The 680 form, also known as the Florida Certification of Immunization, is a crucial document that verifies a child's immunization status for school attendance. This form is governed by specific legal statutes and administrative rules in Florida. Parents or guardians must complete the form by providing necessary vaccination details and signing the appropriate certificate.
The Florida Certification of Immunization, commonly known as the 680 form, plays a vital role in ensuring that children meet immunization requirements for school attendance. This form is governed by various legal authorities, including specific sections of the Florida Statutes and administrative rules. It collects essential information such as the child's name, date of birth, and immunization history. Parents or guardians are responsible for filling out the form, which includes details about each vaccine received, along with the corresponding dates. The form also offers three distinct certificates: Part A for complete immunization, Part B for temporary exemptions, and Part C for permanent medical exemptions. Each section has specific codes that indicate the child's immunization status and any medical conditions that may preclude vaccination. For guidance on completing the form, individuals can refer to the Immunization Guidelines provided by the Florida Department of Health. Proper completion of the 680 form is crucial for ensuring that children are protected against preventable diseases while also complying with state regulations.
What is the purpose of the Florida 680 form?
The Florida 680 form, also known as the Certification of Immunization, is used to document a child's immunization history. This form is essential for school attendance in Florida. It verifies that children have received the required vaccinations to protect their health and the health of others in the school community.
Who needs to complete the 680 form?
The 680 form must be completed for children entering kindergarten, first grade, and seventh grade in Florida. Additionally, it is required for children attending daycare, family daycare homes, and preschool programs. Parents or guardians should ensure that the form is filled out accurately to avoid any issues with school enrollment.
What information is required on the 680 form?
The form requires the child's full name, date of birth, and the parent or guardian's name. It also includes sections for documenting each vaccine received, along with the dates of administration. Optional information such as the child's Social Security number and state immunization ID can also be provided. Parents should ensure that all doses are recorded correctly.
What are the different parts of the 680 form?
The 680 form consists of three parts. Part A certifies that the child has received all necessary immunizations for school attendance. Part B is for children who are in the process of completing their immunizations but have not yet met all requirements. Part C provides a space for permanent medical exemptions, where a physician can indicate if immunizations are medically contraindicated for the child.
How can I obtain the 680 form?
The Florida 680 form can typically be obtained from a child's healthcare provider, such as a pediatrician or clinic. It may also be available at local health departments or online through the Florida Department of Health's website. Parents should ensure they have the most recent version of the form to avoid any complications.
When filling out the Florida Certification of Immunization (Form 680), consider the following key takeaways:
Understanding the 680 form, or the Florida Certification of Immunization, is essential for parents and guardians navigating school requirements. However, several misconceptions surround this important document. Here are six common misunderstandings:
By addressing these misconceptions, parents and guardians can better prepare for their child's educational journey and ensure compliance with Florida's immunization requirements.
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
How Long Does a Qdro Take - Details such as Social Security numbers are vital for processing the order.
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Incomplete Personal Information: Failing to provide the child's full name, date of birth, or parent's details can lead to delays. Ensure all sections are filled out completely.
Missing Immunization Dates: Omitting the specific dates for each vaccine dose is a common error. Each dose must have a corresponding date for proper documentation.
Incorrect Vaccine Codes: Using the wrong codes for vaccines can cause confusion. Double-check the vaccine codes listed on the form to ensure accuracy.
Not Signing the Form: Forgetting to sign and date the certificate can invalidate the submission. Always review the form to ensure it is signed where necessary.
Ignoring Exemption Sections: If a child qualifies for a medical exemption, it's crucial to complete the relevant section. Leaving this blank may lead to unnecessary complications.
Failing to Review Documentation: Not reviewing the child's immunization records before filling out the form can lead to inaccuracies. Take time to verify all information is correct.
Not Following Submission Guidelines: Each submission must adhere to specific guidelines. Ignoring these can result in rejection of the form. Always refer to the latest instructions provided.
When filling out the Florida Certification of Immunization (Form 680), there are several important actions to take and avoid. Here are four guidelines to consider:
The Florida Certificate of Immunization (Form 680) shares similarities with the Certificate of Live Birth. Both documents serve as official records that validate important life events. The Certificate of Live Birth provides proof of birth, including the child’s name, date of birth, and parentage. Similarly, the 680 form confirms that a child has received the necessary vaccinations for school attendance, ensuring their eligibility for education. Both documents require accurate information and signatures from authorized individuals, emphasizing their role in safeguarding public health and welfare.
Another document akin to the 680 form is the School Health Record. This record tracks a student's health history, including immunizations, allergies, and medical conditions. Like the 680 form, it is essential for school enrollment and participation in school activities. Both documents help schools monitor and manage student health, ensuring a safe environment for all children. They require regular updates and may involve input from healthcare providers.
The Immunization Record is also comparable to the 680 form. This document serves as a detailed log of a person's vaccinations throughout their life. Just as the 680 form summarizes a child's immunization status for school, the Immunization Record provides a comprehensive overview of all vaccinations received. Both documents play a crucial role in public health by helping to prevent outbreaks of vaccine-preventable diseases.
Similar to the 680 form, the Health Insurance Portability and Accountability Act (HIPAA) Privacy Notice outlines how personal health information is handled. While the 680 form collects specific immunization data, the HIPAA notice ensures that individuals understand their rights regarding their health information. Both documents emphasize the importance of privacy and the need for informed consent when sharing health-related information.
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The Child Health Assessment form is another document that parallels the 680 form. This assessment evaluates a child's overall health and development, often required for school entry. Like the 680 form, it includes information about immunizations and health screenings. Both documents help ensure that children are healthy and ready to learn, highlighting the importance of preventive healthcare in education.
The Medical Exemption Form is closely related to the 680 form, particularly in its sections regarding medical exemptions. This document allows parents to provide justification for not vaccinating their child due to medical reasons. Both forms require a healthcare provider’s signature to validate the exemption. They play a vital role in maintaining public health while accommodating individual medical needs.
The Certificate of Good Standing for Childcare Facilities also shares similarities with the 680 form. This certificate confirms that a childcare facility meets health and safety standards, including immunization requirements for children in care. Both documents aim to protect the health of children, ensuring that they are in safe environments that adhere to state regulations.
The WIC (Women, Infants, and Children) Program Certification is another document that resembles the 680 form. This certification verifies eligibility for nutritional assistance and includes immunization status as part of the health assessment. Both documents focus on the well-being of children and require updates based on health evaluations, ensuring that children receive necessary resources and vaccinations.
The School Enrollment Form is similar to the 680 form in that it collects essential information for a child’s admission to school. This form often requires proof of immunizations, mirroring the requirements of the 680 form. Both documents are critical for facilitating a child’s entry into the educational system and ensuring compliance with health regulations.
Lastly, the Pediatric Immunization Schedule provides guidelines on when children should receive vaccinations. While the 680 form documents the immunizations a child has already received, the immunization schedule outlines the recommended timeline for vaccinations. Both documents are essential tools for parents and healthcare providers, promoting timely immunizations to protect children’s health.