Fill in Your 680 Form

680 - Usage Guidelines

Filling out the Florida Certification of Immunization (Form 680) is an essential step in ensuring your child meets the state's immunization requirements for school or childcare. The form, while detailed, can be completed accurately with careful attention to each section. Below are step-by-step instructions to guide you through the process.

1. Start by entering the child's personal information at the top of the form. This includes the child's last name, first name, middle initial (MI), date of birth (DOB) in the format MM/DD/YY, and the parent or guardian's name. Note that providing the child's Social Security Number (SSN) and State Immunization ID# is optional.
2. Proceed to the vaccine section and carefully enter all appropriate doses and the dates they were administered. The form is divided by vaccine type (e.g., DTaP/DTP, Polio, MMR) followed by columns for dose numbers (Dose 1 through Dose 5) with corresponding date fields (MM/DD/YY) for each dose.
3. For varicella (chickenpox), there's an option to indicate if the child has had the disease itself instead of the vaccination. If this is the case, enter the year the disease occurred under the "Varicella Disease" section.
4. Select the appropriate certificate at the bottom of the form based on your child's immunization status:
   • Certificate of Immunization for K-12 (Part A) - Complete this section if immunizations are fully up to date for K-12 (excluding 7th grade/middle school requirements).
   • Temporary Medical Exemption (Part B) - Use this section for children who are temporarily incomplete for immunizations in Part A. Be sure to include the expiration date.
   • Permanent Medical Exemption (Part C) - This section is for medically contraindicated immunizations. List each vaccine and provide valid clinical reasoning or evidence for the exemption.
5. For whichever certificate you select (A, B, or C), review the records and to the best of your knowledge, sign, and date the form certifying the information provided is accurate.
6. Ensure that the physician or clinic name is clearly printed, along with the authorized signature of the physician or clinic official.
7. The form is finalized once it is issued by the name of the issuer, typically a healthcare provider or local health department official, is printed along with their signature and the date issued.

After completing these steps, your Form 680 is ready to be submitted to the necessary school, childcare facility, or family daycare home. Remember, accurate and comprehensive completion of this form helps protect not just your child but also the broader community by ensuring compliance with Florida's immunization laws.

What is the DH 680 form?

The DH 680 form, also known as the Florida Certification of Immunization, is a document that verifies a child's immunization records. It is used to demonstrate compliance with Florida's immunization requirements for school, childcare, and family daycare home attendance. The form lists the vaccines received, the dates of vaccination, and includes sections to indicate if immunizations are complete, in progress under a temporary medical exemption, or exempt due to medical contraindications.

Why is the DH 680 form required?

In Florida, the DH 680 form is required for enrollment in schools, childcare facilities, and family daycare homes. This requirement is established under Florida Statutes Sections 1003.22, 402.305, and 402.313, as well as Rule 64D-3.046 of the Florida Administrative Code to ensure that all students attending these facilities are immunized against certain diseases, ensuring the health and safety of all children and staff.

How can I obtain a DH 680 form?

You can obtain a DH 680 form from your healthcare provider, local health department, or the school or facility requiring the document. It must be completed by a healthcare professional who has reviewed the child's immunization records and certified their immunization status according to the guidelines provided by the Florida Department of Health.

Is a Social Security number required on the DH 680 form?

No, providing a Social Security number on the DH 680 form is optional. The form includes spaces for a child's Social Security number and a State Immunization ID number, but these are not mandatory for the form to be valid and accepted by schools or childcare facilities.

What vaccines are documented on the DH 680 form?

The DH 680 form documents a range of immunizations that protect against diseases such as Diphtheria, Tetanus, Pertussis (DTaP/DTP/Tdap/Td), Polio, Hemophilus influenzae type b (Hib), Measles, Mumps, Rubella (MMR), Hepatitis B, Varicella (Chickenpox), and Pneumococcal Conjugate. It includes sections to mark doses received and the dates of each vaccination.

What does each part of the DH 680 form signify?

Part A of the DH 680 form indicates that a child's immunizations are complete for K-12, excluding 7th grade/middle school requirements. Part B is used for children whose immunizations are in progress under a temporary medical exemption. Part C is for children who have permanent medical exemptions for specific vaccines. Each part must be signed and dated by the certifying healthcare provider.

How long is the DH 680 form valid?

The validity of the DH 680 form varies depending on its parts. Part A and Part C generally remain valid as long as the student's immunization status meets current guidelines. Part B, the temporary medical exemption, includes an expiration date by which additional vaccinations must be received or a new form must be submitted to reflect the updated immunization status or continuation of the exemption.

What should I do if my child has a medical reason to be exempt from vaccinations required?

If your child has a medical reason that contraindicates vaccinations, you should have your healthcare provider complete Part C of the DH 680 form. This section requires listing each vaccine that is medically contraindicated and the valid clinical reasoning or evidence for the exemption. It must be signed by the healthcare provider, certifying the exemption.

Can the DH 680 form be rejected by a school or childcare facility?

A school or childcare facility may reject a DH 680 form if it is incomplete, not properly signed, or does not meet the legal requirements and guidelines set forth by the Florida Department of Health. If there are any issues with your form, it is important to address them promptly with your healthcare provider to ensure your child meets the state's immunization requirements for attendance.

Where can I find more information about completing the DH 680 form?

More information about completing the DH 680 form can be found in the Immunization Guidelines - Florida Schools, Childcare Facilities, and Family Daycare Homes manual, available at www.immunizeflorida.org/schoolguide.pdf. This resource provides comprehensive instructions and information for healthcare providers and parents navigating the immunization requirements and documentation process.

Completing the Florida Certification of Immunization (Form DH 680) accurately is vital for ensuring that students meet health requirements for enrollment in schools and daycare facilities. However, mistakes can occur during the process. Here are some common errors:

1. Not filling in the Date of Birth (DOB) correctly in the format MM/DD/YY. This fundamental detail is crucial for the identification of the individual and tracking of their immunization records.

2. Leaving the SSN (Social Security Number) and State Immunization ID# sections blank, even though they are optional, can delay verification processes or make it difficult to retrieve records in a state database if needed.

3. Omitting or inaccurately recording vaccine dates, especially not adhering to the MM/DD/YY format for each dose, can lead to misinterpretation of compliance with the immunization schedule.

4. Choosing the incorrect certificate (A, B, or C) without understanding the distinction between complete immunization (Part A), temporary medical exemption (Part B), and permanent medical exemption (Part C) leads to improper filing and can affect a child's enrollment.

5. Failure to provide detailed information or valid clinical reasoning for a permanent medical exemption (Part C) can result in the rejection of the exemption claim. All information must be accurately and thoroughly documented.

6. Not obtaining or documenting the authorized signature and issuance date at the bottom of the form undermines its validity. An unverified form is as good as not having one at all, which can halt enrollment processes.

Given the importance of the DH 680 form in securing educational and care services for children, attention to detail is crucial. Avoiding these common mistakes ensures a smoother process for parents, guardians, and administrators alike.

The Florida Certification of Immunization (DH Form 680) is a vital document used to verify that a child has received the required immunizations for school entry and attendance in Florida. To ensure compliance with health and educational guidelines, several other forms and documents are often used in conjunction with this form. Each of these documents plays a crucial role in maintaining up-to-date immunization records and ensuring the health and safety of children in various educational and childcare settings.

1. DH Form 150-615, Immunization Guidelines - Florida Schools, Childcare Facilities, and Family Daycare Homes: This document provides comprehensive information and instructions on how to complete the DH 680 form. It includes guidelines for immunization schedules, documentation, and reporting requirements.
2. Physical Examination Form (DH 3040): This form documents that a child has undergone a physical examination. It is often required for initial entry into Florida schools and for participation in certain sports and physical activities. The form ensures that the child is physically fit to attend school and participate in activities.
3. DH Form 680, Part A, B, or C Certification of Exemption: In cases where a child cannot receive certain immunizations due to medical reasons, a certified healthcare provider must complete the appropriate section of this form to document and certify the exemption.
4. School Entry Health Exam Certification: A form that must be completed by a health care professional to certify that a student has passed a school entry health examination. It is a prerequisite for enrollment and attendance in Florida schools, complementing the immunization requirement.

Together with the Florida Certification of Immunization (DH Form 680), these forms ensure that children are properly immunized and fit to participate in the school environment, safeguarding the health of all students. By providing a structured approach to health documentation, these documents help to maintain public health standards and prevent the spread of vaccine-preventable diseases within the community.

• Vaccination Record Cards: Vaccination record cards are similar to the Florida Certification of Immunization (DH 680 form) in that they also detail an individual's vaccination status, listing the specific vaccines received, along with the dates of each dose. These cards are widely used for maintaining a personal health record of immunizations, akin to the comprehensive recording of vaccine doses and dates on the DH 680 form.

• International Certificate of Vaccination or Prophylaxis (ICVP): This document, often referred to as the "Yellow Card," is used primarily for international travel, showing that a person has been vaccinated against diseases such as yellow fever. The similarity with the DH 680 form lies in its function as an official record of vaccination, although the DH 680 is more focused on domestic requirements for school and daycare attendance.

• School Immunization Records: These are documents that record a child's immunization history, required for enrollment in many schools. Like the DH 680 form, school immunization records confirm that a student has received vaccines mandated by state law, assisting in compliance with health regulations for school attendance.

• Medical Exemption Forms: Similar to the DH 680 form's Part C (Permanent), medical exemption forms document when a person is exempt from vaccinations due to medical contraindications. Both types of documents require a healthcare provider's certification that standard immunizations are medically inadvisable for the individual.

• Temporary Immunization Records: Similar to the DH 680 form's Part B (Temporary), these records indicate that an individual has started but not yet completed a vaccination series. They serve as an interim record, showing compliance with vaccine requirements up to a certain point, and stipulate the timeline for completing remaining doses.

• Childcare and Preschool Immunization Records: These documents are required for enrollment in many childcare and preschool programs, similar to how the DH 680 form is used in Florida. They ensure that children in group care settings are vaccinated against common illnesses, thus safeguarding public health within the facility.

• State-Specific Immunization Forms: Nearly every state in the U.S. has its own form or documentation system for recording immunizations, akin to Florida's DH 680 form. While the exact requirements and layout may vary, the purpose of these documents is universally to certify an individual's vaccination status for school, work, or other regulatory compliance.

• Healthcare Provider Immunization Records: Healthcare providers often maintain records of the vaccinations they administer. These records, like the DH 680 form, detail each vaccine given, the date, and the dose. They are essential for keeping track of a patient's immunization status, providing a history that can be referenced for future medical care, school registration, and other needs.

Filling out Florida's Certification of Immunization (DH 680 form) is an important step for ensuring your child meets the state's immunization requirements for school or childcare. Here are things you should and shouldn't do to complete this form correctly and efficiently.

• Do gather all immunization records before starting the form. It's crucial to have accurate and complete information about each vaccine your child has received, including the dates of administration.
• Don't leave sections blank if they apply to your child. Carefully review each vaccine category and enter the appropriate doses and dates. If a section does not apply, such as opting out due to medical reasons, make sure to fill out the corresponding exemption parts of the form.
• Do review the Immunization Guidelines provided by Florida Health. The guidelines, available at www.immunizeflorida.org/schoolguide.pdf, offer detailed instructions and information on form completion, helping to avoid common mistakes.
• Don't rush through the form without double-checking the information entered against your child’s immunization records. Accuracy is key to avoid delays or issues with school or childcare enrollment.
• Do consult with a healthcare professional if you are unsure about any of the vaccines or doses your child has received. They can provide clarity and ensure the form reflects the current and correct immunization status.
• Don't forget to sign and date the certification section that applies to your child (A, B, or C). An unsigned form is incomplete and will not be accepted.
• Do keep a copy of the completed form for your records. After submitting the original to your child's school or childcare facility, it's wise to retain a copy in case of loss or additional paperwork requests.

By following these guidelines, parents and guardians can navigate the process of certifying their child's immunization status with more confidence and less stress. The effort helps protect not only your child but also promotes the overall health and safety of the community.

Understanding the DH 680 form, commonly known as the Florida Certification of Immunization, is crucial for parents, guardians, and educational professionals. However, there are several misconceptions that can lead to confusion regarding this important document. Below are five misconceptions and clarifications to help dispel common myths.

• Misconception 1: The child's Social Security Number (SSN) is required on the form.

This is not true. The SSN is optional, according to the form instructions. While providing it can make records easier to track, it is not a mandatory field, and omitting it does not invalidate the form.

• Misconception 2: The 680 Form is only for public school enrolment.

This misconception overlooks the form’s broader applicability. The form is required not just for public schools but also for childcare facilities, family daycare homes, and for participation in certain community activities. Its purpose is to ensure that children in various group settings are protected against vaccine-preventable diseases.

• Misconception 3: Once completed, the form never needs updating.

In reality, immunization records need regular updating, especially due to the requirements for entering different education levels. For example, additional immunizations are necessary for 7th-grade entry. Parents should ensure the form is current and includes all required doses as per the child's age and school grade.

• Misconception 4: A temporary medical exemption has no expiration date.

Contrary to this belief, a temporary medical exemption (Part B of the form) must include an expiration date. This expiration date is critical as it indicates when the child must resume the vaccination schedule or submit a new exemption.

• Misconception 5: Any physician or clinic can authorize the form.

While it may seem that any healthcare provider can complete and sign off on the DH 680 form, it is vital that the physician or clinic is recognized and authorized to administer vaccinations. Moreover, for exemptions, the reasons must be clearly stated and backed by valid clinical reasoning.

Dispelling these misconceptions helps ensure that the process of immunization documentation is clear, straightforward, and accurately followed, contributing to the health and safety of all children in Florida.

Filling out the Florida Certification of Immunization, known as the 680 form, is essential for documenting a child's immunization status. Here are five key takeaways to keep in mind:

• Ensure all the child’s personal information is correctly filled out, including the last name, first name, middle initial, Date of Birth (DOB), and optionally, Social Security Number (SSN) and State Immunization ID#.
• It is critical to accurately enter each immunization dose and the date it was administered. Pay close attention to the specific vaccines listed and their corresponding dose numbers.
• For formal validation, the appropriate certificate portion of the 680 form must be signed and dated. This can be one of three types: Certificate of Immunization for K-12 (Part A), Temporary Medical Exemption (Part B), or Permanent Medical Exemption (Part C).
• Consult the DH Form 150-615, Immunization Guidelines - Florida Schools, Childcare Facilities, and Family Daycare Homes document for detailed instructions on how to complete the 680 form. This guide provides crucial information and is available online.
• Understanding the distinctions between the certificate parts is vital. Part A confirms full immunization for school attendance, excluding specific requirements for 7th grade. Part B is for temporary medical exemptions, which requires an expiration date, making the form invalid without one. Lastly, Part C is used to document permanent medical exemptions, where each vaccine contraindicated must be listed along with valid clinical reasoning or evidence.

Ensuring accurate and thorough completion of the 680 form is a crucial step in complying with Florida’s immunization documentation requirements. By following these guidelines, you can help streamline the process for both parents and guardians, as well as for educational and childcare institutions.