Free 680 PDF Template

1. What is the Florida Certification of Immunization (DH 680 Form) and why is it required?

   The Florida Certification of Immunization, also known as the DH 680 Form, is a legal document that records a child's immunization history against specific communicable diseases as mandated by Sections 1003.22, 402.305, 402.313 of the Florida Statutes and Rule 64D-3.046 of the Florida Administrative Code. This form is required for enrollment and attendance in Florida schools, childcare facilities, and family daycare homes to ensure that all children are protected against vaccine-preventable diseases. It serves as a standardized record for health officials and educational institutions to verify that a child has received the necessary immunizations.

2. How do you complete the DH 680 form?

   To complete the DH 680 form, enter the child's full name, date of birth, and the parent or guardian's details. Optional fields include the child's Social Security Number and State Immunization ID Number. For each required vaccine, document the dates of all administered doses. After filling out the vaccine section, sign and date the certificate section (A, B, or C) that applies to the child's immunization status. Detailed instructions and the immunization guidelines, including dose requirements, are available in the DH Form 150-615, Immunization Guidelines - Florida Schools, Childcare Facilities, and Family Daycare Homes, provided at www.immunizeflorida.org/schoolguide.pdf.

3. What are the certificates (A, B, C) on the DH 680 form?

   • Certificate of Immunization for K-12 (Part A): Confirms that a child's immunizations are complete for K-12 enrollment, excluding specific requirements for 7th grade.
   • Temporary Medical Exemption (Part B): States that a child has started but not completed the required immunizations due to a temporary medical reason. It is invalid without an expiration date.
   • Permanent Medical Exemption (Part C): Indicates that certain immunizations are permanently medically contraindicated for the child, listing each exempt vaccine along with valid clinical reasoning or evidence.

4. How can one obtain a DH 680 form?

   The DH 680 form can be obtained through healthcare providers licensed in Florida, including private physicians and county health departments. Only these authorized professionals can assess a child's immunization records, complete, and sign the form to certify compliance with Florida's immunization requirements. After completion, the form should be submitted to the child's school or childcare facility. It's recommended to keep a copy for your records.

Filling out the Form DH 680, which is the Florida Certification of Immunization, requires careful attention to detail. It is an essential document for ensuring that children meet the state’s immunization requirements for school and childcare. However, mistakes are not uncommon. Here are five errors people should avoid to ensure the form is accepted without issue.

1. Not completely filling in the personal information section or making errors in the child's name or date of birth. Accurate identification is crucial for linking the form to the right individual.

2. Skipping the optional fields without considering if providing that information could be helpful. For instance, the child's Social Security number and the State Immunization ID# can facilitate record tracking and verification.

3. Entering incorrect vaccine dates or leaving them blank. Each vaccine dose has a specific date, which must be accurately recorded to demonstrate compliance with vaccination schedules.

4. Choosing the wrong certificate (A, B, or C) or not signing and dating the chosen certificate. The correct certificate must be selected based on the child's immunization status and properly authenticated.

5. Not referring to the DH Form 150-615 Immunization Guidelines while completing the form. These guidelines provide important instructions and clarifications that can prevent errors.

By avoiding these mistakes, guardians can ensure the immunization form is accurately completed, helping to smooth the way for school or childcare admission in Florida. Knowing the requirements and paying close attention to the form’s details can make a big difference.

When completing the FLORIDA CERTIFICATION OF IMMUNIZATION (DH 680 form), it's important to acknowledge that this document might not stand alone in the context of school enrollment and healthcare compliance. Several additional documents usually complement this certification to provide a comprehensive overview of a child's health and educational readiness. Here, we outline five commonly associated documents, their purposes, and how they interface with the DH 680 form.

• Birth Certificate: This official document serves as proof of the child's age and citizenship. Schools often require a copy during enrollment to verify the child's identity and to ensure that they are enrolling in the appropriate grade level.
• DH 3040 Form, School Entry Health Exam: Completed by a healthcare provider, this form documents that a child has undergone a physical examination within the past year. It includes details on the child's medical history, a record of a physical examination, and the healthcare provider's recommendations, ensuring that the child is physically ready for school activities.
• Proof of Residence: Often required for school enrollment, this document verifies the child's residential address. Acceptable forms typically include utility bills, a lease agreement, or a mortgage statement in the parent's or guardian's name, establishing the child's eligibility to attend a specific school based on geographical boundaries.
• Emergency Contact Form: This form records the names, relationships, and contact information of individuals authorized to be contacted or to pick up the child from school. It's vital for ensuring the child's safety and for prompt communication in case of emergencies or unforeseen events.
• Consent for Treatment Form: A form signed by the parent or guardian that grants permission for the school or associated healthcare professionals to provide emergency medical care, if necessary. It might also include information on the child's health insurance coverage.

Together, these documents play a crucial role in facilitating a smooth and informed transition into the school environment for children. They ensure that all health, legal, and logistical bases are covered, providing peace of mind to parents, guardians, educators, and healthcare providers alike.

• Form I-693, Report of Medical Examination and Vaccination Record: This form is similar to the 680 form in that it requires documentation of vaccinations, specifically for individuals applying for adjustment of status to become permanent U.S. residents. Both forms serve as official records of immunizations, ensuring compliance with health requirements.

• School Entry Health Exam Certification: Just like the 680 form, this form is required for students entering public schools. It confirms that a child has had a health examination and is up to date on vaccinations, ensuring the child's readiness for school enrollment based on health standards.

• Vaccine Administration Record for Adults: This document tracks vaccinations given over the course of an adult's life, similar to how the 680 form records immunizations for children and adolescents in Florida. Both are crucial for keeping an up-to-date record of one’s immunization history.

• CDC Yellow Card (International Certificate of Vaccination or Prophylaxis): This international travel document proves that the holder has been vaccinated against certain diseases, much like the 680 form does for schoolchildren. It's essential for travel to countries where specific vaccinations are mandatory.

• Childcare Immunization Record: Similar to the 680 form but geared toward younger children in daycare or preschool settings, this record keeps track of immunizations to ensure that all children in a communal setting are protected against communicable diseases.

• College Immunization Records: Many colleges require incoming students to provide a record of immunization, akin to the 680 form, as a condition of enrollment. This ensures a safe and healthy campus by preventing outbreaks of vaccine-preventable diseases.

• Military Immunization Records: Members of the armed forces must keep an up-to-date record of immunizations, similar to the 680 form, which is crucial for maintaining individual and unit health, especially when deploying to areas with prevalent diseases.

• Employee Health Records: In certain industries, like healthcare, employees must maintain up-to-date immunization records akin to the 680 form. This requirement protects both the employees and the populations they serve.

• Immunization Registry Recordings (e.g., IIS or state immunization information system records): These systems track a person’s immunization status over their lifetime, providing a digital analogue to the paper-based 680 form. They ensure that healthcare providers can access accurate immunization records when needed.

Completing the Florida Certification of Immunization (Form DH 680) is a necessary step to ensure school and child care compliance. To aid in this important process, here’s a compiled list of do's and don'ts:

• Do ensure all information filled in is accurate, especially personal details like the child's last name, first name, date of birth, and the parent or guardian's information.
• Do refer to the Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes for detailed instructions on how to complete the form. This guideline ensures you understand the vaccine dose requirements and the correct way to document them.
• Do provide documentation for any exemptions claimed on the form. If claiming a temporary or permanent medical exemption, ensure valid clinical reasoning or evidence is clearly stated.
• Do check the expiration date for temporary medical exemptions. Remember, the form is invalid without this date.
• Do ensure the certificate you sign (A, B, or C) corresponds correctly to the status of the immunizations as per Florida's requirements.
• Don't leave optional fields, like the child's social security number or state immunization ID#, blank if this information is readily available. Providing complete information can assist in the accurate tracking and recording of your child's immunization history.
• Don't forget to sign and date the form. The certification is incomplete and not valid without the authorized signature of the physician, clinic, or issuer.

Correctly filling out the DH 680 form plays a pivotal role in protecting the health of all students and the community at large. Take your time to review all data before submission, ensuring compliance with Florida's immunization requirements.

When discussing the Florida Certification of Immunization, better known as the DH 680 form, there are several misconceptions that need clarification to ensure accurate understanding and compliance with state vaccination requirements for students. Below are ten common misunderstandings about this form:

• Any doctor's note can substitute for the DH 680 form. This is incorrect. Only the DH 680 form, completed and signed by a licensed healthcare provider, is acceptable for proving a child’s immunization status as per Florida’s school and childcare facility entry requirements.

• The DH 680 form is only for public school students. In reality, this form is required for students attending both public and private schools, as well as childcare and family daycare homes, regardless of the institution's public or private status.

• The child’s Social Security Number (SSN) is required to complete the form. While the form has a space for the SSN, providing this information is optional and not a requirement for the form’s completion or validity.

• Immunizations noted on the form do not need to follow Florida’s guidelines. This is incorrect. The vaccines and the schedule they are administered in must adhere to the current Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes to ensure compliance and proper immunization coverage.

• A completed DH 680 form grants exemption from all future immunizations. The form documents immunizations as of the date it is signed; it does not exempt a child from future vaccine requirements. Exemptions for medical reasons must be specifically noted in Part C of the form and are subject to re-evaluation.

• Parents can complete and sign the DH 680 form. Only healthcare professionals can legally complete, sign, and validate this form. Parent or guardian signatures are not accepted for the certification of immunization.

• The DH 680 form is valid indefinitely. The form has a validity period that may require updates, especially when new immunizations are received or upon entry to certain grade levels that have additional vaccine requirements.

• All sections of the DH 680 form must be completed for it to be valid. The form is structured to reflect different circumstances—complete immunization, temporary medical exemption, or permanent medical exemption. Only the relevant section(s) need to be filled based on the child's specific immunization status and exemptions.

• The form can only be issued by physicians. While physicians are a primary source, any Florida licensed healthcare provider authorized to administer vaccines can complete and sign the form, including those operating within clinics and health departments.

• Parents do not need to keep a copy of the DH 680 form. It is highly recommended that parents maintain a copy of this form for their records. Schools and daycare centers require the original document, but keeping a copy ensures parents have proof of their child’s immunization status for future reference or if the form needs to be resubmitted.

Understanding these key points about the DH 680 form can help parents, guardians, and educators ensure they are correctly navigating Florida's immunization requirements for school and daycare attendance.

Filling out the Florida Certification of Immunization, known as the DH 680 form, is critical for ensuring a child meets the state's required immunizations for school and child care attendance. Here are key takeaways for successfully completing and using this form:

• Thorough Record Keeping: Accurately document each vaccine dose received by the child, including the date of immunization (MM/DD/YY). This precise record keeping is crucial for determining the child’s eligibility for school and daycare attendance.
• Understanding the Sections: The form is divided into multiple sections, each serving different purposes. It is important to understand which part of the form needs to be completed based on the child’s current immunization status and school grade.
• Check Immunization Guidelines: Refer to the DH Form 150-615, Immunization Guidelines - Florida Schools, Childcare Facilities, and Family Daycare Homes, for detailed instructions on how to properly complete the 680 form. These guidelines are available online and provide valuable information.
• Temporary and Permanent Medical Exemptions: Certain medical conditions may warrant a temporary or permanent exemption from some immunizations. These exemptions must be documented on the form, including the expiration date for temporary exemptions and specific reasons for permanent exemptions.
• Parent or Guardian Responsibilities: The form requires a signature from the parent or guardian, confirming that the immunization information is accurate to the best of their knowledge. This ensures accountability and the integrity of the immunization records.
• Professional Verification: A physician, clinic, or authorized individual must sign the form, verifying that the child has either received the required immunizations or is exempt due to medical reasons. The verifier's name, signature, and issuance date are all necessary components of the form’s completion.

Proper completion and timely submission of the DH 680 form are essential steps in ensuring a child’s compliance with Florida's immunization requirements, thereby contributing to the health and safety of all children in schools and childcare settings.