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The Florida Certification of Immunization, commonly referred to as the 680 form, serves as an essential document for verifying a child's immunization status. This form is governed by various legal authorities, including Sections 1003.22 and 402.305 of the Florida Statutes, as well as Rule 64D-3.046 of the Florida Administrative Code. The 680 form requires detailed information, including the child’s name, date of birth, and optional identification numbers. Parents or guardians must fill in the appropriate vaccine doses and dates, ensuring that all necessary immunizations are recorded accurately. The form includes multiple sections, allowing for certifications of complete immunization, temporary medical exemptions, and permanent medical exemptions. Each section has specific codes and requirements that must be met for the form to be valid. For guidance on how to complete the form, individuals can refer to the Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes. This document is crucial for school attendance and compliance with state immunization laws.

Common Questions

What is the purpose of the Florida 680 form?

The Florida 680 form, also known as the Certification of Immunization, is used to document a child's immunization history. This form is required for school attendance in Florida, ensuring that children have received the necessary vaccinations to protect their health and the health of others. It is important for parents and guardians to complete this form accurately to avoid any issues with school enrollment.

Who needs to complete the 680 form?

The 680 form must be completed for all children entering K-12 schools in Florida. This includes children starting preschool, kindergarten, or any grade through 12. Additionally, it is required for children in daycare and family daycare homes. If a child has not received all the necessary immunizations, the form can still be used to document their current status and any exemptions.

What information is required on the 680 form?

When filling out the 680 form, parents or guardians need to provide several key pieces of information. This includes the child’s full name, date of birth, and optional details such as their Social Security number and state immunization ID number. The form also requires documentation of each vaccine received, including the dates for each dose. Finally, the parent or guardian must sign and date the appropriate certificate section on the form.

What are the different sections of the 680 form?

The 680 form is divided into three main sections: Part A, Part B, and Part C. Part A is for children who have completed all required immunizations for K-12, while Part B is for those who are in the process of receiving their immunizations. Part C is designated for children who have a permanent medical exemption from immunizations. Each section has specific requirements that must be met, and it's essential to select the appropriate one based on the child's immunization status.

How can I obtain a copy of the 680 form?

The 680 form can be obtained from various sources. Parents can request it from their child's healthcare provider, school, or daycare facility. Additionally, the form is available online through the Florida Department of Health's website. It’s important to ensure that you have the most current version of the form, as updates may occur.

What should I do if my child has not completed their immunizations?

If your child has not completed their immunizations, you can still fill out the 680 form by completing Part B. This section allows you to document the immunizations your child has received and indicate that they are on a schedule to complete the required vaccinations. It is crucial to keep track of their immunization appointments and ensure they receive the necessary doses to meet school requirements.

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

Similar forms

  • Form I-693: This form is used by individuals seeking adjustment of status to document their vaccination history. Like the 680 form, it requires details on immunizations and is essential for school or residency requirements.

  • CDC Vaccine Administration Record: This document records vaccinations received by an individual. Similar to the 680 form, it provides a comprehensive overview of immunization history, ensuring compliance with health regulations.

  • Florida Certificate of Immunization (DH 680): This is the specific version of the 680 form used in Florida schools. It serves the same purpose, certifying that a child has received the necessary vaccinations for school attendance.

  • School Health Assessment Form: This form often includes immunization records as part of a broader health assessment for students. It parallels the 680 form in its focus on ensuring students meet health requirements for school.

  • Childhood Immunization Record: This document tracks the immunizations a child has received over time. It is similar to the 680 form as it provides a detailed account of vaccine doses and dates.

  • State Immunization Registry Records: These records maintain a database of vaccinations administered within a state. They share similarities with the 680 form in that they are used to verify immunization status for school and other requirements.

  • Health Insurance Portability and Accountability Act (HIPAA) Authorization Form: While primarily for privacy, this form can be used to access immunization records. It relates to the 680 form by ensuring individuals can obtain proof of immunizations when necessary.

  • Washington Divorce Settlement Agreement: This form outlines the terms agreed upon by both spouses during a divorce, addressing various aspects such as asset division and child custody. Completing this form is an essential step in finalizing a divorce in Washington State. For more details, you can refer to Washington Templates.

  • Immunization Exemption Form: This document is used for those who qualify for exemptions from vaccination requirements. It is similar to the 680 form's sections for medical exemptions, detailing reasons for not receiving certain vaccines.

  • Travel Vaccination Record: This form is often required for international travel, documenting vaccinations received. Like the 680 form, it is crucial for meeting health requirements related to travel.

  • Adult Immunization Record: This document serves to track vaccinations for adults, similar to how the 680 form tracks childhood immunizations. It is essential for employment or healthcare settings that require proof of immunization.

Misconceptions

Misconceptions about the 680 form can lead to confusion for parents and guardians. Understanding the facts is essential for proper completion and compliance. Below is a list of common misconceptions along with clarifications.

  1. Only children in daycare need the 680 form.

    This form is required for all children attending K-12 schools in Florida, not just those in daycare or preschool settings.

  2. The 680 form is only for immunizations.

    While the primary purpose of the form is to document immunizations, it also allows for medical exemptions and temporary exemptions.

  3. Immunization records can be submitted without a physician's signature.

    A physician or authorized clinic must sign the form to validate the immunization records. Without this signature, the form is considered invalid.

  4. Once the form is submitted, it does not need to be updated.

    Parents must update the 680 form if their child receives additional immunizations or if there are changes in their medical status.

  5. The 680 form is the same for all states.

    Each state has its own requirements and forms for immunization documentation. The 680 form is specific to Florida.

  6. Only vaccines listed on the form are required.

    While the form lists specific vaccines, additional vaccines may be recommended based on age and health guidelines. Parents should consult with their healthcare provider.

  7. A temporary medical exemption lasts indefinitely.

    Temporary medical exemptions have an expiration date and must be renewed if the child still requires an exemption after that date.

  8. The 680 form can be filled out by anyone.

    Only a parent, guardian, or authorized representative can complete and sign the form, ensuring that the information is accurate and verified.

  9. Immunization records from other states are acceptable without verification.

    Records from other states may need to be validated by a Florida healthcare provider to ensure they meet state requirements.

  10. Once the child is in school, the 680 form is no longer necessary.

    The form must be kept up to date throughout the child's school years, particularly as new immunizations are administered.

By addressing these misconceptions, parents and guardians can better navigate the requirements for the 680 form and ensure their child's compliance with Florida's immunization laws.

File Attributes

Fact Name Description
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 necessary immunizations for school attendance in Florida.
Completion Guidelines Parents or guardians must enter all appropriate doses and dates, and sign the certificate. Detailed instructions can be found in DH Form 150-615.
Optional Information While the child's Social Security Number and State Immunization ID are optional, providing them can help streamline the record-keeping process.