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The Florida Certification of Immunization, commonly known as the 680 form, plays a crucial role in ensuring that children meet immunization requirements for school attendance. This form is governed by specific legal authorities, including various sections of the Florida Statutes and the Florida Administrative Code. Designed to document the immunization history of children, it requires essential information such as the child's name, date of birth, and immunization records. Parents or guardians must fill in the appropriate doses and dates for various vaccines, including DTaP, Polio, MMR, and Hepatitis B, among others. The form includes three distinct parts: Part A certifies that immunizations are complete, Part B allows for temporary exemptions, and Part C addresses permanent medical exemptions. Each section requires careful attention to detail, as inaccuracies can lead to complications in school enrollment. For guidance on completing the form, individuals can refer to the Immunization Guidelines provided by the Florida Department of Health. This document is not only essential for compliance but also serves as a protective measure for public health, ensuring that children are adequately immunized against preventable diseases.
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Common mistakes
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Failing to provide the full name of the child. It’s crucial to include the last name, first name, and middle initial to avoid any confusion.
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Not entering the date of birth correctly. Use the MM/DD/YY format to ensure clarity.
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Leaving out the parent or guardian's information. This section must be completed for contact purposes.
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Overlooking the child’s Social Security number. While optional, including it can help with identification.
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Failing to provide the immunization dates for each dose. All doses must be documented accurately.
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Not signing the appropriate certificate (A, B, or C). The form is invalid without a signature.
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Neglecting to check the correct DOE Code. Ensure the code matches the immunization status.
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Forgetting to include an expiration date for temporary medical exemptions. This date is necessary for validity.
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Providing incomplete information for permanent medical exemptions. List each vaccine and provide valid clinical reasoning.
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Not reviewing the guidelines before filling out the form. Familiarity with the instructions can prevent mistakes.
Guide to Writing 680
Completing the 680 form is essential for ensuring that a child's immunization records are properly documented for school attendance. This process involves filling out personal information, vaccine details, and certifying the immunization status. Follow the steps below to accurately fill out the form.
- Obtain the form: Access the 680 form online or request a physical copy from your local health department.
- Fill in personal details: Enter the child's last name, first name, middle initial, and date of birth in the designated fields.
- Parent or guardian information: Provide the name of the parent or guardian and the child’s Social Security number (optional).
- State Immunization ID: If applicable, include the state immunization ID number (optional).
- Document vaccine doses: For each vaccine listed, fill in the dates for each dose received. Use the format MM/DD/YY.
- Select the appropriate certificate: Choose either Part A, B, or C based on the child's immunization status.
- Sign the form: The parent or guardian must sign and date the form to certify the information is accurate.
- Submit the form: Return the completed form to the appropriate school or childcare facility as required.
Documents used along the form
The Florida Certification of Immunization, commonly referred to as the 680 form, is a crucial document for students enrolling in K-12 education. However, several other forms and documents often accompany it to ensure compliance with state health regulations and to address various circumstances related to immunization. Below is a list of these documents, along with brief descriptions of each.
- DH Form 150-615: This form provides detailed immunization guidelines for Florida schools, childcare facilities, and family daycare homes. It outlines the required immunizations and offers instructions for completing the 680 form.
- Medical Exemption Form: Used when a child cannot receive certain vaccinations for medical reasons. This form must be completed by a licensed healthcare provider, detailing the specific vaccines exempted and the medical justification.
- Religious Exemption Form: Parents or guardians may use this document to request an exemption from immunization requirements based on religious beliefs. It typically requires a signed statement affirming the family's religious convictions.
- Non-disclosure Agreement: A crucial document that helps protect sensitive information related to immunization records and processes. For more information on how to create one, visit https://newyorkform.com/free-non-disclosure-agreement-template.
- Temporary Medical Exemption: This is part of the 680 form itself, indicating that a child is temporarily exempt from certain vaccinations due to a medical condition. It must include an expiration date to remain valid.
- Proof of Immunization Records: Schools may require original or certified copies of a child’s immunization records from healthcare providers to verify compliance with vaccination requirements.
- Health Assessment Form: This document may be required by schools and childcare facilities, providing an overview of the child’s health status, including any medical conditions that might affect immunization.
- Enrollment Form: Schools often have their own enrollment forms that require parents to provide immunization information along with other personal details about the child.
- Emergency Contact Form: While not directly related to immunization, this form is often completed during school enrollment. It includes important contact information in case of a medical emergency.
- School District Policies: Each school district may have its own set of policies regarding immunization requirements, which may need to be reviewed and acknowledged by parents during enrollment.
Understanding these accompanying documents is essential for parents and guardians as they navigate the immunization requirements for school enrollment. Each form serves a specific purpose, ensuring that children are protected and that schools maintain compliance with state health regulations.