The 680 form, officially known as the Florida Certification of Immunization, is a crucial document for verifying a child's immunization status in the state of Florida. It serves as proof that a child has received the necessary vaccinations required for school attendance, ensuring public health and safety. Understanding how to complete this form accurately is essential for parents and guardians navigating school enrollment processes.
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 statutes and administrative rules, which outline the necessary vaccinations for children from daycare through K-12. Parents or guardians must provide detailed information, including the child's name, date of birth, and immunization history. The form includes sections for documenting various vaccines, such as DTaP, MMR, and Hepatitis B, along with the corresponding dates of administration. Additionally, it offers options for temporary and permanent medical exemptions, allowing for flexibility in cases where immunizations may not be appropriate. Completing the 680 form accurately is essential for a child's enrollment in Florida schools and childcare facilities. For guidance on filling out the form, resources are available, including the Immunization Guidelines provided by the Florida Department of Health.
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
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
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Completing the 680 form accurately is essential for ensuring that your child meets the immunization requirements for school attendance in Florida. This form documents the necessary vaccinations and their dates, which schools and childcare facilities will verify.
There are three parts to the form: Part A confirms complete immunization status, Part B is for temporary exemptions, and Part C is for permanent medical exemptions. Understanding these sections helps parents choose the correct certification for their child's situation.
Make sure to include all relevant doses and dates for each vaccine. Missing information could lead to delays in school enrollment or childcare acceptance, so double-check before submitting the form.
For additional guidance on filling out the form, refer to the Immunization Guidelines available at the Florida Department of Health website. This resource offers detailed instructions and clarifications to assist parents in navigating the immunization process.