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Printable 680 Form

The 680 form, officially known as the Florida Certification of Immunization, is a crucial document that verifies a child's immunization status for school attendance in Florida. This form is essential for parents or guardians to ensure their children meet the immunization requirements set by state law. For a smooth process in filling out the form, click the button below.

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Structure

Key takeaways

When filling out the Florida Certification of Immunization form, known as the 680 form, several important aspects should be kept in mind to ensure proper completion and usage. Below are key takeaways to consider:

  • Accurate Information: Ensure that all personal details, including the child's full name, date of birth, and parent or guardian information, are filled out accurately.
  • Immunization Records: Enter all appropriate vaccine doses and their corresponding dates in the designated sections of the form.
  • Certificate Selection: Choose the correct certificate (A, B, or C) based on the child's immunization status and needs.
  • Review Guidelines: Familiarize yourself with the Immunization Guidelines available at the provided website to understand the requirements for school attendance.
  • Temporary Exemptions: If applicable, include expiration dates for temporary medical exemptions to ensure the form remains valid.
  • Permanent Exemptions: For permanent medical exemptions, clearly state the clinical reasoning for each vaccine listed to support the exemption request.
  • Authorized Signatures: Ensure that the form is signed by an authorized physician or clinic representative to validate the immunization records.

By following these guidelines, the completion and submission of the 680 form can be streamlined, aiding in the child's compliance with school immunization requirements.

What to Know About 680

What is the purpose of the Florida Certification of Immunization (Form 680)?

The Florida Certification of Immunization, commonly referred to as Form 680, is a document that verifies a child's immunization status. It is required for school enrollment in Florida, ensuring that children have received necessary vaccinations. The form helps schools and childcare facilities confirm that children meet state immunization requirements, promoting public health and safety.

Who needs to complete Form 680?

Form 680 must be completed for children entering K-12 schools, daycare facilities, and family daycare homes in Florida. Parents or guardians of children must provide the necessary immunization records. This includes children who are new to the state or are advancing to a new grade level. It is essential to ensure that all required vaccinations are documented on the form.

What information is required on Form 680?

The form requires basic information such as the child's name, date of birth, and the parent's or guardian's name. Additionally, it includes sections for listing immunization dates for various vaccines, such as DTaP, MMR, and Hepatitis B. Parents must also indicate whether the child has completed the immunization schedule or if there are exemptions due to medical reasons.

What are the different parts of Form 680?

Form 680 consists of three parts. Part A is for children who have completed all required immunizations. Part B is for those who are partially immunized and have a temporary medical exemption. Part C is for children who have a permanent medical exemption due to health reasons. Each part requires specific documentation and signatures from a physician or authorized clinic representative.

How can I obtain Form 680?

Form 680 can be obtained from various sources. You can download it directly from the Florida Department of Health's website or request a copy from your child's school or healthcare provider. It is crucial to ensure you have the most current version of the form to meet state requirements.

680 - Usage Instruction

Completing the 680 form is essential for documenting a child's immunization records for school attendance in Florida. Follow these steps carefully to ensure that all necessary information is provided accurately.

  1. Begin by entering the child's last name, first name, and middle initial in the designated fields.
  2. Provide the child's date of birth in the format MM/DD/YY.
  3. List the parent or guardian's name in the appropriate section.
  4. If applicable, include the child's Social Security number and state immunization ID number in the optional fields.
  5. Fill in the vaccine doses and corresponding dates for each immunization listed. Make sure to enter the correct date for each dose in the format MM/DD/YY.
  6. Select the appropriate certificate (A, B, or C) based on the child's immunization status.
  7. If using Part A, check the corresponding box to indicate if the immunizations are complete for K-12 or 7th grade.
  8. If using Part B, ensure to fill in the expiration date for the temporary medical exemption.
  9. For Part C, list each vaccine that is medically contraindicated and provide valid reasoning for the exemption.
  10. Include the physician or clinic name and obtain the authorized signature from the physician or clinic.
  11. Finally, enter the date when the form is completed.

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