Fill Out Your 680 Template
The Florida Certification of Immunization, commonly referred to as the 680 form, plays a crucial role in ensuring that children meet the necessary immunization requirements for school attendance. This form is governed by specific legal statutes and administrative rules that underscore its importance in public health and safety. Parents or guardians must provide essential details, including the child's name, date of birth, and immunization history, which is documented through a series of vaccine doses and dates. Notably, the form includes sections for both temporary and permanent medical exemptions, allowing for flexibility in cases where immunizations may not be medically advisable. Clear instructions guide users through the completion process, emphasizing the need to sign and date the appropriate certification. Furthermore, resources are available online to assist families in understanding the requirements and ensuring compliance. By facilitating the tracking of immunizations, the 680 form not only protects individual children but also contributes to the broader goal of community health and disease prevention.
Similar forms
The Florida Certification of Immunization (Form 680) is similar to the CDC’s Certificate of Immunization. Both documents serve to verify that an individual has received the required vaccinations. The CDC form is often used for travel or school enrollment across various states, while the Florida form is specifically tailored to meet the immunization requirements for children attending schools and daycare facilities in Florida. Each document requires detailed information about the vaccines received, including dates and types, ensuring that health records are accurately maintained and easily accessible.
Another comparable document is the State Immunization Registry (SIR) record. This document is maintained by health departments to track immunization histories. Like the Florida form, it provides a comprehensive overview of an individual's vaccination status. However, the SIR record is typically more extensive and may include additional health information, while the 680 form focuses specifically on school-related immunization requirements.
The Certificate of Medical Exemption is also similar to the 680 form. This document allows parents to exempt their children from receiving certain vaccinations for medical reasons. Both forms require a physician's signature, ensuring that the exemption is legitimate. While the 680 form outlines immunization history, the Medical Exemption Certificate specifically details the medical rationale for not vaccinating.
Additionally, the Immunization Record Card serves a similar purpose. This card is often issued by healthcare providers to document vaccinations. It includes details such as vaccine types and administration dates. While the Florida 680 form is used for school enrollment, the Immunization Record Card is more of a personal health document that can be used in various settings, including travel and employment.
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The Health Department’s School Health Assessment form shares similarities with the 680 form as well. This document is used to assess a child's overall health and readiness for school. It often includes immunization status as part of the assessment. Both forms are essential for ensuring that children meet health requirements before attending school, but the School Health Assessment may also cover other health screenings.
The Universal Child Health Record is another document that resembles the 680 form. This record is used to track a child's health and development over time, including immunizations. While the Florida form is focused solely on vaccination status for school attendance, the Universal Child Health Record encompasses a broader range of health information, making it useful for ongoing medical care.
The Certificate of Immunization for Child Care is similar to the 680 form, as both documents are required for children attending childcare facilities. This certificate verifies that a child has received the necessary vaccinations before enrollment. While the 680 form is specific to Florida schools, the Child Care certificate may vary by state but serves the same purpose in ensuring that children are immunized before attending daycare.
The School Entry Health Form is another related document. This form is often required by schools to ensure that children are up-to-date on their vaccinations. Like the 680 form, it includes information about immunizations, but it may also require additional health information such as vision and hearing screenings. Both forms aim to promote health and safety in school environments.
The Immunization History Report is also comparable to the Florida Certification of Immunization. This report provides a detailed account of all vaccinations a person has received. It is often used for school enrollment, employment, or travel. While the 680 form is specific to Florida and focuses on school requirements, the Immunization History Report can be used in various contexts, making it a versatile document.
Finally, the Vaccine Administration Record (VAR) is similar in function to the 680 form. This record is used by healthcare providers to document the administration of vaccines. It includes information about the vaccine type, dosage, and administration date. Both documents are essential for maintaining accurate immunization records, but the VAR is typically used in a clinical setting, while the 680 form is used for educational enrollment.
Form Specifications
| Fact Name | Description |
|---|---|
| Legal Authority | The Florida Certification of Immunization is governed by Sections 1003.22, 402.305, and 402.313 of the Florida Statutes, along with Rule 64D-3.046 of the Florida Administrative Code. |
| Purpose | This form serves to document a child's immunization status, ensuring compliance with state requirements for school attendance. |
| Optional Information | Parents or guardians can provide the child's Social Security number and state immunization ID number, although these fields are optional. |
| Immunization Records | All appropriate vaccine doses and dates must be entered on the form, including DTaP, Polio, MMR, and others. |
| Certificate Types | The form includes three certificate types: Part A for complete immunizations, Part B for temporary exemptions, and Part C for permanent medical exemptions. |
| Expiration Date | For temporary medical exemptions, an expiration date must be provided; otherwise, the exemption is invalid. |
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Sample - 680 Form
FLORIDA CERTIFICATION OF IMMUNIZATION
Legal Authority: Sections 1003.22, 402.305, 402.313, Florida Statutes; Rule
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LAST NAME |
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FIRST NAME |
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MI |
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DOB (MM/DD/YY) |
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PARENT OR GUARDIAN |
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CHILD’S SS# (optional) |
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STATE IMMUNIZATION ID# (optional) |
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Directions:
Enter all appropriate doses and dates below.
Sign and date appropriate certificate (A, B,
or C) on form.
See DH Form 










VACCINE |
DOE |
Dose 1 |
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Dose 2 |
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Dose 3 |
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Dose 4 |
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Dose 5 |
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CODE |
MM/DD/YY |
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MM/DD/YY |
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MM/DD/YY |
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MM/DD/YY |
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MM/DD/YY |
DTaP/DTP |
A |
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DT |
B |
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Tdap |
P |
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Td |
Q |
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Polio |
D |
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Hib |
E |
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MMR (Combined) |
F |
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(Separate) |
G, H |
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Measles (dose 1) |
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Measles (dose 2) |
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Mumps (dose 1) |
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Mumps (dose 2) |
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I |
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Rubella (dose 1) |
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Rubella (dose 2) |
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Hepatitis B |
J |
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Varicella |
K |
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Varicella Disease |
L |
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Year
PneumoConju N
Select appropriate
box(es)
Certificate of Immunization
K-12
Part
DOE Code 1: Immunizations are complete
DOE Code 8: Immunizations
are complete for 7th grade
I have reviewed the records available,
and to the best of my knowledge, the above named child has adequately been immunized for school attendance, as documented above.


Temporary Medical Exemption |
Expiration date: _____________ |
Part |
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Part B (For children in daycare, family daycare homes, preschool, kindergarten and grades 1 through 12 who are incomplete for immunizations in Part A) Invalid without expiration date. DOE Code 2
I certify that the above named child has received the immunizations documented above and has commenced a schedule to complete the required immunization. Additional immunizations are not medically indicated at this time.
Permanent Medical Exemption
Part
Part C (For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption.) DOE Code 3 ________________________________________________________________________________________
I certify the physical condition of this child is such that immunizations as indicated in Part C above are medically contraindicated.
Physician or Clinic Name: |
Physician or |
_________________________________________________ |
Authorized Signature: ____________________________________ |
_________________________________________________ |
Issued By:_____________________________________________ |
_________________________________________________ |
Date: _________________________________________________ |
DH 680 (Jul 2010) Stock Number: