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The Florida Certification of Immunization, commonly referred to as the 680 form, serves as an essential document for parents and guardians to verify a child's immunization status. This form is mandated by several legal authorities, including Sections 1003.22 and 402.305 of the Florida Statutes, ensuring that children meet the required immunization standards for school attendance and childcare facilities. The 680 form collects critical information, such as the child's name, date of birth, and immunization history, including specific vaccines and their administration dates. Parents or guardians must fill out the appropriate sections, which include options for certifying complete immunizations, temporary medical exemptions, or permanent medical exemptions. The form is structured to guide users through the immunization documentation process, referencing additional resources like the Immunization Guidelines for Florida Schools. Proper completion of the 680 form not only facilitates school enrollment but also plays a vital role in public health by promoting vaccination among children.

Key takeaways

Filling out the 680 form is an essential step in ensuring that children meet immunization requirements for school attendance in Florida. Here are five key takeaways to keep in mind:

  • Accurate Information is Crucial: Ensure that all personal details, including the child’s full name and date of birth, are filled out correctly. Errors can lead to complications in school enrollment.
  • Document All Immunizations: Record each vaccine dose and its corresponding date in the appropriate sections. This documentation is vital for verifying that the child has received the necessary immunizations.
  • Understand the Certificate Options: Be aware of the different certificates available on the form. Choose the correct one based on the child's immunization status—complete, temporary, or permanent medical exemptions.
  • Follow the Guidelines: Refer to the Immunization Guidelines provided at www.immunizeflorida.org/schoolguide.pdf for detailed instructions on completing the form. This resource can help clarify any uncertainties.
  • Sign and Date the Form: Remember to sign and date the certificate. Without a signature, the form may be considered invalid, which could impact the child's ability to attend school.

Documents used along the form

The Florida Certification of Immunization, commonly known as the 680 form, serves as a crucial document for verifying that children have received the necessary vaccinations for school attendance. However, it is often accompanied by several other forms and documents that provide additional context or fulfill specific requirements. Below is a list of documents frequently used alongside the 680 form, each playing a unique role in the immunization and enrollment process.

  • DH Form 150-615: This document outlines the Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes. It provides detailed instructions on how to complete the 680 form and ensures that parents and guardians understand the immunization requirements.
  • Temporary Medical Exemption Form: This form is used when a child cannot receive certain vaccinations due to medical reasons. It must specify the duration of the exemption and is valid only until the expiration date noted on the form.
  • Permanent Medical Exemption Form: For children who are medically contraindicated to receive specific vaccines, this form must be completed by a healthcare provider. It requires a detailed explanation of the medical reasons for the exemption.
  • Tax Return Transcript: For individuals looking to maintain a clear record of their tax filings, it's essential to have the Sample Tax Return Transcript. This document is available through resources like Formaid Org and provides critical insights into an individual's financial history, aiding in verifying the information reported to the IRS.
  • Health Assessment Form: Some schools may require a health assessment form, which provides a comprehensive overview of the child’s health status. This document may include information about allergies, chronic illnesses, and other relevant health issues.
  • School Entry Health Records: These records may include various health-related documents that schools require for enrollment, such as previous immunization records, physical examinations, and any relevant medical history.
  • Consent for Treatment Form: This form allows parents or guardians to give permission for their child to receive vaccinations at school or during school-sponsored events. It often includes details about the vaccines to be administered.
  • Emergency Contact Form: Schools typically require an emergency contact form that provides information on whom to contact in case of an emergency involving the child. This form can be critical for ensuring the child’s safety and well-being.
  • Enrollment Application: This is the initial form that parents or guardians fill out to enroll their child in school. It usually requires basic information about the child and may include sections related to health and immunization status.

Each of these documents complements the 680 form, ensuring that children meet the necessary health requirements for school attendance. Together, they create a comprehensive framework that promotes the health and safety of students in Florida's educational institutions.

Dos and Don'ts

When filling out the Florida Certification of Immunization (Form 680), it is crucial to follow specific guidelines to ensure accuracy and compliance. Here are six important dos and don’ts to consider:

  • Do enter all required information accurately, including the child's full name and date of birth.
  • Do ensure that all immunization dates are clearly documented in the appropriate sections.
  • Do sign and date the certificate in the designated area once all information is complete.
  • Do refer to the Immunization Guidelines provided for additional instructions if needed.
  • Don't leave any sections blank; incomplete forms may lead to delays in processing.
  • Don't use incorrect codes for vaccines; ensure that you are using the codes specified in the form.

Common mistakes

Completing the Florida Certification of Immunization form, also known as the DH 680, is essential for ensuring that children meet vaccination requirements for school attendance. However, several common mistakes can lead to complications or delays. One frequent error is failing to provide complete information in the personal details section. This includes the child's full name, date of birth, and parent or guardian's name. Omitting any of these details can result in processing issues or rejection of the form.

Another mistake often made involves inaccurate or incomplete vaccine information. Parents may forget to fill in the dates for all required doses or may misidentify the vaccine codes. Each vaccine has specific codes, and entering the wrong code or leaving a field blank can lead to confusion regarding the child's immunization status. It is crucial to double-check all entries against the child's immunization records.

Additionally, individuals sometimes overlook the necessity of signing and dating the appropriate certificate section. The form requires a signature to validate the information provided. Without a signature, the form may be considered invalid. This step is often rushed, leading to incomplete submissions that can delay a child's enrollment in school.

Lastly, misunderstanding the exemption sections can lead to significant issues. Parents may incorrectly fill out the Temporary or Permanent Medical Exemption parts without providing adequate clinical reasoning or expiration dates. This can result in the exemption being deemed invalid. It is vital to ensure that all medical exemptions are well-documented and comply with the guidelines set forth in the form's instructions.

File Characteristics

Fact Name Description
Legal Authority The 680 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 necessary immunizations required for school attendance in Florida.
Optional Information Parents or guardians can provide the child's Social Security number and state immunization ID number, though this is not mandatory.
Completion Guidelines Instructions for completing the form can be found in DH Form 150-615, available at www.immunizeflorida.org/schoolguide.pdf.

Form Sample

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