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Download 680 Template

The 680 form is a vital document known as the Florida Certification of Immunization. It serves to verify that a child has received the necessary vaccinations required for school attendance. Understanding how to complete this form accurately is essential for parents and guardians to ensure their child's compliance with immunization regulations.

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Open 680 Editor

Content Overview

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 in the state of Florida. This form is backed by several legal authorities, including specific sections of the Florida Statutes and the Florida Administrative Code, which establish the guidelines for immunization documentation. Parents or guardians are required to provide essential information about the child, such as their name, date of birth, and optional identification numbers. The form also includes a section for recording the dates of various vaccine doses, ranging from DTaP to Hepatitis B, ensuring that children receive the appropriate immunizations at the right intervals. Additionally, the 680 form accommodates different scenarios, such as complete immunization records, temporary medical exemptions, and permanent medical exemptions, allowing for flexibility based on individual health needs. Clear directions guide users on how to fill out the form accurately, while a reference to the Department of Health’s Immunization Guidelines offers further assistance. By completing this form, parents can help secure their child's eligibility for school, contributing to the overall health and safety of the school community.

Key takeaways

Here are some key takeaways about filling out and using the Florida Certification of Immunization (Form 680):

Understand the Purpose: This form certifies that a child has received the required immunizations for school attendance in Florida.
Gather Necessary Information: Before starting, collect the child's full name, date of birth, and immunization records.
Complete All Sections: Fill in all appropriate doses and dates for each vaccine listed on the form.
Sign and Date: After completing the form, ensure that you sign and date the appropriate certificate (A, B, or C).
Know the Exemption Options: If applicable, understand the differences between temporary and permanent medical exemptions.
Use Official Resources: Refer to the Immunization Guidelines for additional instructions on how to complete the form correctly.
Check for Accuracy: Review the completed form for any errors or missing information before submission.

Guide to Writing 680

Completing the Florida Certification of Immunization Form 680 is an essential step for ensuring that your child meets school immunization requirements. Follow these steps carefully to fill out the form accurately.

Begin by entering the child’s last name, first name, and middle initial in the designated fields.
Fill in the child’s date of birth in the format MM/DD/YY.
Provide the name of the parent or guardian.
Optionally, include the child’s Social Security number.
Optionally, enter the state immunization ID number.
In the section for vaccines, enter the appropriate doses and dates for each vaccine listed. Use the format MM/DD/YY for each date.
Choose the appropriate certificate box (A, B, or C) based on your child's immunization status:

Part A: For K-12 immunizations that are complete.
Part B: For temporary exemptions.
Part C: For permanent medical exemptions.

If applicable, fill in the expiration date for any temporary medical exemption.
Sign and date the form in the designated area.
Ensure that the physician or clinic name is provided along with an authorized signature.
Finally, write the date the form is issued.

After completing the form, make sure to keep a copy for your records. Submit the form to the appropriate school or daycare facility to ensure compliance with immunization requirements.

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Form 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
DT	B
Tdap	P
Td	Q
Polio	D
Polio	D
Hib	E
Hib	E
MMR (Combined)	F
MMR (Combined)	F
(Separate)	G, H
(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	K
Varicella Disease	L
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

Documents used along the form

When dealing with the Florida Certification of Immunization, also known as the DH Form 680, several other forms and documents may be required to ensure compliance with state regulations regarding vaccinations for school attendance. Below is a list of commonly associated forms that can assist parents and guardians in navigating the immunization requirements.

DH Form 150-615: This document provides detailed immunization guidelines for Florida schools, childcare facilities, and family daycare homes. It outlines the necessary vaccinations for children at different educational levels and offers instructions on how to complete the DH Form 680.
Florida Department of Health Immunization Record: This record serves as a comprehensive account of a child's immunization history. Parents can request this document from their healthcare provider to ensure all vaccines are documented accurately, which is crucial for school enrollment.
Motorcycle Bill of Sale: When selling or purchasing a motorcycle in California, it is important to have a properly filled out Motorcycle Bill of Sale form for legal purposes. More information can be found at https://toptemplates.info/bill-of-sale/motorcycle-bill-of-sale/california-motorcycle-bill-of-sale/.
Medical Exemption Form: If a child cannot receive certain vaccinations due to medical reasons, this form must be completed by a licensed physician. It specifies which vaccines are contraindicated and provides the necessary clinical reasoning for the exemption.
Religious Exemption Form: In Florida, parents can submit a religious exemption form if they choose not to vaccinate their child due to sincerely held religious beliefs. This form must be submitted to the school and may require additional documentation.
Proof of Residency Document: Schools often require proof of residency for enrollment. This can include utility bills, lease agreements, or other official documents that verify the child's home address, ensuring they are enrolled in the correct school district.

Having these forms ready and properly completed can significantly streamline the process of enrolling a child in school. It is essential to stay informed about the requirements and ensure all necessary documents are submitted on time to avoid any delays in your child's education.