The 680 form, officially known as the Florida Certification of Immunization, is a crucial document that verifies a child's immunization status for school attendance. This form is essential for parents and guardians to ensure their children meet the state's vaccination requirements, thereby promoting public health and safety. To get started on filling out this important form, click the button below.
Here are key takeaways for filling out and using the Florida Certification of Immunization (Form 680):
The Florida Certification of Immunization Form 680 is essential for documenting a child's immunization history. Along with this form, several other documents may be required or useful for various purposes related to school enrollment, childcare, or medical records. Here’s a list of commonly used forms and documents.
Having these documents prepared and organized can make the process of school enrollment or childcare much smoother. It's always a good idea to check with your specific institution for any additional requirements they may have.
Form 3231 (Georgia Certificate of Immunization): Similar to the FL 680 form, this document certifies that a child has received the required vaccinations for school attendance in Georgia. It includes details about the child's immunization history and is necessary for enrollment in public schools.
Form 8962 (Health Certificate for School): This form serves as a health certification for school entry, documenting immunizations and health screenings required by state regulations. It is comparable to the FL 680 in that it ensures children meet health standards for school attendance.
Form 121 (New York State Immunization Record): This document verifies that a child has received the necessary immunizations before attending school in New York. Like the FL 680, it provides a record of vaccination dates and types.
Form 10-366 (Texas Immunization Record): This form is used in Texas to confirm that a child has received required vaccinations. It shares similarities with the FL 680 by detailing immunization dates and types, ensuring compliance with school entry requirements.
Form 600 (California School Immunization Record): This document is used in California to record a child's immunization status. It is similar to the FL 680 as it lists vaccination dates and types, which are essential for school enrollment.
Form 3 (Illinois Certificate of Child Health Examination): This form documents a child's health examination and immunization status. It is comparable to the FL 680 in that it is required for school entry and includes vaccination information.
Form 680 (Florida Certificate of Immunization): While this is the primary document in question, it is often used alongside other forms to ensure comprehensive immunization records are maintained for school attendance.
Form 103 (Ohio Certificate of Immunization): This document certifies that a child has received the required immunizations for school in Ohio. It is similar to the FL 680 in purpose and structure, providing a record of vaccination history.
Form 8 (Michigan Certificate of Immunization): This form is used in Michigan to verify that a child has received all necessary vaccinations. It parallels the FL 680 by documenting immunization dates and types required for school attendance.
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Incomplete Personal Information: Many people forget to fill in all required fields, such as the last name, first name, and date of birth. Each section is crucial for accurate record-keeping.
Incorrect Vaccine Dates: Entering the wrong dates for immunizations is a common mistake. Double-check each date to ensure they match the child's vaccination records.
Missing Signatures: Failing to sign the appropriate certificate (A, B, or C) can invalidate the form. Ensure that the signature is included and dated.
Not Using the Correct Certificate: Some individuals may use the wrong part of the form. Make sure to select the correct certificate based on the child's immunization status.
Ignoring Optional Fields: While some fields, like the child's Social Security Number and State Immunization ID, are optional, omitting them may delay processing. Providing this information can be beneficial.
Failure to Review Guidelines: Not consulting the Immunization Guidelines can lead to errors. Familiarize yourself with the guidelines to ensure all requirements are met before submission.
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