Free 680 Template in PDF Get Your Form

Free 680 Template in PDF

The 680 form, officially known as the Florida Certification of Immunization, is a crucial document for ensuring that children meet the necessary immunization requirements for school attendance. This form captures essential information about a child's vaccination history, including dates and types of vaccines received. Completing this form accurately is vital for compliance with state regulations, so take action now and fill out the form by clicking the button below.

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Misconceptions

  • Misconception 1: The 680 form is only for K-12 students.
  • This form is used for various age groups, including children in daycare and preschool. It is not limited to just K-12 students.

  • Misconception 2: Completing the 680 form guarantees school enrollment.
  • While the form is important, it does not automatically ensure enrollment. Schools may have additional requirements that must be met.

  • Misconception 3: The 680 form is the only documentation needed for immunizations.
  • Other records may also be required. It’s essential to check with the school or childcare facility for their specific needs.

  • Misconception 4: Parents can fill out the form without any medical input.
  • Medical professionals must verify immunization records. Parents should consult with a healthcare provider to ensure accuracy.

  • Misconception 5: All vaccines are required for all children.
  • Some exemptions exist, such as medical exemptions. It's important to understand which vaccines are necessary based on individual circumstances.

Documents used along the form

The Florida Certification of Immunization, commonly known as the 680 form, is essential for documenting a child's immunization status for school enrollment. Alongside this form, several other documents and forms may be required or helpful in ensuring compliance with state regulations regarding immunizations. Here’s a list of some of these important documents:

  • DH Form 150-615: This is the Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes. It provides detailed instructions on how to complete the 680 form and outlines the immunization requirements for children in Florida.
  • Certificate of Medical Exemption: This form is used when a child cannot receive certain vaccinations due to medical reasons. It must be signed by a licensed physician and specifies the vaccines the child is exempt from.
  • School Enrollment Form: This form collects basic information about the student, including their name, address, and contact details, and often requires proof of immunization as part of the enrollment process.
  • Health History Form: Parents fill out this form to provide the school with a comprehensive health history of the child, including any past illnesses, allergies, or medical conditions that may affect their education.
  • Employment Application PDF Form: Job seekers can complete their applications efficiently by utilizing resources such as smarttemplates.net/fillable-employment-application-pdf, which provides a standard format for personal information, work history, skills, and qualifications.
  • Emergency Contact Form: This document lists individuals who can be contacted in case of an emergency involving the child. It is crucial for schools to have this information readily available.
  • Consent for Treatment Form: This form allows the school to seek medical treatment for the child in case of an emergency when parents or guardians cannot be reached.
  • Immunization Records: These are official records from healthcare providers that detail the vaccines a child has received. They are often required to verify compliance with state immunization laws.
  • Physical Examination Form: Some schools require a recent physical examination for students, especially those entering kindergarten or participating in sports. This form confirms the child's overall health status.
  • Allergy Action Plan: If a child has known allergies, this plan outlines specific actions to take in case of an allergic reaction. It is essential for ensuring the child's safety at school.

These documents work together to ensure that children are properly immunized and that their health and safety are prioritized in educational settings. Keeping these forms organized and readily available can help streamline the enrollment process and maintain compliance with state regulations.

Common mistakes

Filling out the Florida Certification of Immunization Form, commonly known as the 680 form, is a crucial step for ensuring that children meet their immunization requirements for school. However, many people make common mistakes that can lead to delays or complications. Understanding these pitfalls can help streamline the process.

One frequent error is incomplete information. Many individuals forget to fill in all required fields, such as the child’s last name, first name, or date of birth. Omitting even one piece of information can cause the form to be rejected. It’s essential to double-check that all necessary details are included before submission.

Another common mistake involves the incorrect documentation of immunization dates. Parents sometimes write down the wrong dates or fail to include all doses received. Each vaccine has specific dosage requirements, and missing or incorrect dates can create confusion about a child's immunization status.

Additionally, some people overlook the importance of signing the form. The signature of a parent or guardian is a legal requirement for the form to be valid. Without it, the form cannot be processed, and the child may face delays in enrollment or attendance at school.

Another area where mistakes occur is in selecting the appropriate certificate type. Parents may choose the wrong part of the form, such as submitting a temporary exemption when a permanent exemption is needed. Understanding the distinctions between Part A, Part B, and Part C is vital for ensuring that the correct information is provided.

Furthermore, failing to provide supporting documentation for medical exemptions can be problematic. If a child is exempt from certain vaccinations for medical reasons, the form must include valid clinical reasoning or evidence. Without this, the exemption may not be honored, leading to potential issues with school attendance.

Lastly, many individuals neglect to check the expiration dates on temporary exemptions. If the expiration date is not filled in or has passed, the exemption becomes invalid. This oversight can result in the child being considered non-compliant with immunization requirements.

By being aware of these common mistakes, parents and guardians can better navigate the process of completing the 680 form. Taking the time to review the form carefully can save time and ensure that children meet their immunization requirements for school attendance.

Sample - 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