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The Florida Certification of Immunization, commonly referred to as the 680 form, serves as a crucial document for parents and guardians in ensuring that children meet the immunization requirements necessary for school attendance. This form is governed by various legal authorities, including specific sections of the Florida Statutes and rules outlined in the Florida Administrative Code. It requires the entry of essential information such as the child's name, date of birth, and immunization history, which includes multiple vaccine doses and their corresponding dates. The form is divided into several parts, each addressing different immunization statuses: Part A confirms that a child has received all necessary immunizations for K-12 education, Part B provides a temporary exemption for those who have not yet completed their immunization schedule, and Part C allows for permanent medical exemptions under specific circumstances. Completing the 680 form accurately is vital, as it not only facilitates compliance with state regulations but also supports the health and safety of children within educational settings. For further guidance on how to fill out this form, individuals are encouraged to consult the Immunization Guidelines provided by the Florida Department of Health, which can be accessed online.

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Steps to Using 680

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

  1. Begin by entering the child's last name, first name, and middle initial in the designated fields.
  2. Next, provide the child's date of birth in the format MM/DD/YY.
  3. Fill in the parent or guardian's name in the appropriate section.
  4. If applicable, enter the child's Social Security Number (optional) and state immunization ID number (optional).
  5. For each vaccine listed, record the doses and dates administered in the corresponding fields (Dose 1, Dose 2, etc.). Ensure you use the format MM/DD/YY.
  6. Check the appropriate box for the certificate of immunization that applies (Part A, Part B, or Part C).
  7. If using Part A, confirm the immunizations are complete for K-12 or 7th grade by selecting the appropriate DOE Code.
  8. If using Part B, indicate the expiration date for the temporary medical exemption.
  9. If using Part C, list each vaccine that is medically contraindicated and provide a valid reason for the exemption.
  10. Have the physician or clinic name printed clearly in the designated area.
  11. Ensure the authorized signature is provided along with the date of issuance.

After completing the form, review it carefully for accuracy. Once verified, submit the form as required by your child’s school or daycare facility. Keeping a copy for your records is also recommended.

Key takeaways

Filling out the Florida Certification of Immunization, commonly known as the 680 form, is an important step for parents and guardians ensuring their child's compliance with school immunization requirements. Here are key takeaways to keep in mind:

  • Accurate Information: Ensure that all personal details, including the child’s full name, date of birth, and parent or guardian information, are filled out accurately to avoid any delays.
  • Immunization Records: Enter the dates of all required immunizations clearly. Each vaccine must have the corresponding dose number and date of administration.
  • Understanding the Codes: Familiarize yourself with the vaccine codes listed on the form. These codes correspond to specific vaccines and are essential for proper documentation.
  • Certificates: Sign and date the appropriate certificate section (A, B, or C) after completing the form. This validates the information provided.
  • Temporary Exemptions: If your child has not completed all immunizations, consider filling out Part B for a temporary medical exemption. Remember to include an expiration date.
  • Permanence of Exemptions: For permanent medical exemptions, use Part C. Provide a clear explanation of the medical reasons for the exemption and ensure it is signed by a physician.
  • Check for Updates: Stay informed about immunization guidelines by visiting the Florida Department of Health website. Changes may occur, so regular checks are advisable.
  • Submission Process: Submit the completed form to the appropriate school or daycare facility. Ensure that you keep a copy for your records in case it is needed later.

By following these guidelines, you can help ensure that your child's immunization documentation is complete and accurate, making the enrollment process smoother.

Misconceptions

  • Misconception 1: The 680 form is only for K-12 students.

    • This form is used for various age groups, including children in daycare and preschool. It covers immunization requirements for different educational settings.

  • Misconception 2: Completing the form is optional.

    • In Florida, submitting the 680 form is a requirement for school attendance. Without it, children may not be allowed to enroll or attend school.

  • Misconception 3: All immunizations must be completed before submitting the form.

    • The form allows for temporary exemptions. If a child is in the process of receiving immunizations, you can still submit the form with the current records.

  • Misconception 4: The 680 form is the same as the immunization record.

    • While the form includes immunization details, it serves as a certification that must be signed by a physician or authorized personnel. It’s more than just a record.

  • Misconception 5: Parents can fill out the form without any medical input.

    • A healthcare provider must verify and sign the form. Parents cannot complete it independently, as it requires professional validation.

  • Misconception 6: The form does not need to be updated.

    • If a child receives additional immunizations, the form should be updated to reflect the most current information. Keeping it accurate is crucial for school compliance.

  • Misconception 7: The expiration date for exemptions is not important.

    • For temporary medical exemptions, the expiration date is essential. Without it, the exemption may be considered invalid, affecting school attendance.

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

Document Specs

Fact Name Description
Legal Authority The Florida Certification of Immunization 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 serves to document a child's immunization status, ensuring compliance with school attendance requirements in Florida.
Optional Information Parents or guardians may provide the child's Social Security number and State Immunization ID number, although these fields are not mandatory.
Immunization Records All doses and dates of administered vaccines must be accurately entered on the form. It is essential to sign and date the appropriate certificate (A, B, or C) to validate the information.
Exemption Options The form includes sections for temporary and permanent medical exemptions, allowing parents to document valid clinical reasons for not vaccinating their child.