Blank 680 PDF Form

What is the Florida Certification of Immunization (DH 680) form?

The Florida Certification of Immunization, also known as the DH 680 form, is a document used to record and certify the immunization status of children for school entry or attendance in Florida. It details the administration of required vaccines, including the dates and doses received. This form is necessary for enrollment in schools, childcare facilities, and family daycare homes, in accordance with Florida's health regulations.

Where can I find the guidelines for completing the DH 680 form?

Guidelines for completing the DH 680 form can be found at the Florida Health Department's official website, specifically at www.immunizeflorida.org/schoolguide.pdf. This document, titled Immunization Guidelines - Florida Schools, Childcare Facilities and Family Daycare Homes, provides detailed instructions on how to accurately fill out the form.

Are there different parts to the DH 680 form? What do they mean?

Yes, the DH 680 form is divided into three main parts, each serving a different purpose. Part A is for children whose immunizations are complete for K-12 minus the 7th-grade requirements. Part B is a temporary certificate for children whose immunizations are incomplete, indicating that they have started but not yet finished their immunization schedule. Part C is for permanent medical exemptions, indicating that certain vaccines are medically contraindicated due to the child's physical condition.

How do I know if my child's immunizations are complete?

Your child's immunizations are considered complete when they have received all required doses of vaccines, as documented by a healthcare provider on the DH 680 form. Completion is determined by comparing your child's immunization record with the state's requirements for school entry or attendance, which can be found in the guidelines provided by the Florida Health Department.

What is a temporary medical exemption, and how can it be obtained?

A temporary medical exemption, documented in Part B of the DH 680 form, is granted when a child is in the process of completing their required immunizations but is not yet fully immunized. A healthcare professional must certify that the child has received the immunizations documented to date and has commenced a schedule to complete the remaining doses. This exemption has an expiration date and is not valid without one.

What constitutes a permanent medical exemption on the DH 680 form?

A permanent medical exemption is indicated in Part C of the DH 680 form. It is granted when a child has a physical condition that makes receiving one or more of the required vaccines medically inadvisable. To qualify, each contraindicated vaccine must be listed along with a valid clinical reason or evidence for the exemption, as certified by a healthcare professional.

Filling out the Florida Certification of Immunization (Form DH 680) can be complicated, and mistakes may lead to processing delays or even the form being considered invalid. To ensure accuracy and completeness, be mindful of the following common errors:

1. Not including all required dates for each vaccine dose. Each vaccine listed requires the exact dates (MM/DD/YY) of administration to be completely filled out.

2. Failure to write the child’s last name, first name, and middle initial exactly as it appears on official documents can lead to unnecessary confusion and delays.

3. Leaving the child’s Social Security Number (SSN) and State Immunization ID# blank is optional but including them can help with the identification process, especially if records need to be pulled from state or local immunization registries.

4. Omitting the parent or guardian’s information, which is essential for verification and contact purposes.

5. Choosing the wrong certificate (A, B, or C) without understanding the distinctions between each can result in the form not being processed correctly.

6. Incorrectly marking vaccine codes or filling in doses that do not correspond with the child's actual immunization records can misrepresent the child's vaccination status.

7. Not checking the guidelines available at the recommended website for form completion instructions can lead to errors in the form's completion.

8. Forgetting to sign and date the form, which is a critical step in certifying that the information provided is accurate and up to date.

9. Not attaching additional necessary documentation for exemptions or incomplete immunizations. For Parts B and C, specific documentation is required to validate medical exemptions or ongoing immunization schedules.

To ensure the form is correctly processed:

• Review the entire form for completeness before submission.
• Double-check all dates and vaccine codes against the child’s immunization record to ensure accuracy.
• Consult the provided guidelines for any clarification on how to accurately complete the form.
• Ensure that all required sections are filled out, including the certificate needed based on the child's immunization status.

By avoiding these common mistakes, the submission process can be smoother, and children can be ensured access to school or daycare without unnecessary delays.

Understanding the DH 680 form, the Florida Certification of Immunization, is an important step for parents and guardians ensuring their children comply with state vaccination requirements for school and childcare entry. This document is a cornerstone in a suite of documents often needed for full compliance and documentation of a child's health and vaccination status. Alongside the DH 680 form, there are other crucial forms and documents frequently needed that provide additional information or clarify the child's health and vaccination circumstances.

• DH 3040 Form - Florida School Entry Health Exam: This form is required for entry into Florida schools and verifies that a child has received a physical examination by a licensed health care provider within the past 12 months.
• Vaccination Records - Official Immunization Records: While the DH 680 form summarizes a child’s immunization status, presenting the original vaccination records from healthcare providers can be necessary for verification or when the DH 680 form needs updating.
• Birth Certificate: Often required alongside health documents to verify the child's age and to ensure that immunization schedules are appropriate for their age group.
• Exemption Forms - Medical or Religious Exemption Documentation: For children who are not fully vaccinated due to medical reasons or because of religious beliefs, appropriate exemption documents must be provided in place of the standard immunization documentation.
• Emergency Contact and Medical Information Form: Schools and childcare facilities typically require this form to have a record of who to contact in an emergency and to be aware of any special health needs or allergies a child may have.
• DH 680 Part B and Part C Forms - Temporary and Permanent Medical Exemption Forms: When applicable, these sections of the DH 680 form document temporary or permanent medical exemptions for specific vaccines, detailing the medical justification for each exempted vaccine.

Understanding and gathering these forms represent an integral part of preparing for school or childcare enrollment in Florida, ensuring children's health and safety in these environments. Careful attention to the completeness and accuracy of these documents helps streamline the enrollment process and contributes to the overall well-being of all children in care and educational settings.

• The Vaccine Information Statement (VIS) is similar to the DH 680 form in that both provide vital information about vaccinations. The VIS, distributed by vaccine providers, informs recipients about the benefits and risks of a vaccine before administration, much like the DH 680 form includes details about vaccinations required for school entry in Florida.

• The International Certificate of Vaccination or Prophylaxis (ICVP), also known as the Yellow Card, parallels the DH 680 form by documenting vaccinations, specifically for international travel vaccines like yellow fever. Both forms serve as official records to prove immunization status.

• The Medical Exemption Form is akin to Part C of the DH 680 form. Both documents allow medical professionals to indicate specific vaccines that are medically contraindicated for the individual, outlining valid clinical reasoning or evidence for exemption.

• A School Entry Health Exam Certificate shares similarities with the DH 680 form, as both are required for school enrollment in many states. While the DH 680 form focuses on immunization records, the School Entry Health Exam Certificate includes a broader health assessment but also verifies that required immunizations are complete.

• The Immunization Registry Records, like those found in state immunization information systems, resemble the data captured in the DH 680 form. These registries track an individual's immunization history over time, providing a database for healthcare providers, much as the DH 680 form documents immunization status for school compliance.

• The Childcare Immunization Record is comparable to the DH 680 form as it lists the vaccinations required for childcare or preschool enrollment. Both documents ensure children meet immunization standards to protect against vaccine-preventable diseases in group care settings.

When handling the Florida Certification of Immunization, known as the DH 680 form, ensuring accuracy and compliance with guidelines is paramount. This document is not just a formality but a crucial part of ensuring public health safety and compliance with state educational requirements. Here are lists of dos and don'ts to consider when filling out this form:

• Review the guidelines: Before filling out the form, familiarize yourself with the Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes. This ensures the information provided aligns with current standards.

• Complete all sections accurately: Fill out every required field with the correct information, especially the full name, date of birth (DOB), and the doses of vaccines administered. Pay close attention to the dates and ensure they're in the MM/DD/YY format.

• Check vaccine codes: Ensure the vaccine codes entered correspond correctly to the vaccines administered. This minimizes the chance of errors and the need for form resubmission.

• Sign and date the form: The form requires a signature from a physician, clinic, or authorized representative. Don’t forget to include the date of signature to validate the form.

• Keep a copy: After submitting the original form to the necessary educational or childcare institution, retain a copy for your records. This could be useful for future reference or in case the form gets misplaced.

• Leave fields blank: Avoid submitting an incomplete form. If a section does not apply, enter a notation such as "N/A" (not applicable) rather than leaving it empty.

• Guess on dates or information: Don't estimate vaccine dates or doses. If uncertain, consult the child's immunization records or your healthcare provider for accurate information.

• Use outdated information: Ensure that the immunization data reflects the most current records. Using outdated information can lead to compliance issues.

• Alter the form structure: Do not modify the form layout or attempt to create your own version of the form. Use the official DH 680 form provided by the health department.

• Disregard expiration dates: For temporary medical exemptions, the expiration date must be clearly indicated. Failing to include this can result in an invalid form.

Proper completion and submission of the DH 680 form play a critical role in safeguarding not only the health of Florida's youth but also in ensuring their uninterrupted education. By adhering to these guidelines, you contribute to a system designed to protect public health through documented vaccinations.

Understanding the Florida Certification of Immunization, also known as the DH 680 form, is important for parents, guardians, and educators. However, there are several misconceptions about this document that need to be clarified:

• Misconception 1: The DH 680 form is only necessary for public school enrollment.
  In reality, this form is required not just for public schools but also for private schools, childcare facilities, and family daycare homes in Florida.

• Misconception 2: Once completed, the DH 680 form is valid indefinitely.
  The validity of the form can vary, especially for temporary medical exemptions, which have an expiration date. Permanent records, however, do not typically need to be updated unless new immunization guidelines are introduced.

• Misconception 3: Parental or guardian signatures are enough for the form to be valid.
  A healthcare provider’s or authorized clinic's signature is required to validate the immunization information and any exemption statuses documented on the form.

• Misconception 4: The child's social security number is mandatory on the form.
  The SSN is optional and not a requirement for the completion of the DH 680 form.

• Misconception 5: Every child must have all the listed immunizations to attend school or daycare.
  While most immunizations are required, medical exemptions can be granted for specific health reasons, as detailed in Part C of the form.

• Misconception 6: The form can be signed by any physician, regardless of their specialty.
  Only physicians or clinics that are authorized to administer immunizations or grant exemptions can sign off on this form.

• Misconception 7: Digital copies of the DH 680 form are not acceptable.
  In many cases, digital or electronic versions of the DH 680 form are accepted, as long as they are accessible and verifiable by the institution requiring the form.

• Misconception 8: The form is only applicable to children born in Florida.
  Children moving to Florida from other states or countries must also have a completed DH 680 form, based on their immunization records, to enroll in Florida schools or childcare facilities.

• Misconception 9: All vaccines must be completed before the form can be submitted.
  If a child has started but not yet completed all required immunizations, a temporary medical exemption can be issued, allowing for school enrollment while vaccinations are being completed.

• Misconception 10: Parents cannot access immunization guidelines related to the DH 680 form.
  The immunization guidelines for Florida schools, childcare facilities, and family daycare homes are available to the public and can be accessed through the state’s website provided on the form.

Filling out and understanding the Florida Certification of Immunization, commonly known as the 680 form, is essential for parents, guardians, and healthcare providers in Florida. Here are 10 key takeaways to ensure accuracy and compliance:

• Legal Framework: The 680 form is supported by Sections 1003.22, 402.305, and 402.313 of the Florida Statutes, and Rule 64D-3.046 of the Florida Administrative Code, highlighting its importance in the legal context of school and childcare immunization requirements.
• Personal Information: Start by accurately filling in the child's last and first names, middle initial, date of birth, and, optionally, the child’s Social Security Number and the State Immunization ID#. Ensuring accuracy in this section is crucial for the child's immunization record tracking.
• Vaccine Information: Document each vaccine received, including the type (using the designated DOE Code), dates of all doses administered, and any instances of diseases like Varicella (chickenpox) that might grant immunity.
• Completion Certificates: The form offers three certificates (A, B, or C) at the end. The appropriate certificate must be signed and dated, based on the child’s immunization status and specific needs.
• Certificate of Immunization: For school-aged children (K-12), Certificate A validates that all required immunizations are complete, while Certificate B is for temporary medical exemptions with a necessary expiration date, and Certificate C is for permanent medical exemptions with a stated valid clinical reasoning.
• Immunization Guidelines: Reference the DH Form 150-615, Immunization Guidelines - Florida Schools, Childcare Facilities, and Family Daycare Homes for detailed instructions on form completion, vaccine schedules, and exemptions. These guidelines are indispensable for ensuring compliance with state requirements.
• Additional Documentation: Sometimes, additional documentation may be required to support the certifications, especially for medical exemptions. Having detailed medical records or letters from healthcare providers can simplify this process.
• Optional Information: The child’s Social Security Number and State Immunization ID# are optional but can be helpful for accurately tracking and verifying immunization records within state systems.
• Updating Immunizations: If the child receives additional vaccines after the initial form submission, the form should be updated and resubmitted to reflect the current immunization status accurately.
• Professional Certification: A physician or clinic must certify the information on the form, ensuring that all data related to immunizations or exemptions are medically accurate and up to date. The authorized signature at the bottom of the form validates it for official purposes.

Understanding and adhering to these points when completing the Florida Certification of Immunization, or 680 form, ensures not only compliance with state laws but also supports the health and safety of children in schools and childcare settings throughout Florida.