Fill Your 680 Template

Fill Your 680 Template

The 680 form, also known as the Florida Certification of Immunization, is a document required for school enrollment in Florida. It verifies that a child has received the necessary vaccinations as mandated by state law. Completing this form accurately is crucial for ensuring that children meet immunization requirements for school attendance.

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The Florida Certification of Immunization, commonly referred to as the 680 form, plays a crucial role in ensuring that children meet the necessary immunization requirements for school attendance. This form is backed by various legal authorities, including sections of the Florida Statutes and the Florida Administrative Code, which underline its importance in public health. Parents or guardians are required to fill out essential details, such as the child’s name, date of birth, and immunization history. The form includes sections for documenting multiple vaccine doses, allowing for a clear record of compliance with state immunization laws. It also offers options for temporary or permanent medical exemptions, ensuring that those with valid medical reasons can still navigate school enrollment without unnecessary hurdles. For those seeking guidance, the form references additional resources, including the Immunization Guidelines for Florida Schools, which provide comprehensive instructions on completion. Understanding the nuances of the 680 form can help parents ensure their children are ready for school while adhering to state health regulations.

Documents used along the form

The FLORIDA CERTIFICATION OF IMMUNIZATION form, commonly known as the 680 form, is essential for documenting a child's immunization history. However, there are other important forms and documents that are often used alongside it. Here’s a brief overview of these additional documents.

  • DH Form 150-615: This form provides immunization guidelines for Florida schools, childcare facilities, and family daycare homes. It outlines the requirements for immunizations and offers instructions on completing the 680 form.
  • Certificate of Medical Exemption: This document is issued when a child is medically unable to receive certain vaccinations. It must include the specific vaccines exempted and a valid reason from a healthcare provider.
  • Illinois Motor Vehicle Bill of Sale: This important document aids in the transfer of ownership for vehicles in Illinois, ensuring compliance with state laws. For further assistance, open the form to get started.
  • Health Records Release Form: This form allows parents or guardians to authorize the release of their child's health records to schools or daycare facilities. It ensures that the necessary immunization records can be shared without any privacy concerns.
  • School Entry Health Form: Required by many schools, this form collects general health information about the child. It may include details about allergies, medications, and any chronic health conditions that the school should be aware of.

Having these documents ready can make the process smoother when enrolling a child in school or daycare. It's always a good idea to keep everything organized and accessible for easy reference.

Document Preview Example

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

Guidelines on How to Fill Out 680

Completing the Florida Certification of Immunization form, also known as the 680 form, is an important step in ensuring that your child meets the immunization requirements for school attendance. After filling out the form, you will need to submit it to the appropriate school or childcare facility. Here are the steps to guide you through the process of filling out the form.

  1. Begin by entering your child's last name, first name, and middle initial in the designated fields at the top of the form.
  2. Next, provide your child's date of birth in the format MM/DD/YY.
  3. Fill in the name of the parent or guardian responsible for the child.
  4. If applicable, include your child's Social Security number and state immunization ID number, both of which are optional.
  5. Proceed to the section where you will enter the immunization details. For each vaccine, enter the appropriate dose number and the corresponding date received (MM/DD/YY) in the provided spaces.
  6. Continue this process for all vaccines listed, including DTaP/DTP, Polio, MMR, and others, ensuring that you provide accurate dates for each dose.
  7. After completing the immunization section, select the appropriate certificate box (A, B, or C) based on your child's immunization status.
  8. If applicable, indicate any medical exemptions by completing the relevant sections for temporary or permanent exemptions, providing the necessary details and reasoning.
  9. Finally, sign and date the form where indicated, ensuring that all information is accurate and complete.

Once you have filled out the form, review it for any errors before submitting it to the school or childcare facility. Keeping a copy for your records may also be beneficial.

Similar forms

The Florida Certification of Immunization, commonly known as the DH 680 form, is essential for ensuring that children meet immunization requirements for school and daycare. A similar document is the Certificate of Immunization from the Centers for Disease Control and Prevention (CDC). This CDC certificate serves a similar purpose, documenting a child's vaccination history to ensure they are up-to-date with required immunizations. Both forms emphasize the importance of vaccination for public health and require signatures from healthcare providers to validate the information provided.

Another comparable document is the School Immunization Record. This record is often maintained by schools to track the immunization status of students. Like the DH 680 form, it includes details about the vaccines administered, dates, and any exemptions. Schools rely on this document to enforce immunization policies and ensure the safety of all students within their facilities.

The Immunization Registry Record is also similar to the DH 680 form. This state-maintained database collects and stores immunization records for individuals. Parents can access their child's immunization history through this registry, which helps ensure that all vaccinations are accounted for. Both documents provide a reliable way to confirm that children have received necessary immunizations.

The Medical Exemption Form is another document that aligns with the DH 680 form. This form is used when a child cannot receive certain vaccinations due to medical reasons. It requires a healthcare provider's signature, just like the DH 680, to confirm that the exemption is valid. Both forms aim to protect children's health while allowing for exceptions when necessary.

The Religious Exemption Form is similar in purpose to the Medical Exemption Form. This document allows parents to opt out of immunizations for religious reasons. Just as with the DH 680 form, it requires a signature from a parent or guardian and may need to be submitted to schools or daycare facilities to ensure compliance with state laws.

Understanding the nuances of your obligations is essential; therefore, we encourage you to explore the Washington Non-disclosure Agreement form for detailed insights on safeguarding your confidential business information. Explore our Washington Non-disclosure Agreement form to ensure your proprietary data is well protected.

The Child Health Assessment Form is another related document. This form is often required by schools and childcare centers to evaluate a child's overall health, including immunization status. It includes sections for recording vaccinations, making it similar to the DH 680 form in its focus on health and safety for children in educational settings.

The Vaccine Administration Record is also akin to the DH 680 form. This document is filled out by healthcare providers each time a vaccine is administered. It serves as a detailed log of vaccinations received, including dates and types of vaccines. Both forms are critical for maintaining accurate immunization records and ensuring compliance with school requirements.

The Child's Health Record is another document that resembles the DH 680 form. This comprehensive record includes various health information, including immunizations, growth milestones, and medical history. It is often used by healthcare providers and schools to monitor a child's health and development, ensuring that immunizations are up-to-date.

Lastly, the Health Insurance Portability and Accountability Act (HIPAA) Authorization Form can be seen as related. While it primarily deals with the privacy of health information, it may be necessary when sharing immunization records with schools or other entities. Both the DH 680 form and the HIPAA Authorization Form emphasize the importance of protecting children's health information while ensuring that necessary immunization data is accessible when required.

Consider Common Documents

Misconceptions

Understanding the Florida Certification of Immunization, commonly known as the 680 form, is essential for parents and guardians. However, several misconceptions exist regarding its purpose and use. Below is a list of ten common misconceptions along with clarifications.

  1. The 680 form is only for school-aged children. Many believe this form is exclusively for K-12 students. In reality, it is also applicable for children in daycare and preschool settings.
  2. All immunizations must be completed before submitting the form. Some think that immunizations must be fully complete. However, the form allows for temporary exemptions if a child has started the immunization process.
  3. The 680 form is not required for private schools. It is a common belief that only public schools require this form. In fact, many private schools also mandate it for enrollment.
  4. Parents can fill out the form without any medical input. Some parents assume they can complete the form independently. The form must be signed by a healthcare provider to verify the immunization status.
  5. Once submitted, the form does not need to be updated. Many think that the form is a one-time requirement. In truth, it should be updated whenever new immunizations are administered.
  6. The form is only valid for a specific school year. Some believe the 680 form is only valid for one academic year. However, it remains valid as long as the immunization requirements are met.
  7. Temporary medical exemptions are easy to obtain. There is a misconception that getting a temporary exemption is straightforward. In fact, it requires documentation and a clear plan for completing the immunizations.
  8. All vaccines are required for all children. Many parents think every vaccine listed on the form is mandatory. In reality, requirements can vary based on age and health conditions.
  9. Submitting the form guarantees school enrollment. Some believe that submitting the 680 form automatically secures a spot in school. However, schools may have additional requirements beyond immunization documentation.
  10. Once a child has a permanent medical exemption, no further action is needed. There is a belief that a permanent exemption is final. In fact, it may need to be reviewed periodically to ensure it remains valid.

It is crucial for parents and guardians to understand the facts surrounding the 680 form to ensure compliance with immunization requirements and to support their child's educational journey.

File Features

Fact Name Details
Legal Authority The form is governed by Sections 1003.22, 402.305, 402.313 of the Florida Statutes and Rule 64D-3.046 of the Florida Administrative Code.
Purpose This form certifies that a child has received the necessary immunizations for school attendance in Florida.
Completion Requirements Parents or guardians must enter all appropriate doses and dates and sign the certificate to validate it.
Exemption Options The form includes options for temporary and permanent medical exemptions for immunizations.