Free 680 PDF Form

How to Fill Out 680

Filling out the Florida Certification of Immunization (Form DH 680) is a process that requires attention to detail to ensure all pertinent student immunization information is correctly entered and compliant with state requirements. This form is pivotal for parents or guardians in providing proof of their child's immunizations for school, childcare facilities, and family daycare homes in Florida. The following steps guide you through the process of completing the form accurately.

1. Begin by entering the student's last name, first name, and middle initial (MI) in the designated fields at the top of the form.
2. Fill in the student's date of birth (DOB) in the format MM/DD/YY.
3. Optionally, include the parent or guardian's name, the child’s Social Security Number (SS#), and the State Immunization ID# if available.
4. Under the directions provided, enter each vaccine's date of administration in the columns labeled Dose 1 through Dose 5, corresponding to the vaccine's code.
5. For vaccines requiring more clarification such as Varicella (Chickenpox) or Varicella Disease, ensure to indicate whether the immunity was due to the vaccine or the disease itself by marking the appropriate box and providing the year if pertaining to the disease.
6. Select the appropriate certificate (A, B, or C) based on the child’s immunization status:
   • Certificate A for completed K-12 immunizations (excluding specific middle school requirements).
   • Certificate B for temporary medical exemptions, including an expiration date for the exemption.
   • Certificate C for permanent medical exemptions with detailed reasons for each exempted vaccine.
7. In the selected certificate section, fill in any required dates, check boxes that apply, and provide detailed information for exemptions as necessary.
8. The form must be signed and dated by a physician or authorized clinic staff validating the immunization records or exemptions listed.
9. Ensure the physician or clinic name is clearly printed, along with the issuer's name and the date of issuance.
10. Double-check the form for completeness and accuracy before submission to the required school or facility.

After the form is filled out, it should be submitted according to the guidelines provided by the school, childcare facility, or family daycare home where it is being requested. It's essential to keep a copy for your records and be prepared to provide additional information if required. The DH 680 form is an important document in ensuring the health and safety of children and those around them by documenting and confirming their immunization status.

What is the Florida Certification of Immunization (Form 680)?

The Florida Certification of Immunization, known as Form 680, is a document that records all the immunizations a child has received. It is required by Florida law for enrollment and attendance in schools, childcare facilities, and family daycare homes. The form is divided into sections that reflect immunizations complete for K-12, immunizations still in progress, and medical exemptions. It provides a comprehensive record of vaccinations like DTaP/DTP, Polio, MMR, Hepatitis B, and Varicella, among others.

How can I obtain the DH 680 form?

To obtain the DH 680 form, parents or guardians must submit their child's immunization records to a Florida county health department or directly to their healthcare provider. The health department or provider will review the records and then enter the immunizations into the Florida State Health Online Tracking System (SHOTS). Once entered, they can issue the certified DH 680 form, which can be used for school registration and compliance.

Is a child's Social Security Number (SSN) necessary on the form?

No, including a child's Social Security Number (SSN) on the Form 680 is optional. It is not a requirement for the completion or submission of the form. Parents and guardians have the option to omit this information if they prefer.

What does "Temporary Medical Exemption" mean on the form?

A "Temporary Medical Exemption" on the Form 680 indicates a certified physician or clinic has determined that it is currently not in the best medical interest for the child to receive one or more required immunizations. This part of the form must include an expiration date, signaling when the child's immunization status will be reevaluated. This exemption allows for enrollment and attendance while protecting both the child's health and public health interests.

Can the DH 680 form be modified after it is issued?

Yes, the DH 680 form can be updated or modified after it is originally issued. If a child receives additional immunizations or if an error on the original form needs correction, parents or guardians should provide the updated immunization information to the issuing health department or healthcare provider. The form can then be reissued with the current immunization record.

What is meant by "Permanent Medical Exemption"?

A "Permanent Medical Exemption" on the DH 680 form indicates that a child has a physical condition that makes receiving one or more of the required immunizations medically inadvisable. This exemption is granted when there is clinical evidence or reasoning that supports the exemption for each vaccine. A physician must certify that the condition is permanent, and specific vaccines must be listed with the reasons for the exemption.

Who can sign and issue the DH 680 form?

The DH 680 form can be signed and issued by physicians, clinicians, or authorized representatives from the Florida Department of Health's county offices or healthcare facilities registered with the Florida SHOTS system. This ensures that only qualified individuals who can accurately assess immunization records and understand the relevant public health guidelines complete the form.

1. One common mistake is not providing complete information for each vaccine, including all the required doses and their respective dates. The form asks for details about specific doses for vaccines like DTaP/DTP, Polio, and MMR among others. It's crucial to fill in every applicable field with accurate information.

2. Omitting the child’s last name, first name, or middle initial can lead to processing delays. Ensuring that the full name matches what is on other legal documents is important for identifying and updating the child's immunization records accurately.

3. Leaving the child’s Social Security Number (SSN) and State Immunization ID# fields empty when this information is available is another oversight. While these fields are optional, providing them can help in uniquely identifying the child in the state's immunization registry, making it easier to keep their records updated.

4. Forgetting to select the appropriate certificate (A, B, or C) at the end of the form and signing and dating it can invalidate the submission. Each certificate serves a different purpose, highlighting whether immunizations are complete, in progress, or medically exempt, and thus needs to be correctly identified and authenticated by the parent or guardian.

5. Another mistake is not reviewing the validity of temporary or permanent medical exemptions. Temporary exemptions require a clearly stated expiration date, and permanent exemptions should include valid clinical reasoning or evidence. Failing to provide these details can result in errors in processing the exemptions.

6. Not consulting the provided guidelines from the Department of Health’s Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes before completing the form can lead to various errors. These guidelines offer critical information and instructions that aid in accurately filling out the form.

It's important to carefully review all the guidelines provided and double-check the form for completeness and accuracy before submission to ensure that the child’s immunization records are correctly documented and updated in the state registry.

When navigating the legal and procedural landscape surrounding immunization in Florida, particularly concerning the DH 680 form—Florida's Certification of Immunization—individuals often find themselves handling a collection of additional documents that provide further evidence of immunization, ensure compliance with state laws, and facilitate the enrollment processes for schools and childcare facilities. These documents, while not as widely recognized as the DH 680 form, play crucial roles in maintaining the health and safety standards within educational and care settings. Below is an outline of other significant forms and documents typically associated with the DH 680 form, each with its unique place in the immunization documentation spectrum.

• DH 681 - Religious Exemption From Immunization: This form is for parents or guardians who seek an exemption from immunization requirements for their children on the basis of religious beliefs. Its approval allows children to attend school or childcare without the immunizations typically required.
• DH 3040 - Child's Medical Evaluation / School Entry Health Exam: This certificate is filled out by a healthcare provider and indicates that a child has undergone a physical examination. It's often required for entry into Florida schools and includes sections that may reference a child’s immunization status.
• Immunization Guidelines - Florida Schools, Childcare Facilities and Family Daycare Homes: Although not a form, this guideline document is essential for understanding the requirements detailed in DH 680 and other related forms. It offers comprehensive instructions on completing immunization documentation correctly.
• Immunization Registry Reporting: While not a single document, contributions to Florida’s State Health Department's Immunization Registry are crucial. These data entries ensure an individual’s immunization records are centrally stored and accessible, supporting public health efforts.
• Vaccine Information Statements (VIS): Provided by the Centers for Disease Control and Prevention (CDC), these informational sheets are distributed to recipients or their guardians at the time of vaccination. They describe the benefits and risks of vaccines and are often retained for personal records and discussions with healthcare providers.
• Vaccination Record Card: This personal document tracks the vaccinations an individual has received. It serves as a quick reference for schools, employers, and healthcare providers to verify a person's immunization history.
• DH 680 (Form Parts A, B, C): Though it is the primary document discussed, it’s worth noting that the DH 680 form itself comes in multiple parts—each designed to document different aspects of immunization compliance or exemptions, as detailed in the main description.

Together, these documents form a comprehensive network that supports the DH 680's goal of verifying immunization for individuals in educational and childcare settings. By ensuring that these forms are properly completed and maintained, parents, guardians, and administrators contribute to the larger aim of safeguarding community health, preventing the spread of communicable diseases, and complying with Florida's educational standards and regulations.

• The I-693 Form, also known as the Report of Medical Examination and Vaccination Record, is similar to the DH 680 form as both documents serve as proof of required immunizations. The I-693 is specifically used in the context of immigration to ensure applicants are free from any communicable diseases that could pose a public health risk, similarly emphasizing the safety of communal environments.

• The Blue Card or Immunization Record Card commonly used in many school districts across the United States parallels the DH 680 form. This card tracks a child’s vaccination history, crucial for school enrollment, just like the DH 680 form delineates a comprehensive immunization status for children in Florida.

• MedicAlert Immunization Registry shares similarities with the DH 680 form by providing a system in which individuals’ vaccine histories are securely stored and accessed. Both ensure that immunization information is readily available for school, employment, or in case of emergency, promoting health and safety.

• The VAERS Form (Vaccine Adverse Event Reporting System) is akin to the DH 680 form in its connection to vaccines but differs in purpose. While the DH 680 form documents immunizations received, VAERS collects information about any adverse effects post-vaccination, underlining the surveillance aspect of public health management.

• Yellow International Certificate of Vaccination or Prophylaxis (ICVP), used for international travel, shares goals with the DH 680 form—preventing the spread of diseases. It shows proof of vaccination, sometimes required for entry into some countries, similar to how the DH 680 form is required for school attendance in Florida.

• The Electronic Health Record (EHR) systems in which immunization data can be stored, recalled, and shared among healthcare providers, schools, and individuals, serve a parallel function to the paper-based DH 680 form. Both compile important health data with the aim of safeguarding public health through informed decisions on vaccine-preventable diseases.

Filling out the Florida Certification of Immunization (Form 680) is an important step for ensuring that children meet the state's immunization requirements for school and daycare. To help make this process as smooth as possible, here’s a quick guide on what to do and what not to do when completing this form.

1. Review the Immunization Guidelines - Florida Schools, Childcare Facilities, and Family Daycare Homes (July 2010) available at www.immunizeflorida.org/schoolguide.pdf. This will keep you up to date with the requirements.

2. Ensure that all information is legible, especially the names, dates of birth, and the dates of immunizations. Clear information helps avoid processing delays.

3. For each vaccine, record all appropriate doses along with their dates. If the child has a history of varicella (chickenpox) disease, remember to note the year it occurred.

4. Choose the correct certificate - Part A, B, or C - based on the child's immunization status, and don’t forget to sign and date the form.

5. If applicable, clearly list any medical exemptions in Part C, including valid clinical reasoning or evidence for each exempted vaccine.

1. Don’t leave any fields blank. If a section does not apply, make sure to indicate this appropriately rather than leaving it empty.

2. Avoid using nicknames or shortened versions of names. Use the child’s full legal name to prevent any confusion or mismatches in records.

3. Do not guess immunization dates. If you are unsure about specific dates, it’s better to consult with the physician or clinic for accurate records.

4. Refrain from submitting the form without reviewing it for mistakes. Even small errors can result in significant delays.

5. Do not overlook the expiration date of any temporary medical exemptions in Part B; these need to be clearly recorded to remain valid.

The Florida Certification of Immunization, commonly referred to as the DH 680 form, is a critical document in ensuring the health and safety of children attending school and child care facilities in Florida. However, misconceptions about the form and its requirements can lead to confusion. Here are five common misconceptions:

• Misconception 1: The child's Social Security Number (SSN) is required on the form. While the form has a space for the child’s SSN, providing this information is optional, not mandatory. The primary purpose of the 680 form is to document the child's immunization record for school or childcare attendance, not to collect social security details.
• Misconception 2: All children must complete the entire series of vaccinations listed on the form to attend school. The form allows for exemptions, such as medical reasons where certain vaccines are contraindicated. Part C of the form is specifically designed for these cases, allowing a physician to list vaccines that are medically contraindicated for the child.
• Misconception 3: Temporary medical exemptions are indefinite. Part B of the form allows for temporary medical exemptions, but it's crucial to note these are not indefinite. An expiration date must be provided, indicating when the child is expected to resume the vaccination schedule.
• Misconception 4: The form is only for public school students. Florida's immunization documentation requirements extend to children in childcare, family daycare homes, and private schools as well, ensuring a broad protection against vaccine-preventable diseases across various child-centered environments.
• Misconception 5: Once completed, the form never needs to be updated. Immunization requirements can change, and children may receive additional vaccines after the initial submission of their form. Therefore, it is necessary to update the DH 680 form to reflect any new vaccines received, ensuring the child’s immunization record is current.

Understanding these misconceptions is crucial for parents, guardians, and healthcare providers to navigate the requirements for school and childcare attendance in Florida successfully. Proper completion and maintenance of the DH 680 form ensure the health and well-being of children, aligning with public health goals.

• Understanding the Florida Certification of Immunization (Form 680) is imperative for ensuring that children meet the required immunization standards for school, childcare, and family daycare home attendance in Florida. This form verifies that a child has received the necessary vaccinations.
• The form should be completed with the child's full name, date of birth, and information about the parent or guardian. While providing the child's Social Security Number and State Immunization ID# is optional, these details can assist in maintaining accurate health records.
• Accurately entering all doses and dates of vaccinations is crucial. The form is designed to document doses of DTaP/DTP, Polio, Hib, MMR, Hepatitis B, Varicella, and additional vaccines. Each vaccine is identified by a specific code, and there's space to note each dose and its administration date.
• For the form to be considered complete, it must be signed and dated in the appropriate certificate section (A, B, or C), depending on the child's immunization status. Each section serves different circumstances — ranging from complete immunizations to medical exemptions.
• Certificate of Immunization for K-12 (Part A) is used when a child's immunizations are fully up to date for K-12 (excluding specific requirements for 7th-grade/middle school). This part is essential for school enrollment.
• Temporary Medical Exemption (Part B) applies to children who are in the process of receiving their required immunizations or cannot receive additional immunizations temporarily for medical reasons. Notably, this section must include an expiration date to remain valid.
• Permanent Medical Exemption (Part C) is designated for situations where certain immunizations are permanently contraindicated due to the physical condition of the child. This section requires a detailed explanation of the clinical reasoning or evidence for each exempted vaccine.

For detailed instructions and further information on completing the form, the Florida Department of Health provides guidelines, available at their website. This resource outlines the specific requirements and provides clarification on the completion process, ensuring that children's immunization records are accurately and effectively documented for school and childcare attendance.