Official 680 Template in PDF Open 680 Editor

Official 680 Template in PDF

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.

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Key takeaways

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

  • Understand the Purpose: This form is essential for documenting a child's immunization status for school and daycare requirements.
  • Gather Information: Collect all necessary details, including the child's name, date of birth, and immunization records.
  • Complete All Sections: Fill in all doses and dates for each vaccine. Ensure accuracy to avoid delays in school enrollment.
  • Sign the Certificate: After completing the form, the parent or guardian must sign and date the appropriate certificate (A, B, or C).
  • Use the Right Certificate: Choose Part A for complete immunizations, Part B for temporary exemptions, and Part C for permanent exemptions.
  • Check Expiration Dates: For temporary exemptions, include an expiration date. The form is invalid without it.
  • Consult Guidelines: Refer to the Immunization Guidelines available at www.immunizeflorida.org/schoolguide.pdf for detailed instructions.
  • Optional Information: Providing the child's Social Security number and State Immunization ID is optional but may help in record-keeping.
  • Keep Copies: Retain a copy of the completed form for your records. This can be useful for future school registrations.
  • Submit Promptly: Ensure the completed form is submitted to the appropriate school or daycare facility as soon as possible to avoid any enrollment issues.

Documents used along the form

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.

  • DH Form 150-615: This form provides guidelines for completing the Immunization Certification. It outlines the requirements for immunizations in Florida schools and childcare facilities.
  • Health Assessment Form: Often required for school entry, this form details a child’s overall health status, including physical examinations and any chronic conditions.
  • School Registration Form: This document collects essential information about the student, including personal details and emergency contacts, necessary for enrollment in a school.
  • Medical Exemption Form: Used to document a child's medical reasons for not receiving certain vaccinations, this form must be completed by a licensed healthcare provider.
  • Texas Motor Vehicle Bill of Sale: This form is crucial for recording the sale and transfer of ownership of a vehicle in Texas, providing necessary details about the buyer, seller, and vehicle. For more information, visit https://documentonline.org/blank-texas-motor-vehicle-bill-of-sale/.
  • Parental Consent Form: This form grants permission for schools or childcare facilities to administer medications or treatments, if necessary.
  • Immunization Records: These are official records from healthcare providers that detail all vaccinations a child has received, often needed for school admission.
  • Emergency Contact Form: This document lists individuals to contact in case of an emergency involving the child, ensuring prompt communication and care.
  • Child Health Record: This comprehensive document tracks a child's health history, including immunizations, allergies, and previous illnesses.
  • Proof of Residency: Schools may require documentation to verify a family's address, which can include utility bills or lease agreements.
  • Special Needs Documentation: If applicable, this paperwork outlines any special accommodations or services a child may require in an educational setting.

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.

Similar forms

  • 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.

  • Access Florida Fax Form: This form is crucial for submitting various necessary documents to the ACCESS Florida Program, including applications and renewals. For further information, you can refer to All Florida Forms.
  • 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.

Document Data

Fact Name Details
Legal Authority The form is governed by Sections 1003.22, 402.305, and 402.313 of the Florida Statutes, along with Rule 64D-3.046 of the Florida Administrative Code.
Purpose This form certifies that a child has received the necessary immunizations required for school attendance in Florida.
Optional Information The child’s Social Security Number and State Immunization ID are optional fields on the form.
Completion Guidelines Instructions for filling out the form can be found in DH Form 150-615, which includes immunization guidelines for Florida schools and childcare facilities.
Certificate Parts The form includes three parts: Part A for complete immunizations, Part B for temporary exemptions, and Part C for permanent medical exemptions.
Expiration Requirement Part B, which addresses temporary medical exemptions, is invalid without an expiration date specified on the form.

More PDF Forms

Common mistakes

  1. 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.

  2. 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.

  3. Missing Signatures: Failing to sign the appropriate certificate (A, B, or C) can invalidate the form. Ensure that the signature is included and dated.

  4. 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.

  5. 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.

  6. 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.

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