680 Template

Instructions on How to Fill Out 680

Completing the 680 form is essential for documenting a child's immunization status for school attendance in Florida. Ensure all information is accurate and complete to avoid any delays in enrollment or attendance. Follow these steps carefully to fill out the form correctly.

1. Begin by entering the child's last name, first name, and middle initial in the designated fields.
2. Fill in the child's date of birth in the format MM/DD/YY.
3. Provide the parent or guardian's name.
4. If applicable, enter the child's Social Security Number (this is optional).
5. Include the state immunization ID number if available (this is also optional).
6. For each vaccine listed, enter the corresponding dose dates in the format MM/DD/YY:
• DTaP/DTP: Dose 1, Dose 2, Dose 3, Dose 4, Dose 5
• Polio: Dose 1, Dose 2, Dose 3, Dose 4
• D Hib: Dose 1, Dose 2
• MMR: Combined or separate doses as applicable
• Measles: Dose 1, Dose 2
• Mumps: Dose 1, Dose 2
• Rubella: Dose 1, Dose 2
• Hepatitis B: Dose 1, Dose 2, Dose 3
• Varicella: Dose 1, Dose 2, or indicate if the child had the disease
• PneumoConju: Indicate the dose
7. Select the appropriate certificate box (A, B, or C) based on the child's immunization status:
• Certificate of Immunization for K-12 (Part A)
• Temporary Medical Exemption (Part B)
• Permanent Medical Exemption (Part C)
8. For Part A, check the box indicating immunizations are complete for K-12 or 7th grade.
9. For Part B, fill in the expiration date for the temporary exemption.
10. For Part C, provide a detailed explanation of the medical contraindications.
11. Sign and date the form where indicated, including the physician or clinic name and authorized signature.
12. Finally, ensure the form is submitted to the appropriate school or childcare facility as required.

When filling out and using the Florida Certification of Immunization (Form 680), consider the following key takeaways:

• Accurate Information: Ensure all personal details, including the child’s name, date of birth, and immunization dates, are entered accurately to avoid any issues with school enrollment.
• Signature Requirement: The form must be signed and dated by an authorized individual, such as a physician or clinic representative, to validate the immunization records.
• Certificate Selection: Select the appropriate certificate part (A, B, or C) based on the child’s immunization status. Each part serves a different purpose, including complete immunization, temporary exemptions, or permanent medical exemptions.
• Consult Guidelines: Reference the Immunization Guidelines for Florida Schools, available online, for detailed instructions on completing the form and understanding immunization requirements.

The Florida Certification of Immunization, commonly known as the 680 form, is essential for documenting a child's immunization history. However, several other forms and documents are often used in conjunction with the 680 form to ensure comprehensive compliance with health and educational requirements. Below is a list of these related documents.

• DH Form 150-615: This form provides guidelines for completing the immunization certification. It outlines the necessary immunizations for school attendance and offers detailed instructions for parents and guardians.
• Florida Department of Health Immunization Records: These records serve as official documentation of a child's immunizations. They may be requested by schools or childcare facilities to verify compliance with state requirements.
• School Health Assessment Form: This form assesses a child's health status and is often required by schools. It may include information about medical history, allergies, and other relevant health concerns.
• Emergency Contact Form: Schools typically require this form to ensure they can reach a parent or guardian in case of an emergency. It includes contact information and any special instructions regarding the child's care.
• Medical Exemption Form: If a child cannot receive certain vaccinations for medical reasons, this form must be completed by a healthcare provider. It provides the necessary documentation for a permanent medical exemption.
• Religious Exemption Form: Some parents may seek exemptions from immunization requirements based on religious beliefs. This form must be submitted to the school to document the exemption.
• Health History Form: This form collects comprehensive health information about the child, including past illnesses, surgeries, and any ongoing medical treatments. Schools may use this information to provide appropriate care.

Understanding these forms and their purposes can help ensure that children meet immunization requirements and that schools have the necessary information to support their health and safety. Proper documentation is crucial for compliance and helps facilitate a smooth educational experience.

When filling out the Florida Certification of Immunization (Form 680), it is crucial to adhere to specific guidelines to ensure accurate and complete submission. Below are four recommendations on what to do and what to avoid:

• Do ensure that all required fields are filled out completely, including the child's name, date of birth, and immunization dates.
• Do double-check the vaccine codes and corresponding dates to avoid errors in documentation.
• Do sign and date the appropriate certificate (A, B, or C) as required by the form.
• Do review the immunization guidelines available at the provided link for any additional instructions.

• Don't leave any sections blank; incomplete forms may be considered invalid.
• Don't use outdated vaccine codes or dates; always reference the latest guidelines.
• Don't submit the form without verifying that the information is accurate and up-to-date.
• Don't forget to include the expiration date for any temporary medical exemptions.