures that children meet the necessary vaccination requirements set forth by Florida law. Parents or guardians must complete the form accurately to facilitate their child's enrollment in educational settings.
The Florida Certification of Immunization, commonly referred to as the 680 form, plays a crucial role in ensuring that children meet the immunization requirements for school attendance in the state of Florida. This form is governed by various legal authorities, including specific sections of the Florida Statutes and the Florida Administrative Code, which outline the requirements for immunization documentation. Parents or guardians are required to provide essential information such as the child’s name, date of birth, and optional identification numbers. The form allows for the entry of multiple vaccine doses, along with their corresponding dates, ensuring that children receive the necessary immunizations, including DTaP, MMR, and Hepatitis B, among others. It also includes sections for certifying complete immunization records, requesting temporary medical exemptions, or documenting permanent medical exemptions due to contraindications. To aid in the completion of the form, guidelines are available online, providing clear instructions for parents and healthcare providers. Ultimately, the 680 form serves as a vital tool in promoting public health and safeguarding the well-being of children in educational settings.
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
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
The Florida Certification of Immunization, known as the 680 form, is an important document for ensuring that children meet the necessary immunization requirements for school attendance. Along with this form, several other documents may be needed to provide a complete picture of a child's health and immunization status. Below are some commonly used forms and documents that often accompany the 680 form.
Understanding these forms and documents is essential for parents and guardians to ensure their children are adequately protected and compliant with school immunization requirements. Proper documentation not only supports the health of the child but also contributes to the overall well-being of the community.
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When filling out and using the Florida Certification of Immunization Form (680), keep these key takeaways in mind:
The Florida 680 form, also known as the Certification of Immunization, serves as a record of a child's immunizations. It is required for school attendance in Florida, ensuring that children are vaccinated against certain diseases as mandated by state law. This form is essential for both public and private school enrollment, as well as for daycare and childcare facilities.
The 680 form must be completed for children entering kindergarten, preschool, or any grade level from 1 through 12 in Florida schools. It is also necessary for children attending daycare or family daycare homes. Parents or guardians are responsible for providing accurate immunization records on this form.
The form requires several key pieces of information, including:
Additionally, the form includes sections for certifying the completion of immunizations, temporary medical exemptions, and permanent medical exemptions.
To fill out the 680 form, start by entering the child's personal information at the top of the form. Next, document all appropriate vaccine doses and their corresponding dates in the designated areas. After completing the form, the parent or guardian must sign and date the appropriate certification section (A, B, or C) to confirm the accuracy of the information provided.
The 680 form includes three certification sections:
Additional information and guidelines for completing the 680 form can be found on the Florida Department of Health's website. The specific document, DH Form 150-615, provides comprehensive instructions regarding immunization requirements for schools, childcare facilities, and family daycare homes. Access it at www.immunizeflorida.org/schoolguide.pdf .
If your child is not fully immunized, you should complete Part B of the 680 form. This indicates that your child has started the immunization process and outlines the schedule for completing the required vaccinations. It is crucial to keep track of all immunizations and to ensure that additional doses are administered as needed. Consult with your healthcare provider to determine the best course of action.
This form is often thought to be limited to K-12 students. However, it also applies to children in daycare, preschool, and kindergarten. The form accommodates various educational settings, ensuring that all children receive the necessary immunizations.
Some believe that providing a child's Social Security number is mandatory on the 680 form. In fact, it is optional. Parents can choose to leave this section blank without any repercussions.
While the 680 form does require the dates of immunizations, it also asks for the specific vaccines administered. Parents must ensure that they fill out both the dates and the types of vaccines received.
Some individuals mistakenly think that a temporary medical exemption lasts indefinitely. In reality, it has an expiration date and must be renewed or updated as necessary. This ensures that medical conditions are re-evaluated over time.
Not all vaccines are mandatory for every grade level. The requirements vary by age and grade, particularly for middle school students. Parents should check the specific requirements for their child's grade to ensure compliance.
Many believe that submitting the 680 form is sufficient for school enrollment. However, schools may require additional documentation, such as proof of residency or other health records, depending on their policies.
Some think they can fill out the form independently without consulting a healthcare provider. However, it is essential to have a healthcare professional verify and sign the document to ensure accuracy and compliance with state regulations.
There is a belief that immunization records do not need to be current. In fact, schools require up-to-date records to ensure that children are protected against preventable diseases. Parents should regularly check their child’s immunization status and update the form as needed.