Fill Out a Valid 680 Form

680 - Usage Guide

Filling out the Florida Certification of Immunization (Form 680) is a necessary step to ensure compliance with Florida's immunization requirements for school and childcare enrollment. This document is crucial for recording a child's vaccination history and determining eligibility for attendance based on the state's health standards. It's important to fill out this form accurately and completely, following each step meticulously. Below are detailed instructions to assist you in completing Form 680.

1. Start by entering the child's last name, first name, and middle initial (MI) in the designated fields.
2. Fill in the child's Date of Birth (DOB) using the MM/DD/YY format.
3. If available, enter the Parent or Guardian name to associate with the child's record.
4. Providing the Child’s Social Security Number (SSN) is optional but can be filled in if preferred.
5. Similarly, the State Immunization ID# is optional but enter it if available to aid in record tracking and verification.
6. Under the Vaccine section, input all received doses with their respective dates (MM/DD/YY) for each vaccine listed. Ensure to fill in for DTaP/DTP, Tdap/Td, Polio, Hib, MMR, Hepatitis B, Varicella, and PneumoConjugate, among others as applicable.
7. Refer to the DOE Codes to identify which certificate section (A, B, or C) you must complete based on the child's immunization status.
   • For K-12 excluding 7th grade requirements, complete Part A.
   • If the immunizations are incomplete and a schedule is underway, fill out Part B and note the Temporary Medical Exemption expiration date.
   • For Permanent Medical Exemptions, document each contraindicated vaccine in Part C and provide the clinical reasoning or evidence for exemption.
8. In the relevant certificate section, verify the records and acknowledge the statement regarding the child's immunization adequacy for school attendance by signing and dating the form.
9. Provide the Physician or Clinic Name and ensure the form is signed by the physician or authorized clinic representative.
10. Finally, ensure the form is issued by, and contains the signature of, the individual completing the form, along with the issuance date.

Once completed, this form serves as a vital document, facilitating the enrollment process and helping ensure public health standards are maintained in educational and childcare settings. Accurate and thorough completion is essential for compliance and to support the child's educational journey.

What is the DH 680 form?

The Florida Certification of Immunization, also known as the DH 680 form, is a document that records a child's immunizations required for school and daycare attendance in Florida. It’s authorized by Sections 1003.22, 402.305, and 402.313 of the Florida Statutes, and Rule 64D-3.046 of the Florida Administrative Code. Parents or guardians, in collaboration with healthcare providers, fill out this form to certify that a child has received the necessary vaccinations.

How can I complete the DH 680 form?

To complete the DH 680 form, you must enter all appropriate vaccine doses and the dates they were administered in the form's provided sections. Each vaccine is listed with space for you to record up to five doses, depending on the vaccine requirements. Three sections are available for different types of certifications: 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. The form must be signed and dated by a physician or authorized clinic personnel to be valid.

Where can I find guidelines for filling out the DH 680 form?

Guidelines for completing the DH 680 form are available in the DH Form 150-615, Immunization Guidelines - Florida Schools, Childcare Facilities, and Family Daycare Homes (July 2010). These comprehensive guidelines provide detailed information and instructions for form completion, ensuring all immunization reporting is accurate and meets state requirements. You can access these guidelines online at: www.immunizeflorida.org/schoolguide.pdf.

What do the different parts of the DH 680 form signify?

Part A of the DH 680 form indicates that a child's immunizations are complete for K-12 admission, excluding specific requirements for 7th-grade/middle school. Part B provides a temporary medical exemption for children whose immunizations are incomplete. This part requires an expiration date and signifies the child has begun a schedule to complete the required immunizations but cannot yet fulfill Part A criteria. Part C is for permanent medical exemptions, where each contraindicated vaccine must be listed along with valid clinical reasoning or evidence for the exemption. This part certifies that certain immunizations are medically contraindicated for the child.

Is a Social Security Number required to complete the DH 680 form?

No, providing a child's Social Security Number (SSN) is optional on the DH 680 form. The form also has a space for a State Immunization ID#, which is also optional. These fields are there to help with recordkeeping and identification but are not mandatory for the form’s validity or for your child’s immunization certification.

What should I do if my child cannot be vaccinated due to medical reasons?

If your child cannot be vaccinated due to medical reasons, you must complete Part C of the DH 680 form, which is for permanent medical exemptions. In this section, list each vaccine that is medically contraindicated for your child and provide valid clinical reasoning or evidence supporting each exemption. This part must be certified by a physician or authorized clinic personnel. A permanent medical exemption ensures that your child can still attend school or daycare despite not being able to receive certain immunizations for medical reasons.

Filling out the DH 680 form, the Florida Certification of Immunization, is a critical step for parents and guardians to ensure their child's compliance with school and childcare immunization requirements. However, mistakes can occur during this process, which may lead to delays or complications in the child's enrollment. Here are ten common mistakes to avoid.

One common error is not including the child's full name as it appears on official documents. The form requires the last name, first name, and middle initial (MI). This ensures the immunization record is accurately matched to the child's identity.

Another mistake involves the date of birth (DOB) format. It must be written as MM/DD/YY. Incorrect formats or typos can cause confusion or incorrect recording of the child's age and vaccination due dates.

Although the child’s Social Security Number (SSN) is optional, if chosen to be included, it must be accurately entered. Any mistakes in the SSN can lead to issues with record tracking and identification.

Similarly, inaccuracies with the State Immunization ID# can hinder the identification and verification process of the child’s immunization status, as this is another optional but important identifier.

Failure to record each vaccine dose with the correct date in MM/DD/YY format can result in the rejection of the form. Each vaccine section, from DTaP/DTP to Varicella and beyond, must have the accurately recorded dates for all administered doses.

Selecting the wrong code for the Certificate of Immunization section is a significant mistake. Parents must choose the appropriate certificate (A, B, or C) based on their child's immunization status and accurately complete the accompanying information.

Overlooking the expiration date for a temporary medical exemption (Part B) invalidates the temporary exemption status. This date is critical to ensure the child continues to receive necessary immunizations in a timely manner.

In the Permanent Medical Exemption section (Part C), failing to list each vaccine that is medically contraindicated and not providing valid clinical reasoning can lead to the exemption being questioned or denied.

Not having a physician or clinic name clearly printed can raise questions about the legitimacy of the immunization record or exemption claims. This information must be legibly provided for verification purposes.

Finally, an absence of an authorized signature and date can render the entire form invalid. It is essential to have these final elements to confirm the accuracy and legitimacy of the recorded information and any claimed exemptions.

In summary, attention to detail and accuracy are paramount when completing the DH 680 form. By avoiding these common mistakes, parents and guardians can ensure a smoother process for their child's immunization compliance and school enrollment.

When managing health and immunization records, especially within the educational and childcare systems, the Florida Certification of Immunization, also known as the DH 680 form, plays a crucial role. However, to ensure comprehensive documentation and adherence to legal and health guidelines, several other forms often accompany the DH 680. These documents each serve distinct purposes, from detailing immunization schedules to providing medical exemptions. Understanding these auxiliary documents enhances the efficiency and legality of record-keeping and compliance processes.

• DH Form 150-615: This form, titled Immunization Guidelines - Florida Schools, Childcare Facilities, and Family Daycare Homes, offers detailed instructions on the completion of the DH 680 form, ensuring compliance with state regulations.
• DH 681: The Religious Exemption from Immunization form is used when a family's religious beliefs preclude the vaccination of their child. This document must be processed and issued by a county health department.
• DH 3040: The School Entry Health Exam form, required for entry into a Florida school for the first time, certifies that a child has undergone a physical examination within the past year.
• DH 3203: The Varicella (Chickenpox) Vaccination Exemption form is specifically for documenting a child's immunity to chickenpox, either through vaccination or previous infection, separate from the DH 680 form.
• Immunization Record Cards: These cards provide a portable record of a child's vaccinations, often used by parents and guardians for reference or when transferring schools.
• Medical Exemption Documentation: For children who cannot be vaccinated due to medical reasons, detailed documents from healthcare providers outline the medical contraindications for each vaccine.
• School Immunization Report: Schools use this form to report aggregate immunization compliance, exemptions, and outbreaks to health departments, aiding in public health monitoring and response.
• Conditional Admission Letter: Issued for children not fully immunized, this letter outlines the temporary conditions under which a child may attend school or childcare, specifying the timeline for required vaccinations.
• Immunization Waiver for Healthcare Personnel: Applicable in certain employment situations, this form is used for individuals in healthcare settings to document immunity or exemptions based on occupational health guidelines.

In summary, the DH 680 form is integral to Florida's immunization documentation, but it doesn't stand alone. Each auxiliary document supports the main form by providing detailed health histories, exemptions, and compliance information. Together, these forms create a comprehensive ecosystem ensuring that children attending school or childcare are immunized according to public health standards, thus safeguarding communities against vaccine-preventable diseases. Professionals navigating these requirements benefit from a thorough familiarity with each document's purpose and application, ensuring both compliance and the health of Florida's youngest residents.

The DH 680 form, a Florida Certification of Immunization, resembles the I-693 form, the Report of Medical Examination and Vaccination Record, used in immigration processes within the United States. Both documents are designed to provide a comprehensive record of an individual's immunization history, verifying that they have received the requisite vaccines for their specific circumstances. The I-693 form specifically substantiates that an immigrant has received all vaccinations required by U.S. law, facilitating the assessment of their medical admissibility into the country, while the DH 680 form ensures compliance with state vaccination requirements for school and daycare attendance.

Similar to the DH 680 form is the Blue Card or the Personal Health Record, commonly issued at birth in several states. This card tracks an individual’s vaccination history from birth and is frequently updated with each vaccine received. Like the DH 680 form, the purpose is to maintain an up-to-date record of vaccinations to ensure public health and safety, specifically focusing on the individual's eligibility for school enrollment or daycare services based on their immunization status.

The Vaccine Adverse Event Reporting System (VAERS) form is another document related to the DH 680, in that it deals with vaccinations. While the DH 680 form records the vaccinations received, the VAERS form is used to document any adverse reactions following immunization. It's crucial for monitoring vaccine safety and identifying potential issues with vaccine batches or vaccination protocols, indirectly supporting the efficacy and safety of immunization programs that the DH 680 form certifies for school and daycare entry.

The Certificate of Exemption form, found in various states, shares similarities with the DH 680 form’s section on medical exemptions. Both documents include provisions for exempting individuals from mandatory vaccination requirements due to medical contraindications. The key difference lies in their focus, with the Certificate of Exemption being entirely dedicated to outlining the reasons and validity of the exemption, whereas the DH 680 form also encompasses complete immunization documentation alongside the exemption option.

The International Certificate of Vaccination or Prophylaxis (ICVP), also known as the Yellow Card, is akin to the DH 680 form in its function of recording vaccine history, specifically for international travelers. The Yellow Card is recognized globally and is often required for entry into certain countries, especially those with high risks of yellow fever. Both forms serve as official records of vaccination, albeit for different purposes—one for ensuring public health within educational and care settings in Florida, and the other for facilitating safe international travel.

The Immunization Information System (IIS) records share a foundational goal with the DH 680 form: to maintain accurate and complete immunization records to protect public health. IIS is a database that collects vaccination records, making the information easily accessible to healthcare providers and public health officials. While IIS provides a broader, more comprehensive approach to managing immunization data, the DH 680 form plays a crucial role within this system by certifying individual compliance with school and daycare vaccination requirements in Florida.

School Entry Health Exam forms, required in many states for school registration, complement the DH 680 form by providing a broader health assessment including, but not limited to, immunization status. These forms often require a physician’s examination and clearance, verifying that a child is healthy and fit for school attendance, with a section similar to the DH 680 form to document immunization records specifically.

The Child Health Certificate, similar to the DH 680 form, is used primarily in pediatric healthcare to record a child’s health information, including their vaccination history. The intent is to maintain a document that reflects the child’s overall health and immunization status over time, crucial for preventive healthcare and compliance with institutional policies such as those governing school or daycare attendance.

Travel Health Consultation forms, though different in application, relate to the DH 680 form by emphasizing preventative healthcare through vaccinations. These forms are used by healthcare providers during travel health consultations, recommending specific vaccinations based on the traveler’s destination. The focus on vaccine-preventable diseases in global travel health indirectly supports the importance of comprehensive immunization documentation, like that provided by the DH 680 form for domestic institutional requirements.

Last, Consent for Immunization forms bear a resemblance to the DH 680 form in their role in the vaccination process. Before vaccines are administered, particularly in settings like schools and public health clinics, a consent form is often required, detailing the vaccines to be given and obtaining permission from the patient or guardian. This step is fundamental to the creation of records like those contained in the DH 680 form, which certify that the necessary immunizations have been received and documented appropriately.

Completing the Florida Certification of Immunization (Form 680) involves careful attention to detail and adherence to specific guidelines. To ensure the process goes smoothly, here are some important dos and don'ts to consider:

• Review the guidelines carefully before starting. This will help you understand what information is needed and how to accurately complete the form.
• Gather all immunization records in advance. This ensures all vaccine doses and dates are accurately documented.
• Enter information as accurately as possible, double-checking dates and vaccine codes to avoid any errors.
• Use ink when filling out the form, as this ensures the information remains legible and permanent.
• Sign and date the appropriate certificate section (A, B, or C) to validate the information provided.
• Consult a healthcare professional if you have any questions or uncertainties about the immunizations or how to properly document them.

• Rush through the form without reviewing the instructions or immunization guidelines. Mistakes can lead to delays or require resubmission.
• Leave sections blank that are applicable to your child. Incomplete information can invalidate the form.
• Use pencil or erasable ink, as these can smear or be altered, which may question the form's authenticity.
• Guess vaccination dates or details. If you're unsure, verify the information with the child's healthcare provider to maintain accuracy.
• Forget to check for temporary or permanent medical exemptions if applicable. Be sure to complete the relevant section if your child cannot receive certain vaccines due to medical reasons.
• Ignore the need for an authorized signature. Without the signature of a physician or authorized clinic staff, the form may not be accepted.

There are several misconceptions about the Florida Certification of Immunization (Form DH 680) that need to be addressed to ensure accurate understanding and compliance.

• Misconception 1: The Social Security Number (SSN) of the child is required.

  While the form includes a space for the child's SSN, providing this information is entirely optional and not a mandatory requirement for the form's validity.

• Misconception 2: All vaccines must be completed before submitting the form.

  Form DH 680 allows for temporary and medical exemptions, meaning it can be submitted even if the child's immunizations are not yet complete, under certain conditions.

• Misconception 3: Medical exemptions are permanent and cannot be reviewed or reversed.

  Part C of the form is for permanent medical exemptions; however, if a child's medical condition changes, these exemptions can be reviewed and possibly reversed by a healthcare professional.

• Misconception 4: The form is only for school-aged children.

  The form applies to children in schools, childcare facilities, and family daycare homes, thus covering a broader age range than just school-aged children.

• Misconception 5: A separate form is needed for each vaccine.

  Form DH 680 is comprehensive and designed to document all required immunizations on a single form.

• Misconception 6: Immunizations documented on Form DH 680 do not need to follow the official guidelines.

  The form must be completed in accordance with the Immunization Guidelines - Florida Schools, Childcare Facilities, and Family Daycare Homes, ensuring all entries align with state requirements.

• Misconception 7: The form is valid indefinitely once signed.

  Temporary medical exemptions have an expiration date, and the form itself may need to be updated or reissued based on immunization schedules or changes in medical exemptions.

• Misconception 8: Parent or guardian signatures are sufficient for submission.

  The form must be signed by a physician or an authorized clinic representative, in addition to any parent or guardian information provided.

• Misconception 9: Digital copies of the form are not acceptable.

  With advancements in digital record-keeping, digital copies that are properly completed and signed are acceptable in many instances. However, requirements can vary by institution, so it’s essential to check with the specific school or facility.

Understanding these misconceptions is crucial for ensuring that the immunization records are accurately documented and comply with Florida's requirements. Always refer to the most current guidelines and consult with healthcare providers for clarification.

Filling out the Florida Certification of Immunization, also known as the DH 680 Form, is an essential process for parents and guardians in Florida, ensuring that children are ready for school or childcare by meeting the state's immunization requirements. The following key takeaways provide a foundation for understanding the form's structure and the necessary steps for completion:

• Sections 1003.22, 402.305, and 402.313 of the Florida Statutes, alongside Rule 64D-3.046 of the Florida Administrative Code, provide the legal basis for the DH 680 form, outlining the required immunizations for school and childcare attendance.
• The form requires detailed information on the child's vaccination history, including each vaccine's dates and doses. This ensures comprehensive documentation of the child's immunization status against various communicable diseases.
• It offers flexibility regarding the child’s Social Security Number and State Immunization ID#, both of which are optional, thereby catering to privacy concerns while still maintaining the integrity of health records.
• The form is divided into three parts: Part A for complete K-12 immunization records (excluding 7th grade/middle school requirements), Part B for children with incomplete immunizations starting a schedule to complete the required immunizations, and Part C for permanent medical exemptions, each catering to different statuses of immunization and providing clear pathways depending on the child's situation.
• The necessity to sign and date one of the certificates (A, B, or C) on the form authenticates the information provided and verifies the responsible party's acknowledgment of the child's immunization status.
• Guidance on filling out the form is available through the DH Form 150-615, Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes, offering a resource for understanding the specific requirements and exemptions related to immunization.
• Medical exemptions require detailed justification, including valid clinical reasoning or evidence for each vaccine contraindicated, underlining the importance of physician assessment in determining if a child is exempt from certain immunizations.

This overview provides essential insights into completing the DH 680 form correctly, emphasizing the crucial role that accurate immunization documentation plays in safeguarding the health of children and the broader community in Florida. Adherence to these guidelines ensures compliance with state laws and supports public health initiatives aimed at preventing the spread of vaccine-preventable diseases.