680 PDF Form

Detailed Instructions for Filling Out 680

Filling out the DH 680 form, known as the Florida Certification of Immunization, is a crucial step for ensuring compliance with Florida's immunization requirements for students attending public schools, childcare facilities, and family daycare homes. This document, which reflects a student's immunization status, is typically required for enrollment and attendance. The form should be completed with precision, following the guidelines provided in the DH Form 150-615, available online. Below, you will find step-by-step instructions to assist you in the accurate completion of the DH 680 form.

1. Start by entering the child's LAST NAME, FIRST NAME, and MIDDLE INITIAL (MI) at the top of the form.
2. Fill in the child's Date of Birth (DOB) using the MM/DD/YY format.
3. (Optional) Provide the PARENT OR GUARDIAN name, along with the child's SOCIAL SECURITY NUMBER (SS#) and STATE IMMUNIZATION ID# if available.
4. Under the VACCINE section, enter all appropriate doses and dates for each vaccine received. This includes the following vaccines: DTaP/DTP, Tdap, Td, Polio, Hib, MMR (Combined or Separate), Measles, Mumps, Rubella, Hepatitis B, Varicella, Varicella Disease, and PneumoConjugate. Record the dates in MM/DD/YY format.
5. Choose and complete the appropriate certificate (A, B, or C) based on the child’s immunization status:
   • Part A: Complete if K-12 immunizations are complete, excluding 7th grade/middle school requirements. Check the appropriate box for DOE Code 1 or 8.
   • Part B: Use for children in daycare, family daycare homes, preschool, kindergarten, and grades 1 through 12 who are incomplete for immunizations in Part A. Indicate the temporary medical exemption expiration date. This section cannot be valid without an expiration date.
   • Part C: Fill this out for immunizations that are medically contraindicated. List each exempt vaccine and provide valid clinical reasoning or evidence for exemption. This section is for permanent medical exemptions.
6. Write the Physician or Clinic Name and have the Physician or Authorized Signature at the bottom of the form to certify the information provided.
7. The form is issued by the person completing the form, so include the issuer's name and date in the designated sections.

Once completed, the DH 680 form provides a standardized document to certify a child's immunization status according to Florida's requirements. Keeping an accurate record on this form is essential for school enrollment and ensuring public health within community settings.

1. What is the DH 680 form?

   The DH 680 form, also known as the Florida Certification of Immunization, is a document used in the state of Florida to certify that a child has received the required immunizations for school attendance. It records doses of vaccines administered, including information on doses of DTaP/DTP, Polio, MMR, Hepatitis B, and Varicella, among others. This form is essential for enrollment in Florida schools, childcare facilities, and family daycare homes.

2. Where can I find the Immunization Guidelines for completing the DH 680 form?

   The Immunization Guidelines, referenced as DH Form 150-615, which detail the requirements for completing the DH 680 form, are available online at the www.immunizeflorida.org/schoolguide.pdf. These guidelines offer comprehensive information on vaccine schedules, doses, and other essential instructions for accurately completing the form.

3. Is the child's Social Security Number (SSN) required on the DH 680 form?

   No, the child's Social Security Number (SSN) is optional on the DH 680 form. While providing it can help in maintaining the child’s immunization records accurately, it is not mandatory for the form's submission or acceptance.

4. What are the parts A, B, and C in the DH 680 form?

   The DH 680 form is divided into three parts for different situations:

   • Part A is for documenting that immunizations complete for K-12, excluding 7th grade/middle school requirements, are met.
   • Part B is for children whose immunizations are incomplete for what is required in Part A. This temporary medical exemption requires an expiration date and documentation of a commute to complete required immunizations.
   • Part C is designated for permanent medical exemptions, where certain immunizations are medically contraindicated. The exempted vaccines and the valid clinical reasons must be listed.

5. How do I obtain a DH 680 form?

   To obtain a DH 680 form, you can visit your healthcare provider or local health department. These entities are authorized to complete and issue the form after reviewing your child's immunization records. Some locations may also offer access to the form online through patient portals or state health department websites.

6. Can I complete the DH 680 form myself?

   No, you cannot complete the DH 680 form yourself. The form must be completed and signed by a healthcare provider or authorized personnel at a clinic or health department. This ensures that all the immunization information is accurate and meets the state's guidelines for school entry.

7. What happens if the DH 680 form is not submitted for school enrollment?

   If the DH 680 form is not submitted for school enrollment, your child may not be allowed to attend school until the required documentation is provided. Florida law requires proof of immunizations or a valid exemption for school attendance to protect the health of all students.

8. Can I request a medical exemption through the DH 680 form?

   Yes, you can request a medical exemption through Part C of the DH 680 form. This section is specifically for vaccines that are medically contraindicated for the child. A healthcare provider must list each exempt vaccine and provide valid clinical reasons or evidence for the exemption. This part must also be signed by the provider.

9. How long is the DH 680 form valid?

   The validity of the DH 680 form can vary depending on whether temporary or permanent exemptions are applied. Temporary exemptions (Part B) require an expiration date, after which the form would need to be updated or replaced. Permanent exemptions (Part C) and complete immunization records (Part A) typically do not expire but should be updated as additional immunizations are received.

10. Can the DH 680 form be updated?

    Yes, the DH 680 form can be updated. If a child receives additional vaccines after the initial form is completed, or if a temporary exemption expires and the required immunizations are now complete, the form should be updated and resubmitted to reflect the current immunization status. This ensures that school records remain accurate and up to date.

Filling out the Florida Certification of Immunization (DH 680 form) accurately is crucial for parents and guardians to ensure that their children meet the state's immunization requirements for school and childcare facility attendance. However, several common mistakes can lead to delays or complications. Identifying these errors and understanding how to avoid them can streamline the process and ensure compliance with Florida's health standards.

One common mistake involves the improper recording of vaccine dates. It is essential to enter the full date (month/day/year) for each vaccination dose administered. Often, individuals might omit the year or enter the date in an incorrect format. This oversight can create confusion and potentially require the form to be resubmitted. Ensuring each date is complete and follows the MM/DD/YY format, as specified in the form's instructions, is paramount for accurate processing.

Another frequent error is neglecting to select the appropriate certificate (A, B, or C) at the end of the form. Certificate A is for students with complete immunizations for K-12 (excluding 7th-grade/middle school requirements), Certificate B is for those with incomplete immunizations, and Certificate C is for students with medical exemptions. Failure to check the correct box or sign the document can render the form invalid, delaying the child's school enrollment or participation in child care facilities.

Incorrectly entering optional information, such as the child’s Social Security Number (SSN) or State Immunization ID#, is also a common misstep. While these fields are optional, if chosen to be filled, they must be accurately completed. An incorrect SSN or ID# can lead to record mismatches or privacy concerns. Therefore, double-checking these numbers for accuracy is crucial if you decide to include them.

Lastly, many forget to review the immunization guidelines linked in the form's instructions before completing it. The Guidelines for Immunization - Florida Schools, Childcare Facilities, and Family Daycare Homes provide critical information on form completion and immunization requirements. This oversight can result in incomplete or incorrect form submission. Familiarizing oneself with these guidelines beforehand can significantly reduce errors and the likelihood of form rejection.

By paying careful attention to these common pitfalls and ensuring all information is accurate and complete, parents and guardians can facilitate a smoother processing of the DH 680 form, helping to ensure their children are ready and eligible for school or child care participation in Florida.

When navigating the requirements for immunizations in Florida, particularly for school attendance, the DH 680 form, also known as the Florida Certification of Immunization, is a crucial document. However, to complete the immunization process, parents and guardians may need to be aware of and possibly prepare additional forms and documents that often accompany the DH 680. These documents ensure that a child's health information is accurately recorded and meets state requirements for school enrollment.

• Physical Examination Form (DH 3040): This form records a child's comprehensive physical examination. It is often required for initial entry into a Florida school and should be completed by a licensed health care provider. The form includes sections on medical history, physical examination results, and recommendations for further medical evaluation, if necessary.
• Birth Certificate: While not a health form per se, a copy of the child's birth certificate is typically required for school enrollment to verify age and identity. This document supports the information provided in the DH 680 form.
• Vaccination History Documentation: In addition to the DH 680 form, official documentation of vaccination history provided by a healthcare provider may be required. This documentation includes dates and types of vaccines administered and serves as a detailed record of the child's immunization status.
• Exemption Forms: For children who are not immunized due to medical reasons or religious beliefs, Florida law allows for exemptions. Specific forms must be completed and approved to obtain these exemptions. These include the Religious Exemption Form (DH 681) and the Medical Exemption Form, which require detailed information and appropriate signatures to be valid.

Ensuring that a child's immunization records are up to date is essential for protecting the health and well-being of all students and staff in the school environment. The DH 680 form and accompanying documents play a critical role in this process. For a smoother enrollment experience, it is advisable for parents and guardians to gather and prepare these forms well in advance of the school year or upon moving to Florida.

• The DS-11 form for a U.S. Passport Application shares similarities with the 680 form in that both require detailed personal information and documentation to support the applicant's eligibility. Just like the 680 form, the DS-11 form is used to verify the applicant's identity and provide official records, in this case for the purpose of international travel.

• I-9 Employment Eligibility Verification form is similar to the 680 form as they both involve the verification process. While the 680 form certifies that a person has received immunizations, the I-9 form verifies the employee's legal right to work in the United States, requiring documentation and personal information.

• The 1040 form, used for individual income tax returns in the United States, is similar to the 680 form in that it requires individuals to accurately report personal information and other specifics - income in the case of the 1040, and immunization records for the 680. Both forms are crucial for compliance with regulations and must be completed truthfully and in full.

• A state's Driver's License Application form also bears resemblance to the 680 form because it gathers detailed personal data and requires the submission of supporting documents to ascertain the applicant's identity and eligibility, in this case, for a driver’s license.

• The SS-5 form for applying for a Social Security Card is similar to the 680 form in its requirement for detailed personal information, documentation to establish identity, and its role in enabling access to certain rights and services, in the SS-5’s case, access to social security benefits and services.

• The Vaccine Information Statement (VIS) handed out before receiving a vaccination is similar to the 680 form in its connection to immunizations. Although the VIS provides critical vaccine information and potential effects rather than documenting immunization records, both are integral parts of the vaccination process.

• The Medical Records Release form shares similarities with the 680 form, as both deal with personal health information. The Medical Records Release allows for the sharing of an individual's health records between providers, while the 680 form documents the immunization status for school or work purposes.

• The School Enrollment forms that require a child’s health and vaccination history for registration share a purpose with the 680 form. These forms ensure that the child meets health requirements for a safe learning environment, similar to how the 680 form certifies immunization compliance for school attendance.

• Health Insurance Application forms, which gather personal and medical history information to establish coverage eligibility, are similar to the 680 form. They both require detailed personal and medical history to access services, whether it be education with immunization records or medical care through insurance.

When filling out the Florida Certification of Immunization (DH 680 form), it's important to be meticulous and thorough. Ensure an accurate and compliant completion by following these dos and don'ts:

Things You Should Do:

• Double-check all entries for accuracy, especially the dates of vaccines which should follow the MM/DD/YY format.
• Include all doses of the vaccines received, as per the required fields. If any are missing, this could affect school enrollment.
• Consult the Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes for any clarifications on form completion.
• For the sections that apply, such as temporary or permanent medical exemptions, ensure the physician or clinic’s details are clearly written, along with a valid signature.

Things You Shouldn't Do:

• Leave sections incomplete. If a section does not apply, ensure it is clearly marked as such.
• Forget to sign and date the form in the appropriate certificate section (A, B, or C). An unsigned form is considered invalid.
• Include social security numbers or state immunization ID numbers unless you are comfortable doing so, as these fields are optional.
• Assume all vaccinations are up to date without verifying records, especially when transferring from out-of-state or starting a new school year.

Understanding the DH 680 Form, which is Florida's Certification of Immunization, can sometimes be complicated due to common misconceptions. It's crucial to know the facts to ensure compliance and accuracy for your child's immunization records. Below, we address five common misconceptions about the DH 680 Form.

• Misconception 1: Social Security Number and State Immunization ID# are mandatory.
  

  This is not true. While the form asks for the child's Social Security Number (SSN) and State Immunization ID#, it clearly states that these fields are optional. Providing this information can make it easier to keep track of your child's immunization records, but it's not a requirement.

• Misconception 2: The form is valid without a signature.
  

  Actually, a valid DH 680 Form must be signed by a healthcare provider or an authorized representative. This signature is critical as it certifies the accuracy of the immunization information for school attendance, childcare, or family daycare homes.

• Misconception 3: There's only one type of immunization certificate.
  

  The DH 680 Form comprises different certificates: Part A for complete K-12 (excluding 7th-grade requirements), Part B for temporary medical exemptions, and Part C for permanent medical exemptions. Each serves unique situations depending on a child's immunization status and medical conditions.

• Misconception 4: Once completed, the form never needs updating.
  

  On the contrary, the DH 680 Form may require updates as children receive additional immunizations or as temporary medical exemptions expire. It's necessary to maintain an up-to-date form to comply with school and daycare entry requirements.

• Misconception 5: Any healthcare provider can sign the form.
  

  While it might seem that any healthcare provider can sign off on the form, it must be completed, reviewed, and signed by a healthcare provider licensed in the state of Florida. This ensures that the immunization records meet the state's guidelines and regulations.

By clearing up these common misconceptions, you can better navigate the requirements for your child's immunization documentation, ensuring that the DH 680 Form is accurately completed and up-to-date.

Understanding the DH 680 form, known as the Florida Certification of Immunization, is crucial for ensuring that children meet the state's immunization requirements for school and daycare. This document plays a pivotal role in public health within the state of Florida. Here are key takeaways about completing and utilizing this form:

• The DH 680 form is required by law under Sections 1003.22, 402.305, 402.313, Florida Statutes, and Rule 64D-3.046, Florida Administrative Code. These statutes ensure that children attending school or daycare in Florida have received the necessary immunizations.
• Parents or guardians are responsible for providing accurate information about the child's name, date of birth, and, optionally, Social Security Number and State Immunization ID#.
• The form requires detailed documentation of vaccines administered, including doses and dates for a range of immunizations such as DTaP/DTP, Polio, MMR, Hepatitis B, Varicella, and others.
• There are three parts to the form: Part A for complete K-12 immunizations (excluding 7th grade/middle school requirements), Part B for temporary medical exemptions, and Part C for permanent medical exemptions. Each section must be filled out based on the child's immunization status.
• Signing the form requires a declaration that, to the best of the signer's knowledge, the child has been adequately immunized for school attendance, as documented on the form.
• Temporary Medical Exemptions (Part B) specify an expiration date, making it clear that additional immunizations are planned or underway. Without an expiration date, the temporary exemption is invalid.
• Permanent Medical Exemptions (Part C) necessitate a detailed listing of each vaccine that is medically contraindicated, along with valid clinical reasoning or evidence supporting the exemption.
• The form must be signed by a physician or clinic staff authorized to attest to the child's immunization status or medical exemption, ensuring the veracity of health information provided.
• Completion and submission of the DH 680 form are essential for compliance with Florida's school and childcare admission requirements. Adequate documentation aids in protecting the health of all students and staff.
• For detailed instructions on form completion and immunization guidelines, the Department of Health in Florida provides resources, such as the DH Form 150-615, Immunization Guidelines - Florida Schools, Childcare Facilities, and Family Daycare Homes.

These takeaways emphasize the importance of the DH 680 form in maintaining public health standards and ensuring a safe educational environment for children in Florida. Proper completion and understanding of each part of the form enable compliance with state laws and contribute to community health efforts.