Active PDF Forms
Homepage ⇨ Free 680 Template
Table of Contents

The Florida Certification of Immunization, commonly referred to as the 680 form, plays a crucial role in ensuring that children receive the necessary vaccinations for school attendance. This form is mandated by various Florida statutes and administrative rules, reflecting the state's commitment to public health and safety. Parents or guardians must fill out key information, including the child's name, date of birth, and immunization history. The form requires documentation of all vaccine doses, along with specific dates, to verify that a child is up to date on their immunizations. Additionally, it offers options for temporary and permanent medical exemptions, allowing for flexibility in cases where vaccinations may not be advisable for health reasons. Completing the 680 form accurately is essential, as it serves as proof of compliance with immunization requirements for K-12 education and daycare settings. For further guidance, the form directs users to the Immunization Guidelines available online, ensuring that families have access to the most current information regarding immunization protocols.

Document Specifics

Fact Name Description
Legal Authority This 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 The Florida Certification of Immunization (DH 680) is used to document that a child has received the necessary immunizations for school attendance.
Immunization Records Parents or guardians must enter all appropriate vaccine doses and dates on the form to ensure compliance with school immunization requirements.
Optional Information Providing the child's Social Security number and state immunization ID number is optional on the form.
Certificate Types The form includes three parts: Part A for complete immunizations, Part B for temporary exemptions, and Part C for permanent medical exemptions.
Expiration Dates For temporary medical exemptions, an expiration date must be provided; without it, the exemption is invalid.
Physician's Role A physician or clinic must sign the form, certifying that the child is either fully immunized or has a valid medical exemption.
Immunization Guidelines Additional guidance on completing the form can be found in the DH Form 150-615, available at www.immunizeflorida.org/schoolguide.pdf.
Stock Number The stock number for the DH 680 form is 5740-000-0680-6, indicating its official designation for distribution.

Similar forms

  • Florida Certificate of Immunization (DH Form 680): This form is used to document a child's immunization status for school entry. Like the DH Form 680, it includes personal information about the child and their vaccination history. Both forms require a signature from a healthcare provider to validate the information provided.

  • Notice to Quit Form: Similar to other legal documents, the https://nytemplates.com/blank-notice-to-quit-template/ is essential for landlords signaling a tenant to vacate the property, ensuring clarity in rental agreements.

  • CDC Vaccination Record Card: This card serves as a personal record of vaccinations received. Similar to the DH Form 680, it lists vaccines and dates administered. Both documents are important for tracking immunization history and may be required for school enrollment.

  • State Immunization Registry Records: These records are maintained by state health departments and provide a comprehensive overview of an individual's vaccination history. Like the DH Form 680, they are used to verify immunization status for school and daycare requirements.

  • School Health Forms: Many schools require specific health forms that include immunization records. These forms are similar to the DH Form 680 in that they document a child's health status and vaccination history, ensuring compliance with state health regulations.

Free 680 File

680 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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

Understanding 680

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

The Florida Certification of Immunization, commonly referred to as the 680 form, serves as an official record of a child's immunization status. It is required for school attendance in Florida, ensuring that children are vaccinated against certain preventable diseases. The form documents the specific vaccines a child has received, their corresponding dates, and any exemptions that may apply.

Who needs to complete the 680 form?

The 680 form must be completed for children entering K-12 schools in Florida, including those in daycare, preschool, and family daycare homes. Parents or guardians are responsible for ensuring that the form is filled out accurately and submitted to the appropriate educational institution. Additionally, children who are transferring from one school to another may also need to provide this documentation.

What information is required on the 680 form?

When filling out the 680 form, specific details must be provided. This includes the child's name, date of birth, and, optionally, their Social Security number and state immunization ID number. The form requires a record of all vaccines administered, including the dates for each dose. It also includes sections for certifying completion of immunization requirements or for indicating temporary or permanent medical exemptions.

What are the options for medical exemptions on the 680 form?

The 680 form allows for both temporary and permanent medical exemptions. A temporary exemption is valid for a specified period, indicating that a child has not yet completed their immunization schedule but is in the process of doing so. A permanent exemption is applicable when a child has a medical condition that contraindicates specific vaccinations. Documentation from a physician is required to support any claims for medical exemptions.

Where can I find additional resources or guidelines for completing the 680 form?

Additional resources and guidelines for completing the 680 form can be found on the Florida Department of Health's website. The Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes provide comprehensive information. The specific guidelines can be accessed at www.immunizeflorida.org/schoolguide.pdf, which can assist parents and guardians in ensuring accurate completion of the form.

Dos and Don'ts

Filling out the Florida Certification of Immunization form (Form 680) is an important step in ensuring your child meets school requirements. Here are some essential dos and don’ts to keep in mind:

  • Do gather all necessary immunization records before starting the form.
  • Do ensure all dates are written in the correct format (MM/DD/YY).
  • Do double-check the vaccine codes to ensure accuracy.
  • Do sign and date the appropriate certificate (A, B, or C) at the end of the form.
  • Don't leave any sections blank; fill out all required fields.
  • Don't forget to include optional information, like the child's Social Security number, if available.
  • Don't submit the form without reviewing it for errors or omissions.
  • Don't ignore the guidelines provided; refer to the Immunization Guidelines for clarity.

By following these guidelines, you can help ensure a smooth process for your child's immunization certification.

Check out Common Templates

Faa 8050-2 - People selling aircraft without the AC 8050-2 risk complications with the ownership transfer.

The Arizona Transfer-on-Death Deed form allows property owners to designate beneficiaries who will receive their property upon their passing, without the need for probate. This legal document can simplify the transfer of property and provide clarity for heirs, ensuring that assets are distributed according to the owner's wishes. To start the process of securing your property for future beneficiaries, consider filling out the form by clicking the button below, or find more details regarding this process at Arizona PDF Forms.

Hunter Permission - Hunters are reminded to follow all firearm safety guidelines set forth.