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Content Overview

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 and childcare facilities. This form is governed by various legal authorities, including specific sections of the Florida Statutes and the Florida Administrative Code, which outline the necessary immunizations for students. It collects essential information such as the child's name, date of birth, and immunization history, allowing parents or guardians to document the vaccination status accurately. The form includes sections for different types of immunizations, such as DTaP, MMR, and Hepatitis B, among others. Additionally, it provides options for certifying complete immunization, temporary exemptions, or permanent medical exemptions, each requiring appropriate documentation and signatures from a healthcare provider. For those seeking guidance on how to fill out the form, the Florida Department of Health offers comprehensive immunization guidelines, accessible online. Completing the 680 form is not just a bureaucratic step; it is a vital part of safeguarding children's health and facilitating their educational journey.

Similar forms

  • Form 680A: This document is also related to immunization records but is specifically tailored for children entering school. It includes similar vaccine information and serves as proof of compliance with school immunization requirements.

  • Form 680B: Like Form 680, this version focuses on children in daycare settings. It outlines immunization requirements and exemptions, ensuring that children are protected in early childhood environments.

  • Form 1010: This form is used for health screenings in schools. It collects health history and immunization status, similar to how the 680 form documents vaccination details.

  • Form 1400: The Certificate of Health Examination is comparable in that it provides a comprehensive overview of a child’s health status, including immunizations, required for school enrollment.

  • Form 3040: The Immunization Record Card serves a similar purpose by tracking a child's immunizations over time, ensuring parents have a clear record of vaccinations.

  • Form 3000: This document is a Health History form that collects information about a child's past medical history and immunizations, helping schools assess health needs.

  • Form 680C: Similar to the 680 form, this one is for children with permanent medical exemptions. It outlines the vaccines the child cannot receive and the reasons for these exemptions.

  • Form 1250: The School Health Services Referral Form is used to refer students for additional health services. It often includes immunization status, reflecting the importance of vaccination records.

  • Hold Harmless Agreement: This legal document ensures one party will not hold the other responsible for injuries or damages, similar to the role of the DH 680 in managing immunization records. Understanding the implications of the Hold Harmless Agreement is crucial for risk management in various contexts.
  • Form 150-615: This document provides guidelines for completing the 680 form. It offers detailed instructions on immunization requirements for schools and childcare facilities.

  • Form 680D: This form is an extension of the 680 series, specifically designed for documenting immunization exemptions. It includes similar data on vaccine status and reasons for exemption.

Document Specifics

Fact Name Details
Legal Authority Sections 1003.22, 402.305, 402.313, Florida Statutes; Rule 64D-3.046, Florida Administrative Code
Form Purpose This form certifies a child's immunization status for school attendance in Florida.
Optional Information Child’s Social Security number and State Immunization ID number are optional fields.
Vaccine Documentation All vaccine doses and dates must be documented on the form.
Certificate Types There are three parts: A (complete), B (temporary), and C (permanent medical exemption).
Expiration Date Part B requires an expiration date for temporary medical exemptions.
Immunization Guidelines Guidelines for completing the form are available at www.immunizeflorida.org/schoolguide.pdf.
Physician Signature The form must be signed by a physician or authorized clinic representative.
Form Version This version of the form is dated July 2010.
Stock Number The stock number for this form is 5740-000-0680-6.

Things You Should Know About This Form

  1. What is the purpose of the Florida Certification of Immunization Form (680 form)?

    The Florida Certification of Immunization Form, commonly referred to as the 680 form, serves as an official record of a child's immunization status. It is primarily used to ensure that children are adequately vaccinated before attending school, daycare, or other educational settings in Florida. This form is essential for compliance with state regulations regarding immunizations.

  2. Who needs to fill out the 680 form?

    The 680 form must be completed for children entering K-12 schools, as well as those in daycare, preschool, and family daycare homes. Parents or guardians are responsible for providing accurate immunization records for their children, ensuring that all required vaccinations are documented on the form.

  3. What information is required on the 680 form?

    The form requires various details, including the child's full name, date of birth, and immunization history. Parents or guardians must list the vaccines received along with the corresponding dates. Additional optional information includes the child's Social Security number and state immunization ID number.

  4. What are the different parts of the 680 form?

    The form is divided into three parts:

    • Part A: Certifies that the child has received all required immunizations for school attendance.
    • Part B: Provides a temporary exemption for children who have not completed their immunizations but are on a schedule to do so.
    • Part C: Allows for a permanent medical exemption if a child has a valid medical reason for not receiving certain vaccinations.
  5. 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 Part B of the form. This part indicates that your child has started their vaccination schedule and that additional immunizations are not currently medically indicated. Be sure to include an expiration date for this exemption.

  6. How can I obtain a copy of the 680 form?

    The 680 form can be obtained from various sources, including healthcare providers, schools, and the Florida Department of Health. Additionally, it is available online through the Florida Department of Health's website. Ensure that you are using the most current version of the form.

  7. What happens if I do not submit the 680 form?

    Failure to submit the 680 form may result in your child being unable to attend school or daycare. Schools and childcare facilities in Florida require proof of immunization to ensure the safety and health of all children. It is important to submit this form as soon as possible to avoid any disruptions in your child's education.

  8. Can I make changes to the 680 form after it has been submitted?

    Changes to the 680 form may be necessary if new immunizations are received or if there are corrections to the information provided. In such cases, it is advisable to contact the school or daycare facility to determine the proper procedure for submitting updated information.

  9. Where can I find more information about immunization guidelines in Florida?

    Additional information about immunization guidelines can be found on the Florida Department of Health's website. Specifically, you can refer to the Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes, which provide comprehensive instructions and resources.

  10. Is there a fee associated with obtaining the 680 form?

    Generally, there is no fee for obtaining the 680 form itself. However, some healthcare providers may charge for immunization services or for the time spent reviewing and completing the form. It is best to check with your healthcare provider for any potential costs involved.

Documents used along the form

The Florida Certification of Immunization (Form 680) is often accompanied by several other important documents. These forms help to ensure that immunization records are complete and compliant with state regulations. Below is a list of commonly used documents that may be required alongside the 680 form.

  • DH Form 150-615: This document provides guidelines for completing the immunization certification. It details the requirements for immunizations for children attending schools and daycare facilities in Florida.
  • Georgia Motor Vehicle Bill of Sale: Essential for documenting the transfer of vehicle ownership in Georgia, this form ensures a clear record of the transaction; download the document now.
  • Temporary Medical Exemption Form: Used when a child cannot receive certain vaccinations for medical reasons. This form must be completed by a healthcare provider and includes an expiration date.
  • Permanent Medical Exemption Form: This form is for children who are permanently exempt from vaccinations due to medical contraindications. A physician must provide specific clinical reasoning for the exemption.
  • Immunization Records: These are official records that document all vaccinations a child has received. They may need to be submitted to verify compliance with immunization requirements.
  • School Enrollment Forms: Many schools require additional enrollment forms that may ask for immunization status. These forms help schools track student health records.
  • Health History Form: This document collects information about a child's medical history, allergies, and previous illnesses. It aids healthcare providers in making informed decisions about vaccinations.
  • Parental Consent Form: This form is often required to obtain permission from parents or guardians for a child to receive vaccinations. It ensures that parents are informed about the immunization process.
  • State Health Department Guidelines: These guidelines outline the immunization requirements set by the Florida Department of Health. They provide essential information for parents and healthcare providers.

It is crucial to ensure that all necessary forms are completed and submitted accurately to avoid any delays in the immunization process. Keeping these documents organized can help facilitate a smooth enrollment experience for children entering school or daycare.

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