Blank 680 Form

Blank 680 Form

The 680 form, also known as the Florida Certification of Immunization, is a crucial document required for school enrollment in Florida. It provides a record of a child's immunizations and ensures compliance with state health regulations. Understanding how to fill out this form accurately is essential for parents and guardians to secure their child's educational opportunities; click the button below to get started.

Make This 680 Online

The Florida Certification of Immunization, commonly referred to as the 680 form, plays a crucial role in ensuring that children meet the immunization requirements for school attendance in Florida. This form is governed by specific sections of Florida Statutes and the Florida Administrative Code, which outline the legal framework for immunization documentation. Parents or guardians must provide essential information, including the child's name, date of birth, and optional identifiers such as the child's Social Security number. The form requires a detailed record of all administered vaccines, including dates and doses, which must be accurately filled out. There are different sections within the form that cater to various scenarios, such as complete immunization records for K-12 students, temporary exemptions for those still completing their vaccinations, and permanent medical exemptions for children who cannot receive certain vaccines for valid medical reasons. Proper completion of the 680 form is vital, as it ensures compliance with state regulations and facilitates a child's enrollment in educational settings. For additional guidance, resources are available through the Florida Department of Health's Immunization Guidelines, which provide comprehensive instructions on how to complete the form correctly.

Your Questions, Answered

What is the purpose of the Florida 680 Form?

The Florida 680 Form, also known as the Certification of Immunization, serves as an official record of a child's immunizations. It is required for school attendance in Florida, ensuring that children are vaccinated against certain diseases as mandated by state law. The form helps schools verify that students have received the necessary vaccinations to protect public health.

Who needs to complete the 680 Form?

Parents or guardians of children entering K-12 schools, daycare facilities, or preschool programs in Florida must complete the 680 Form. This includes children in grades 1 through 12 and those starting kindergarten. Additionally, the form is necessary for children who are incomplete with their immunizations, as it outlines their current vaccination status and any exemptions.

What information is required on the 680 Form?

The 680 Form requires several key pieces of information:

  1. Child's full name, date of birth, and optional Social Security number.
  2. Parent or guardian's information.
  3. State immunization ID number, if available.
  4. Details of the vaccines received, including dates for each dose.
  5. Certification of immunization status, including any exemptions.

It is crucial to provide accurate and complete information to avoid issues with school enrollment.

What are the different parts of the 680 Form?

The 680 Form is divided into three main parts:

  • Part A: Certification of complete immunization for K-12 students.
  • Part B: Temporary certification for children who are in the process of completing their immunizations.
  • Part C: Permanent medical exemption for children who cannot receive certain vaccines due to medical reasons.

Each part has specific requirements and must be filled out accurately to ensure compliance with state regulations.

How can I obtain the 680 Form?

The 680 Form can be obtained from various sources. Parents can request it from their child's healthcare provider, or they can download it directly from the Florida Department of Health's website. Additionally, schools and childcare facilities often have copies available for parents to fill out during enrollment.

What should I do if my child has a medical exemption?

If your child has a medical exemption, you must complete Part C of the 680 Form. This section requires you to provide details about the medical condition that contraindicates vaccination. A physician or clinic must authorize the exemption, and it is essential to include valid clinical reasoning or evidence. Ensure that the exemption is documented correctly to avoid complications during school enrollment.

Similar forms

  • Form 1010: Certificate of Immunization - Similar to the 680 form, this document certifies that a child has received the necessary vaccinations. It serves as proof for school enrollment and includes details about the immunization schedule.
  • Form 150-615: Immunization Guidelines - This document provides comprehensive guidelines for completing immunization forms. Like the 680 form, it ensures that parents and guardians understand the requirements for school and daycare immunizations.
  • Form 3280: Medical Exemption Request - This form allows parents to request exemptions for their child’s vaccinations due to medical reasons. It parallels the 680 form’s sections on temporary and permanent exemptions.
  • Form 900: Commercial Lease Agreement - This document is crucial for those engaging in commercial property leasing in Florida, as it outlines the terms and conditions thoroughly, similar to guidelines provided by Florida Documents.
  • Form 680A: School Entry Health Form - This document is required for school entry and includes immunization records similar to those found in the 680 form. It focuses specifically on the health requirements for children entering school.
  • Form 680B: Child Care Health Assessment - Similar to the 680 form, this assessment is necessary for children in daycare. It includes immunization records and health evaluations to ensure the child's readiness for childcare environments.
  • Form 850: Vaccination Record - This form tracks an individual’s vaccination history. It serves a similar purpose as the 680 form, documenting the immunizations a child has received.
  • Form 990: Health History Form - This document collects comprehensive health information, including vaccination status. It complements the 680 form by providing a broader health context for the child.
  • Form 1200: School Health Records - This record keeps track of a student’s health and immunization history throughout their schooling. Like the 680 form, it is essential for maintaining compliance with school health regulations.
  • Form 500: Immunization Waiver - This form allows parents to waive immunization requirements under certain conditions. It is similar to the exemption sections of the 680 form, providing an alternative for families with specific concerns.

Documents used along the form

The Florida Certification of Immunization Form, also known as the DH 680 form, is essential for documenting a child's immunization status. When completing this form, there are several other documents that may be required or useful. Below is a list of these documents, along with brief descriptions of each.

  • DH Form 150-615: This document provides comprehensive guidelines on immunization requirements for Florida schools, childcare facilities, and family daycare homes. It outlines how to properly complete the DH 680 form.
  • Texas Motorcycle Bill of Sale Form: For those involved in motorcycle transactions, reviewing the detailed Texas motorcycle bill of sale requirements is vital for ensuring all parties are legally protected.
  • Certificate of Medical Exemption: This certificate is used when a child is medically unable to receive certain vaccinations. It must be signed by a licensed physician and specify the vaccines that are contraindicated.
  • Immunization Records: Parents may need to provide detailed records from healthcare providers that show the dates and types of vaccinations a child has received. These records help verify the information on the DH 680 form.
  • Temporary Medical Exemption Form: This form is for children who cannot receive vaccinations for a limited time due to medical reasons. It requires an expiration date and must be updated as needed.
  • School Enrollment Forms: Many schools require specific enrollment forms that may ask for immunization status. These forms often accompany the DH 680 form during the registration process.
  • Health Assessment Form: Some schools may request a health assessment, which includes a general health evaluation and may reference immunization status as part of the child's health history.
  • Parent Consent Form: This document is often required for schools to obtain consent from parents for their child to receive vaccinations, particularly in school-based health programs.
  • Proof of Residency: Schools may require proof of residency to verify that a child is eligible to attend. This can include utility bills or lease agreements, which may need to be submitted alongside the DH 680 form.

Understanding these additional documents can help streamline the process of enrolling a child in school and ensure that all immunization requirements are met. Proper documentation is crucial for compliance with state regulations and for the health and safety of the child and the community.

Key takeaways

The Florida Certification of Immunization, commonly referred to as the 680 form, is essential for documenting a child's immunization status for school attendance. Here are key takeaways regarding its completion and use:

  • Accurate Information: Ensure all personal details, including the child's full name, date of birth, and parent or guardian information, are entered correctly.
  • Immunization Records: Record all appropriate vaccine doses and dates in the designated sections. This includes DTaP, Polio, MMR, and others as applicable.
  • Signatures Required: The form must be signed and dated by an authorized physician or clinic representative to be valid.
  • Certificate Options: Select the correct certificate part (A, B, or C) based on the child's immunization status: complete, temporary exemption, or permanent exemption.
  • Expiration Dates: For temporary medical exemptions, include an expiration date. This is crucial for the validity of the exemption.
  • Guidelines Reference: Refer to the Immunization Guidelines for Florida Schools, available online, for detailed instructions on completing the form.
  • Submission: Submit the completed form to the appropriate school or childcare facility as part of the enrollment process.

Completing the 680 form accurately ensures compliance with Florida’s immunization requirements and facilitates a smooth enrollment process for children in educational settings.