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Common mistakes

  1. Failing to include the child's full name. Ensure that the last name, first name, and middle initial are all provided. Omitting any part can lead to confusion and delays.

  2. Not entering the correct date of birth. The format required is MM/DD/YY. A common mistake is using the wrong format or entering an incorrect date.

  3. Leaving out the parent or guardian's name. This section is crucial for identifying who is responsible for the child's immunization records.

  4. Neglecting to fill in the child's Social Security number. Although this is optional, including it can help streamline the process.

  5. Forgetting to sign and date the appropriate certificate. Each certificate (A, B, or C) must be signed to validate the information provided.

  6. Incorrectly documenting vaccine doses and dates. Each vaccine dose must be accurately recorded with the correct MM/DD/YY format.

  7. Using the wrong codes for vaccines. Familiarize yourself with the codes listed on the form to ensure proper documentation.

  8. Failing to indicate the appropriate certificate of immunization for K-12. Be sure to select the correct DOE code based on the child's immunization status.

  9. Not providing an expiration date for temporary medical exemptions. This is a requirement for the exemption to be considered valid.

  10. Omitting the physician or clinic name and authorized signature. This information is essential for verifying the legitimacy of the immunization records.

Similar forms

The FLORIDA CERTIFICATION OF IMMUNIZATION, commonly known as the 680 form, shares similarities with several other documents related to immunization and health records. Here are six documents that are comparable:

  • CDC Immunization Record Card: This card tracks an individual's vaccination history, including dates and types of vaccines received. Like the 680 form, it serves as proof of immunization for school and employment.
  • Tractor Bill of Sale Form: This document is essential for transferring ownership of a tractor in Missouri and must be completed accurately. For a comprehensive resource, visit Missouri PDF Forms.
  • State Immunization Registry Records: These records are maintained by state health departments to document vaccinations. They are similar to the 680 form in that they provide official verification of immunization status.
  • School Health Records: Schools often maintain health records for students, including immunization information. These records, like the 680 form, ensure compliance with state health regulations for school attendance.
  • Vaccine Administration Record (VAR): This document is issued by healthcare providers after administering vaccines. It details the vaccine type and date, similar to the information required on the 680 form.
  • Medical Exemption Form: This form is used to document medical reasons for not receiving certain vaccines. It parallels the 680 form's sections for temporary and permanent medical exemptions.
  • Childhood Immunization Schedule: This schedule outlines recommended vaccines for children by age. It is similar to the 680 form as it helps parents track immunization requirements for school enrollment.

Dos and Don'ts

Things You Should Do:

  • Fill in all required fields accurately, including last name, first name, and date of birth.
  • Provide the child's immunization dates in the correct format (MM/DD/YY).
  • Sign and date the appropriate certificate (A, B, or C) on the form.
  • Double-check the vaccine codes to ensure they match the immunizations given.
  • Review the guidelines at www.immunizeflorida.org/schoolguide.pdf for clarity on requirements.

Things You Shouldn't Do:

  • Do not leave any required fields blank; incomplete forms may be rejected.
  • Avoid using incorrect dates or formats when entering immunization information.
  • Do not forget to include the expiration date for temporary medical exemptions.
  • Refrain from altering or erasing any information on the form.
  • Do not submit the form without reviewing it for accuracy and completeness.

Preview - 680 Form

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

 

MM/DD/YY

 

MM/DD/YY

 

MM/DD/YY

 

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

Misconceptions

There are several misconceptions about the Florida Certification of Immunization Form 680. Understanding these can help clarify its purpose and requirements.

  • Misconception 1: The form is only for school-aged children.
  • This is not entirely true. While the form is commonly used for K-12 students, it also applies to children in daycare and preschool settings. Parents should ensure their child's immunization records are complete regardless of their age.

  • Misconception 2: Completing the form is optional.
  • In Florida, the completion of this form is often required for school attendance and childcare enrollment. It is important to check with the specific school or facility for their requirements.

  • Misconception 3: All immunizations must be completed before submitting the form.
  • This is not always the case. The form allows for temporary exemptions, indicating that some immunizations may be in progress. Parents can still submit the form if their child has started the immunization schedule.

  • Misconception 4: The form is only valid if signed by a physician.
  • While a physician's signature is often required, other authorized personnel can also sign the form. This includes clinic staff or healthcare providers who have reviewed the child's immunization records.

How to Use 680

Completing the Florida Certification of Immunization (Form 680) is essential for ensuring your child's school attendance. Follow these steps carefully to fill out the form accurately.

  1. Obtain the form, either online or from your local health department.
  2. Fill in the child's last name, first name, and middle initial.
  3. Enter the child's date of birth in the format MM/DD/YY.
  4. Provide the parent or guardian's name.
  5. Optionally, enter the child's Social Security number.
  6. Optionally, include the state immunization ID number.
  7. Complete the vaccine section by entering the vaccine code and the corresponding dates for each dose.
  8. Choose the appropriate certificate box (A, B, or C) based on the child's immunization status.
  9. If applicable, fill out the expiration date for temporary medical exemptions.
  10. For Part C, list any medically contraindicated immunizations and provide valid reasoning.
  11. Sign and date the form in the designated area.
  12. Submit the completed form to the appropriate school or childcare facility.