Free 680 PDF Template

Here are key takeaways about filling out and using the Florida Certification of Immunization (Form 680):

• Accurate Information: Ensure that all personal details, including the child's name, date of birth, and immunization dates, are filled out correctly.
• Completion of Sections: Complete the appropriate sections (A, B, or C) based on the child's immunization status. Select the correct DOE code that applies to the situation.
• Signature Requirement: The form must be signed by a physician or authorized clinic representative. This signature verifies the information provided is accurate.
• Expiration Dates: For temporary medical exemptions, include an expiration date. Without this, the exemption will not be considered valid.

The Florida Certificate of Immunization (Form 680) is similar to the Certificate of Vaccination used in many states. This document serves as proof that a child has received the necessary vaccinations required for school entry. Like the 680 form, it includes details about the child's immunization history, listing specific vaccines and their administration dates. Both forms aim to ensure that children are protected against preventable diseases and comply with state health regulations.

Another document that parallels the 680 form is the School Immunization Record. This record is maintained by schools to track student vaccinations. Similar to the Florida Certificate of Immunization, it provides a comprehensive overview of a child's immunization status. Schools often require this document for enrollment, making it essential for parents to keep it updated and accurate.

The Health Department Immunization Certificate is also comparable to the 680 form. Issued by health departments, this certificate confirms that a child has received all required vaccinations. Like the 680 form, it includes the child's name, date of birth, and a list of vaccines administered. This document is crucial for parents seeking to enroll their children in daycare or school.

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The Certificate of Medical Exemption is another document that resembles the 680 form. This certificate is issued when a child is unable to receive certain vaccinations due to medical reasons. Similar to Part C of the 680 form, it requires a physician's signature and outlines the specific medical conditions that warrant an exemption. Both documents serve to protect children while ensuring compliance with health regulations.

The Vaccination Record Card, often provided by healthcare providers, shares similarities with the Florida Certificate of Immunization. This card contains a detailed list of vaccines received, along with dates of administration. Parents can use this card to track their child's immunizations, just as they would with the 680 form. Both documents are vital for ensuring children meet vaccination requirements for school and other activities.

The Immunization History Report is another document akin to the 680 form. This report is often generated by healthcare providers and summarizes a child’s vaccination history. Like the Florida Certificate of Immunization, it includes important details such as the types of vaccines received and the dates they were administered. Parents can use this report to verify their child's immunization status when enrolling in school or childcare.

The Child Health Record is similar to the 680 form in that it documents a child's overall health, including immunizations. This record is often maintained by pediatricians and includes growth charts, health screenings, and vaccination history. Both documents emphasize the importance of vaccinations in maintaining a child's health and readiness for school.

The Immunization Compliance Form is another document that resembles the Florida Certificate of Immunization. This form is used by schools to verify that students have met immunization requirements. Similar to the 680 form, it includes information about the child's immunization status and is essential for school enrollment. Both forms help ensure that children are protected against infectious diseases.

Finally, the Child Care Immunization Record shares similarities with the 680 form. This record is specifically designed for children attending daycare or preschool. Like the Florida Certificate of Immunization, it lists required vaccinations and their administration dates. Both documents play a crucial role in ensuring that children are immunized and protected from preventable illnesses in group settings.

How to Use 680

After gathering the necessary information, you can begin filling out the 680 form. This form is essential for documenting a child's immunization status for school enrollment. Follow these steps to ensure accurate completion.

1. Gather Information: Collect the child's last name, first name, middle initial, date of birth, parent or guardian's name, child's Social Security number (optional), and state immunization ID number (optional).
2. Fill in Personal Details: Write the child's last name, first name, middle initial, and date of birth in the designated fields.
3. Enter Parent or Guardian Information: Provide the name of the parent or guardian in the appropriate section.
4. Complete Immunization Records: For each vaccine listed, enter the date for each dose received. Use the format MM/DD/YY for all dates.
5. Select the Appropriate Certificate: Choose between Part A, Part B, or Part C based on the child's immunization status. Mark the corresponding box.
6. Sign and Date: The parent or guardian must sign and date the form to certify the information provided is accurate.
7. Review the Form: Double-check all entries for accuracy and completeness before submitting.

Once the form is filled out correctly, it can be submitted to the appropriate school or childcare facility. Make sure to keep a copy for your records.

The Florida Certification of Immunization, known as the 680 form, is essential for documenting a child's immunization status for school attendance. Several other forms and documents may accompany the 680 form to ensure compliance with state regulations and provide additional information regarding a child's health and immunization history.

• DH Form 150-615: This document provides guidelines for completing the 680 form. It outlines the immunization requirements for schools, childcare facilities, and family daycare homes in Florida. The guidelines help parents and guardians understand the necessary vaccinations for their children.
• Temporary Medical Exemption Form: This form is used when a child cannot receive certain vaccinations due to medical reasons. It must include an expiration date and be signed by a physician. This exemption allows children to attend school while their immunization schedule is incomplete.
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• Permanent Medical Exemption Form: Similar to the temporary exemption, this form is for children with long-term medical contraindications to vaccinations. It requires a physician's signature and a detailed explanation of the medical reasons for the exemption.
• School Health Records: These records provide a comprehensive overview of a child's health history, including immunizations, allergies, and other relevant medical information. Schools often require these records to ensure the safety and well-being of all students.
• Health Assessment Form: This document may be required by schools to assess a child's overall health status before enrollment. It often includes information about physical examinations, screenings, and any ongoing health issues that may need attention.

In summary, the 680 form is a critical part of a child's immunization documentation, but it is often accompanied by other important forms and records. Together, these documents help ensure that children meet health requirements for school attendance while addressing any medical exemptions that may apply.

1. Incomplete Information: Many individuals fail to provide all required details, such as the child's last name, first name, and date of birth. Omitting these crucial elements can delay processing.

2. Incorrect Dates: Entering the wrong dates for immunizations is a common mistake. It is essential to double-check each date entered to ensure accuracy.

3. Missing Signatures: The form must be signed and dated by the appropriate party. Failing to include a signature can render the form invalid.

4. Improper Vaccine Codes: Using incorrect codes for vaccines can lead to confusion and misinterpretation of the immunization status. Each vaccine has a specific code that must be used correctly.

5. Ignoring Exemption Requirements: For those claiming medical exemptions, it is crucial to provide valid clinical reasoning. Not including this information can result in the exemption being denied.

Things to Do:

• Fill in the child's full name, including last name, first name, and middle initial.
• Provide the date of birth in the correct format (MM/DD/YY).
• Enter all immunization doses and dates accurately in the designated sections.
• Sign and date the appropriate certificate (A, B, or C) at the bottom of the form.
• Review the completed form for any errors before submission.
• Keep a copy of the completed form for your records.

Things Not to Do:

• Do not leave any required fields blank.
• Avoid using incorrect date formats or abbreviations.
• Do not submit the form without the necessary signatures.
• Do not forget to check for expiration dates on exemptions if applicable.
• Do not provide false information regarding immunizations.
• Do not ignore the instructions provided in the guidelines.