Blank 680 Form

When filling out the Florida Certification of Immunization form (Form 680), it is important to follow specific guidelines to ensure accuracy and compliance. Here is a list of things to do and avoid while completing the form:

• Do enter the child's full name, including last name, first name, and middle initial, as it appears on official documents.
• Do include the date of birth in the correct format (MM/DD/YY).
• Do provide the parent or guardian's name, ensuring it is clearly written.
• Do list all immunization doses received, along with the corresponding dates.
• Do sign and date the appropriate certificate (A, B, or C) at the end of the form.
• Don't leave any required fields blank; ensure all necessary information is filled in.
• Don't use abbreviations or shorthand when writing dates or names; clarity is essential.
• Don't forget to check the appropriate box for the immunization status (complete or incomplete).
• Don't provide false information; all entries must be truthful and accurate.
• Don't submit the form without reviewing it for errors or omissions.

Following these guidelines can help ensure that the form is completed correctly, facilitating a smoother process for school attendance and compliance with immunization requirements.

1. What is the purpose of the Florida Certification of Immunization (680 Form)?

   The Florida Certification of Immunization, commonly referred to as the 680 Form, is used to document a child's immunization history. It is required for school attendance in Florida. The form verifies that a child has received the necessary vaccinations as mandated by Florida law, ensuring that children are protected against vaccine-preventable diseases.

2. Who needs to complete the 680 Form?

   The 680 Form must be completed for children entering kindergarten through 12th grade in Florida. Additionally, it is required for children attending daycare, family daycare homes, and preschool programs. Parents or guardians are responsible for providing accurate immunization records on this form.

3. What information is required on the 680 Form?

   The form requires several key pieces of information, including:

   • Child's full name, date of birth, and Social Security number (optional)
   • Parent or guardian's name
   • Immunization dates for each required vaccine
   • Certification of immunization status, including any exemptions

   It is essential to accurately fill in all sections to avoid any delays in school enrollment.

4. What are the different parts of the 680 Form?

   The 680 Form consists of three parts:

   • Part A: Confirms that the child has received all required immunizations for school attendance.
   • Part B: Provides a temporary exemption for children who have not yet completed their immunization schedule.
   • Part C: Documents permanent medical exemptions for children who cannot receive certain vaccinations due to medical contraindications.

5. Where can I find more information about completing the 680 Form?

   Detailed guidelines for completing the 680 Form can be found in the DH Form 150-615, Immunization Guidelines - Florida Schools, Childcare Facilities and Family Daycare Homes. This document provides comprehensive instructions and is available online at www.immunizeflorida.org/schoolguide.pdf. It is advisable to consult these guidelines to ensure accurate completion of the form.