The 680 form is a Florida Certification of Immunization used to document a child's immunization status for school attendance. It is required for children in daycare, preschool, and grades K-12, ensuring they meet the state's immunization requirements. Completing this form accurately is essential for compliance with Florida's educational regulations.
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
Misconception 1: The 680 form is only for school-aged children.
Many people believe that the 680 form is exclusively for children who are already in school. However, this form is also applicable for younger children in daycare and preschool settings. It serves as a certification of immunization for children from birth through 12th grade.
Misconception 2: Completing the 680 form is optional.
Some parents think that they can skip filling out the 680 form if they believe their child is up-to-date on vaccinations. In reality, this form is often a requirement for school and daycare enrollment in Florida. It is important to ensure compliance with local regulations to avoid issues with enrollment.
Misconception 3: All immunizations must be completed before submitting the form.
While it is ideal for children to be fully immunized, the 680 form allows for partial completion. For children who have started their vaccination schedule but are not yet fully vaccinated, parents can indicate this on the form and provide a plan for completing the immunizations.
Misconception 4: The 680 form can be filled out by anyone.
It is a common misunderstanding that anyone can complete the 680 form. In fact, the form must be filled out by a licensed healthcare provider who can verify the immunization records. This ensures that the information is accurate and credible.
Misconception 5: The 680 form is only valid for a short time.
Some parents worry that the 680 form has a very limited validity period. While it is important to keep immunization records up-to-date, the form itself does not expire quickly. As long as the information is accurate and reflects the child's current immunization status, it remains valid for school and daycare enrollment.
When filling out and using the Florida Certification of Immunization (Form 680), several important points should be considered to ensure compliance and accuracy.
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