Free 680 PDF Form

680: Usage Guide

Filling out the Florida Certification of Immunization (DH 680 form) is a necessary step for ensuring your child meets the state's immunization requirements for school and childcare attendance. This document verifies that the child has received all the required vaccinations. Be mindful of the form’s sections and the details it asks for, including vaccine doses and dates. You should refer to the Florida Immunization Guidelines for Schools, Childcare Facilities, and Family Daycare Homes for comprehensive instructions. Here's how to complete the form accurately.

1. Start with the child's information, entering the LAST NAME, FIRST NAME, MI (Middle Initial), and DOB (Date of Birth in MM/DD/YY format).
2. Fill in the PARENT OR GUARDIAN name. Add the child’s SS# (Social Security Number) and STATE IMMUNIZATION ID# if available. Both are optional but can help accurately identify the child in health records.
3. In the VACCINE section, enter the date (MM/DD/YY) for each dose of the vaccines listed. Refer to the codes provided (DOE CODE) to ensure you're filling out the details correctly. The vaccines listed include DTaP/DTP, Tdap, Td, Polio, Hib, MMR, Measles, Mumps, Rubella, Hepatitis B, Varicella, PneumoConjugate, and Varicella Disease.
4. Choose the appropriate certificate—Part A, B, or C—based on the child’s immunization status. Part A is for complete K-12 immunizations, Part B is for temporary exemptions, and Part C is for permanent medical exemptions. Select the box next to the relevant DOE Code for the certificate you’re completing.
5. For Part A, confirm the immunizations are complete for either K-12 (excluding 7th grade requirements) or for 7th grade, by checking the appropriate DOE Code box (1 or 8).
6. If choosing Part B, provide the temporary medical exemption expiration date. Certify that the child has received the document immunizations and has commenced a schedule to complete the remaining immunizations. This part is invalid without an expiration date.
7. For Part C, list each vaccine that is medically contraindicated and provide valid clinical reasoning or evidence for exemption. Indicate that the physical condition of the child is such that the immunizations listed are medically contraindicated.
8. Include the Physician or Clinic Name along with the healthcare provider’s or clinic’s authorized signature. Fill in the Issued By section and the date of issuance.

Once you've completed the form, make sure to review all the information for accuracy. The correctly filled out DH 680 form ensures that your child's educational institution or childcare facility receives accurate and up-to-date immunization information, adhering to Florida's requirements and protecting the health and safety of all children.

Frequently Asked Questions about the Florida Certification of Immunization (DH 680 Form)

1. What is the DH 680 Form and why is it necessary?

   The DH 680 Form, also known as the Florida Certification of Immunization, is a state-mandated document that records a child's vaccinations. Its purpose is to ensure that all children attending school or childcare facilities in Florida meet the state's immunization requirements. The form is required for entry into schools, childcare facilities, and family daycare homes, ensuring that public health standards are maintained and preventable diseases are controlled through immunization.

2. How can I obtain the DH 680 Form?

   This form can be obtained through your child's healthcare provider or the local Florida Department of Health office. After reviewing your child's immunization records, the healthcare provider will complete, sign, and issue the form if your child meets the state's immunization requirements. It can also be issued with temporary or permanent medical exemptions if necessary.

3. Are there any exemptions allowed for the immunization requirements?

   • Temporary Medical Exemption: This is given when a child is temporarily unable to receive certain vaccines due to a medical condition. An expiration date will be indicated, and immunizations must be completed by this date.

   • Permanent Medical Exemption: Issued when a child has a physical condition that makes receiving certain vaccines medically contraindicated. Each exempted vaccine and the reason for exemption must be listed.

   It's important to note that exemptions for reasons other than medical conditions are subject to different regulations and may require additional documentation.

4. What happens if my child’s immunizations are not up to date?

   If your child's immunizations are not up to date, they may be temporarily admitted to school or childcare under a temporary medical exemption outlined in Part B of the form. This allows your child to start attending while catching up on the required immunizations. Failure to complete the immunizations by the specified expiration date may result in exclusion from the facility until the required vaccines are administered.

5. Is it mandatory to provide my child’s Social Security Number on the DH 680 Form?

   No, providing your child’s Social Security Number on the DH 680 Form is optional. However, including it can assist healthcare providers and schools in accurately maintaining and accessing immunization records. The State Immunization ID#, if known, can also be helpful for the same purpose. Privacy and confidentiality of this information are maintained per state and federal laws.

1. Filling out the form without consulting the Immunization Guidelines: Many individuals attempt to complete the DH 680 form without first reviewing the detailed instructions and guidelines provided by the Florida Department of Health. This can lead to errors in documenting vaccine doses or overlooking necessary immunizations. The guidelines, accessible online, offer crucial information for correct form completion and are designed to ensure that children meet all vaccine requirements for school and daycare attendance.

2. Incorrectly entering vaccine dates: A common mistake involves inaccurately recording the dates vaccines were administered. It's essential to enter the date in the specified MM/DD/YY format for each dose. Mistakes in this area can lead to misunderstandings about a child's immunization status and potentially delay school admission.

3. Leaving optional sections blank when applicable: The sections for the child’s Social Security Number (SSN) and the State Immunization ID# are marked as optional but can be critical for accurately tracking an individual’s immunization record. When this information is available, including it helps ensure the child’s records are correctly matched and updated in state databases.

4. Not selecting the appropriate certificate part (A, B, or C): Each part of the form serves a distinct purpose—Part A for complete immunizations for K-12 (excluding 7th-grade requirements), Part B for temporary medical exemptions, and Part C for permanent medical exemptions. Failing to select the correct certificate can misrepresent a child’s immunization status or exemption needs.

5. Incomplete documentation of vaccine doses: It is crucial to document each relevant vaccine dose received, including the vaccine code and the date administered. Sometimes, individuals fill out the form but miss documenting one or more doses, which can inaccurately reflect the child's immunization status. Every dose counts towards meeting the state's requirements for school and daycare attendance.

6. Omitting the signatures and date: The DH 680 form requires a signature and date at the bottom to certify the accuracy of the information provided. This certification can come from a physician, clinic, or other authorized personnel. Without this signed confirmation, the form is incomplete and cannot be used to verify the child’s immunization status, potentially hindering their enrollment in school or daycare facilities.

When managing health and immunity documentation, particularly for school and childcare entry in Florida, the FLORIDA CERTIFICATION OF IMMUNIZATION (DH 680 Form) is essential. However, to ensure comprehensive compliance with all requirements, additional forms and documents are often utilized alongside it. These documents support various purposes, from providing detailed guidelines for immunization to granting exemptions based on medical grounds.

1. DH Form 150-615, Immunization Guidelines - Florida Schools, Childcare Facilities, and Family Daycare Homes: This document offers detailed instructions and guidelines on how to complete the DH 680 form effectively. It is a critical resource for understanding Florida's immunization requirements for children attending school or daycare.
2. School Entry Health Exam (DH 3040 form): A comprehensive health examination report that must be completed by a health care provider. This form certifies that a child has undergone a physical examination and is in a suitable condition for school attendance.
3. Religious Exemption From Immunization (DH 681 Form): For children who are not immunized due to religious beliefs, this form provides an exemption. It must be filed with the school or childcare facility to document the exemption on religious grounds.
4. Vaccination Record: An official record of all vaccinations received by the child. It is used in conjunction with the DH 680 form to ensure all immunization records are accurate and up to date.
5. Medical Exemption Statement: A document provided by a healthcare provider that outlines specific immunizations that are medically contraindicated for the child. This statement supports the issuance of a Permanent Medical Exemption noted in the DH 680 form.
6. Authorization for Medication/Treatment: For children who need medication or medical treatment during school hours, this form grants permission for school staff to administer necessary care. It is relevant for ensuring the well-being of children with specific health needs.

Together, these forms and documents create a comprehensive framework to meet Florida's health and immunization requirements for school and childcare attendance. While the DH 680 form stands as a central document, the supportive paperwork ensures that all health considerations are meticulously documented and managed, allowing for a safe and conducive learning environment for all children.

• Vaccine Exemption Forms for Other States: Like Florida’s DH 680 form, many states have specific forms for vaccine exemptions based on medical, religious, or philosophical reasons. These documents serve a similar purpose, allowing individuals to attend school or work without the required immunizations by providing proof of exemption.

• School Physical Examination Forms: Similar to the DH 680 form, school physical examination forms are used across the United States to document a child's health status and physical fitness for school participation. These forms might also include a section on immunizations to ensure that the child meets state health requirements for school entry.

• International Certificate of Vaccination or Prophylaxis (ICVP): The ICVP, often referred to as the Yellow Card, is used internationally to provide proof of vaccination, particularly for diseases like yellow fever. Similar to the DH 680, it serves as official documentation of immunization, facilitating travel and adherence to health regulations in various countries.

• Childcare and Daycare Enrollment Health Forms: These forms, required for enrollment in many childcare and daycare facilities, often mirror the sections dedicated to immunization history seen in the DH 680 form. They ensure that children are vaccinated according to state guidelines, protecting the health of all children in the facility.

• College and University Immunization Forms: Higher education institutions often require incoming students to provide a record of immunizations, similar to the DH 680 form. These forms help in preventing the spread of vaccine-preventable diseases in densely populated campus environments.

• Immigrant Health and Immunization Forms: Individuals applying for immigrant or refugee status in the United States must provide documentation of vaccination. These documents, akin to the DH 680 form, ensure that immigrants meet public health standards, similar to U.S. citizens.

• Military Immunization Records: Members of the U.S. military are required to maintain up-to-date immunization records, similar in purpose to the DH 680 form. These records are crucial for deployment eligibility and for the overall health and readiness of military personnel.

• Employment Health and Immunization Records: Certain professions, particularly those in healthcare, require employees to provide proof of immunization. These records ensure a safe working environment and minimize the spread of infectious diseases, mirroring the intent behind the DH 680 form.

• Travel Vaccination Records: For individuals traveling to countries where certain vaccine-preventable diseases are endemic, keeping a record of vaccinations can be essential. This is similar to the DH 680 form in that it provides documented proof of immunization, albeit for international rather than educational requirements.

Filling out the Florida Certification of Immunization (Form DH 680) is a crucial step in ensuring that children meet the state's vaccination requirements for school and daycare attendance. It's important to complete this form accurately and thoroughly. Here are some tips on what to do and what not to do when filling out the form:

Do:

• Review the most current immunization guidelines available at www.immunizeflorida.org/schoolguide.pdf before filling out the form to ensure compliance with the latest requirements.
• Enter all doses and dates of vaccines accurately. Cross-check the information with the child's immunization record to prevent any mistakes.
• Choose the correct certificate type (A, B, or C) based on the child's immunization status and accurately sign and date the form to validate it.
• Consult a healthcare provider if there's any uncertainty about which vaccines are medically indicated or contraindicated for the specific child in question.

Don't:

• Leave sections blank. If certain information is optional or not applicable, make sure to indicate as such by writing 'N/A' or 'None' to avoid the form appearing incomplete.
• Guess vaccine codes or dates. If unsure, it's better to verify the information with a healthcare provider or the child's immunization records to ensure accuracy.
• Sign the form without ensuring that all the information entered is correct and matches the child's immunization records. Inaccuracies can lead to unnecessary delays or complications.
• Forget to check the expiration date for temporary medical exemptions. These need to be current; otherwise, the form, and thereby the exemption, becomes invalid.

When it comes to the Florida Certification of Immunization, known as the DH 680 form, there are several misconceptions that can lead to confusion. Understanding these misconceptions is crucial for parents, guardians, and educators alike.

• Anyone can sign the form: Only a healthcare professional or authorized personnel at a clinic can legally certify and sign the DH 680 form, ensuring the child has received the appropriate vaccinations.

• It’s only for public school children: This form is actually required for all children attending public and private schools, childcare facilities, and family daycare homes in Florida, not just those in the public education system.

• The child’s Social Security Number is required: While the form includes a space for the child’s SSN, providing this information is completely optional and not a mandatory requirement for the form’s completion.

• All sections must be completed for school attendance: The form contains parts A, B, and C, but only the sections relevant to the child’s age and grade level need to be completed. For instance, Part A is for K-12 excluding 7th grade requirements, and Parts B and C cater to specific exemption circumstances.

• Temporary exemptions do not have a deadline: Part B of the form, which covers temporary medical exemptions, requires an expiration date. Without this date, the exemption is considered invalid, emphasizing the temporary nature of such exemptions.

• Vaccines listed are the only ones acceptable: While the form outlines the state’s required immunizations, it also allows for the documentation of additional vaccines, such as the Pneumococcal Conjugate vaccine, under certain conditions, showing flexibility in meeting health needs.

• Permanent medical exemption is easily granted: Part C of the form, which addresses permanent medical exemptions, demands specific clinical evidence or reasoning for each exempted vaccine. This process ensures that exemptions are granted only when there’s a legitimate health risk involved.

Correcting these misconceptions helps in navigating the requirements for school and childcare facility attendance in Florida more effectively. It emphasizes the importance of accurate, legal documentation in safeguarding children's health, as well as the health of the community at large.

Filling out and using the Florida Certification of Immunization (DH 680 form) is an essential process for ensuring children are vaccinated according to the state's requirements for school and daycare attendance. Understanding key aspects of this form can simplify the process for parents, guardians, and healthcare providers. Here are some important takeaways:

• Legal Authority: The DH 680 form is mandated by specific sections of the Florida Statutes and Administrative Code, highlighting its significance in the compliance with state law regarding immunizations.
• Comprehensive Documentation: It requires a detailed account of the child’s vaccinations, including dates and doses for various vaccines such as DTaP/DTP, Polio, MMR, Hepatitis B, and Varicella, among others. This ensures a thorough immunization record.
• Options for Certification: The form includes three parts for certification - Part A for complete K-12 (excluding 7th grade/middle school requirements) immunizations, Part B for temporary medical exemptions, and Part C for permanent medical exemptions. This allows for flexibility based on the child's medical situation and immunization status.
• Expiration Dating for Temporary Exemptions: Part B of the form, which covers temporary medical exemptions, requires an expiration date, emphasizing the temporary nature of the exemption and the need for eventual compliance.
• Requirement for Professional Certification: The form must be signed by a physician or clinic representative, authenticating the documented immunizations or granting medical exemptions. This adds a level of medical oversight to the immunization reporting and exemption process.

Overall, the DH 680 form serves as a critical tool in managing public health through immunization for school-aged children in Florida. Proper completion and understanding of this form can ensure compliance with state laws and contribute to the safeguarding of community health.