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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 state's immunization requirements for school attendance. This form is governed by specific legal authorities, including various sections of the Florida Statutes and the Florida Administrative Code. It requires detailed information about the child, such as their name, date of birth, and optional identification numbers. Parents or guardians must provide a comprehensive record of all immunizations received, including specific vaccines like DTaP, MMR, and Hepatitis B, along with the corresponding dates. The form consists of multiple sections, allowing for the documentation of complete immunization status, temporary medical exemptions, or permanent medical exemptions. Each section has its own criteria and must be signed by a physician or authorized clinic representative. Completing the 680 form accurately is essential, as it serves as proof of compliance with state immunization laws, thereby facilitating a child’s entry into educational settings.

680 Preview

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

Common mistakes

  1. Incomplete Information: Failing to fill out all required fields can lead to delays or rejection of the form. Ensure that every section, including the child's name and date of birth, is complete.

  2. Incorrect Dates: Entering the wrong dates for immunizations is a common mistake. Double-check that each date corresponds to the correct vaccine dose.

  3. Missing Signatures: The form requires signatures from a parent or guardian. Omitting this crucial step can invalidate the submission.

  4. Wrong Vaccine Codes: Each vaccine has a specific code. Using the incorrect code can lead to confusion and might require resubmission.

  5. Ignoring Expiration Dates: For temporary medical exemptions, not providing an expiration date renders the exemption invalid. Always include this date when applicable.

  6. Not Following Guidelines: The form refers to specific guidelines for completion. Ignoring these instructions can result in errors. Review the guidelines carefully before submission.

  7. Failing to Check for Updates: Regulations and forms can change. Not checking for the latest version of the form may lead to using outdated information.

  8. Providing Optional Information: While some sections, like the child's Social Security number and state immunization ID, are optional, leaving them out can sometimes delay processing. Consider including them if available.

Dos and Don'ts

When filling out the Florida Certification of Immunization (Form 680), it is important to follow specific guidelines to ensure accuracy and compliance. Here are five things to do and five things to avoid.

  • Do enter the child’s full name, including last name, first name, and middle initial.
  • Do provide the date of birth in the correct format (MM/DD/YY).
  • Do list all appropriate vaccine doses and dates clearly in the designated sections.
  • Do sign and date the appropriate certificate (A, B, or C) at the end of the form.
  • Do review the completed form for accuracy before submission.
  • Don't leave any required fields blank, as this may delay processing.
  • Don't use any other format for the date of birth or vaccine dates.
  • Don't forget to include the physician or clinic name and authorized signature.
  • Don't submit the form without verifying that all information is correct.
  • Don't ignore the guidelines provided in DH Form 150-615, as they offer essential instructions.

Misconceptions

  • Misconception 1: The 680 form is only for K-12 students.
  • This form is used for children in various educational settings, including daycare and preschool, not just K-12.

  • Misconception 2: Parents do not need to provide any information about their child.
  • Parents must fill out essential details like the child's name, date of birth, and immunization records.

  • Misconception 3: The 680 form is optional for school enrollment.
  • In Florida, this form is often required for school attendance, especially for certain grades.

  • Misconception 4: The form can be completed without any medical guidance.
  • It is crucial to have accurate immunization records, often verified by a healthcare provider.

  • Misconception 5: All vaccines must be completed before filling out the form.
  • There are options for temporary and permanent medical exemptions if immunizations are incomplete.

  • Misconception 6: The 680 form is the same as a general medical record.
  • This form specifically documents immunizations and is tailored for school and childcare requirements.

  • Misconception 7: Only the parent can sign the form.
  • A healthcare provider can also sign the form to certify the child's immunization status.

  • Misconception 8: The form does not need to be updated.
  • Any changes in immunization status should be reflected on the form to maintain accuracy.

  • Misconception 9: There is no expiration for exemptions listed on the form.
  • Temporary medical exemptions must have an expiration date to remain valid.

  • Misconception 10: The 680 form is only valid if completed in person.
  • While in-person completion is common, the form can also be filled out electronically, depending on the healthcare provider's policies.

Detailed Guide for Using 680

Completing the Florida Certification of Immunization Form 680 is essential for ensuring that a child meets the immunization requirements for school attendance. Following the steps outlined below will help streamline the process and ensure that all necessary information is accurately recorded.

  1. Begin by entering the child's last name, first name, and middle initial in the designated fields at the top of the form.
  2. Next, fill in the child's date of birth using the MM/DD/YY format.
  3. Provide the name of the parent or guardian responsible for the child.
  4. If applicable, enter the child's Social Security number in the optional field. You may skip this if you prefer not to provide it.
  5. Complete the State Immunization ID number if available, as this field is also optional.
  6. Proceed to the section where you will enter the vaccine doses. For each vaccine listed, provide the corresponding dates for Dose 1 through Dose 5 in the MM/DD/YY format.
  7. Once all doses have been documented, select the appropriate box for the Certificate of Immunization based on the child's educational level and immunization status.
  8. Sign and date the form in the designated area to certify that the information provided is accurate and complete.
  9. If applicable, complete the sections for Temporary Medical Exemption or Permanent Medical Exemption, providing the necessary details and reasoning for the exemption.
  10. Finally, ensure that the form is submitted to the appropriate school or childcare facility to fulfill the immunization requirements.

After filling out the form, it is advisable to keep a copy for your records. This documentation may be required in the future for school enrollment or other purposes. Always check with local guidelines to ensure compliance with any additional requirements that may apply.