680 Template

Guidelines on Filling in 680

Filling out the DH 680 form, officially known as the Florida Certification of Immunization, is an essential step for ensuring compliance with Florida's immunization requirements for school, childcare facilities, and family daycare homes. A clear understanding of the immunization history and current status of the individual is necessary to complete this form accurately. Through a step-by-step approach, individuals can successfully fill out the form, catering to the distinct sections tailored for different circumstances such as complete immunization, temporary medical exemptions, or permanent medical exemptions. Here is how to approach this task:

1. Start by entering the LAST NAME, FIRST NAME, MI (Middle Initial), and DOB (Date of Birth) in the format MM/DD/YY at the top of the form.
2. Fill in the PARENT OR GUARDIAN name if applicable.
3. Though optional, include the CHILD’S SS# (Social Security Number) and STATE IMMUNIZATION ID# if available for easier identification and record matching.
4. Under the VACCINE section, enter all relevant doses along with their dates (MM/DD/YY) for each listed vaccine. The form segments vaccines into different fields such as DTaP/DTP, Polio, Hib, MMR, and others, ensuring each immunization is accounted for.
5. For Varicella (Chickenpox), note if the disease was contracted naturally under the Varicella Disease section by marking the year.
6. Choose the appropriate certificate that applies to the recipient:
   • For Part A - Complete all necessary fields and check DOE Code 1 if immunizations are complete for K-12 (excluding 7th grade/middle school requirements), or DOE Code 8 if immunizations are complete for 7th grade.
   • For Part B - Temporary Medical Exemption. Note the expiration date and check DOE Code 2. This part is for recipients who have started but not yet completed the immunization schedule.
   • For Part C - Permanent Medical Exemption. List each vaccine that is medically contraindicated and provide valid clinical reasoning or evidence for exemption.
7. Ensure the Physician or Clinic Name is printed at the bottom of the form, followed by the physician's or authorized individual’s signature, issuer's name (if different), and the date of issuance.

By following these steps, the DH 680 form can be accurately and efficiently filled out, meeting Florida's legal requirements for immunization reporting. It's important to refer to the Immunization Guidelines - Florida Schools, Childcare Facilities, and Family Daycare Homes for detailed information on form completion and immunization schedules. This ensures that all participants in these settings are protected against communicable diseases, safeguarding community health.

What is Form DH 680?

Form DH 680, also known as the Florida Certification of Immunization, is a document that verifies a child's immunization records in compliance with Florida Statues and the Florida Administrative Code. This form is required for enrollment in schools, childcare facilities, and family daycare homes in Florida. It records vaccinations against diseases such as DTaP/DTP, Polio, Measles, Mumps, Rubella, Hepatitis B, and Varicella, among others.

Who needs to complete the DH 680 form?

Parents or guardians of children who are being enrolled in Florida schools, childcare facilities, and family daycare homes must complete the DH 680 form. This ensures that the child has received the required immunizations for school attendance.

Where can I find the DH 680 form and guidelines for completion?

The DH 680 form and its completion guidelines can be found on the Immunize Florida website. The guidelines provide detailed instructions on how to correctly fill out the form and are available for download at www.immunizeflorida.org/schoolguide.pdf.

How are immunizations documented on the form?

Immunizations are documented on the DH 680 form by entering the date each vaccine dose was administered. The form includes space for recording doses of vaccines such as DTaP/DTP, Polio, MMR, Hepatitis B, and Varicella, among others. Appropriate codes from the Department of Education (DOE) are used to indicate the completion status of the required immunizations.

What are the different certificates sections on the form?

The DH 680 form has three certificate sections:

1. Part A - Complete: Used when all required K-12 immunizations (excluding 7th grade/middle school requirements) are complete.
2. Part B - Temporary: Used for children whose immunization records are incomplete. It requires an expiration date and indicates a commitment to complete the required vaccines.
3. Part C - Permanent Medical Exemption: For children who cannot be vaccinated due to medical reasons. Each contraindicated vaccine must be listed along with valid clinical reasoning or evidence for the exemption.

Is a child's Social Security number required on the form?

A child's Social Security number is optional on the DH 680 form. While it can be included, it is not mandatory for the completion or processing of the form.

Can exemptions be requested through the DH 680 form?

Yes, exemptions can be requested through the DH 680 form. Part C of the form is specifically designed for Permanent Medical Exemptions, where a physician or authorized clinic staff can certify that immunizations are medically contraindicated for the child.

What is the legal authority behind the DH 680 form?

The DH 680 form is mandated by Sections 1003.22, 402.305, and 402.313 of the Florida Statutes, in addition to Rule 64D-3.046 of the Florida Administrative Code. These laws and regulations require proper documentation of immunizations for children attending school and childcare facilities in Florida.

What happens if the DH 680 form is not submitted?

If the DH 680 form is not submitted, the child may not be permitted to enroll or attend school, childcare facilities, or family daycare homes in Florida. Compliance with this requirement is crucial for both public health safety and adherence to state law.

How often does the DH 680 form need to be updated?

The DH 680 form needs to be updated whenever additional immunizations are received. This ensures the form reflects the most current immunization status of the child, in compliance with Florida's school entry health requirements.

1. Not thoroughly reviewing the Immunization Guidelines. People often miss the step of consulting the guidelines provided at www.immunizeflorida.org/schoolguide.pdf. These guidelines offer critical information on how to accurately complete the form, including which vaccines are required for school attendance in Florida. Overlooking these guidelines can result in incomplete or incorrect form submission.

2. Incorrectly filling in the DOE Codes. Each certificate type (A, B, or C) has a specific DOE Code that must be correctly identified and entered on the form. The DOE Code signifies whether the child's immunizations are complete, in progress, or exempt due to medical reasons. Misidentifying or omitting the DOE Code can lead to processing delays or the need for resubmission.

3. Failing to indicate the Temporary Medical Exemption Expiration date. When filling out Part B for a temporary medical exemption, it is mandatory to include an expiration date. Without this date, the form is considered invalid, which can prevent the child from attending school or daycare until the oversight is corrected.

4. Omitting optional information when it's actually available. Although the child’s Social Security Number and the State Immunization ID# are marked as optional, providing them can enhance the accuracy and efficiency of record-keeping. This detail is particularly important if transferring records between states or different educational facilities.

5. Listing vaccines under incorrect sections or missing doses. Some individuals mistakenly list vaccines under the wrong sections or omit doses, particularly for vaccines requiring multiple doses at specific intervals (e.g., DTaP/DTP, Polio). Each vaccine type and the corresponding dose must be accurately entered with the correct date to ensure compliance with state immunization requirements.

6. Not having the form signed by an authorized individual. The certification section at the bottom of the form requires a signature from a physician or clinic representative. This signature verifies the accuracy of the immunization records. Failing to have the form appropriately signed renders the document incomplete, potentially barring the child from enrollment in school or daycare.

Ensuring compliance with vaccination requirements, especially in educational and childcare settings, requires careful attention to documentation and record-keeping. The Florida Certification of Immunization, known as Form 680, plays a central role in this process. However, alongside this crucial form, several other documents often need to be managed to ensure full compliance and to address specific circumstances that might arise. Highlighted below are forms and documents that frequently accompany the Form 680, each serving a unique purpose in the broader scope of immunization documentation.

• DH Form 150-615, Immunization Guidelines: This document provides comprehensive guidelines for the vaccination of children in Florida's schools, childcare facilities, and family daycare homes. It offers detailed instructions on completing the Form 680, outlining the immunization schedule required for school attendance and how to document vaccinations properly.
• Form DH 3040, School Entry Health Exam: To ensure that children entering the school system are in good health and up-to-date on vaccinations, this form records a child's health examination findings. It is typically completed by a healthcare provider and must be submitted to the school upon entry or within a specified period.
• Religious Exemption From Immunization (Form DH 681): This form is used when a child is exempt from vaccinations due to religious beliefs. It must be filed with the school or childcare facility and is recognized as a valid exemption under Florida law, alongside medical exemptions documented on the Form 680.
• Vaccine Adverse Event Reporting System (VAERS) Form: Though not directly related to school immunization compliance, this form is essential in documenting any adverse reactions following vaccination. Health professionals or parents can report adverse events, which are then used to monitor vaccine safety at a national level.
• Medical Exemption Documentation: Apart from the Form 680's Part C, additional documentation may be necessary for medical exemptions that require detailed explanation or ongoing monitoring. This could include physician's notes or medical records outlining the reason for the exemption and any relevant health conditions.

Together, these forms create a comprehensive framework for managing immunization requirements, ensuring that children remain safe and healthy while maintaining the necessary legal and procedural standards. As such, anyone involved in the administration of vaccines, school admissions, or childcare should be familiar with these documents and their correct application within the context of Florida's immunization laws and guidelines.

• Medical Records Release Form: Similar to the DH 680 form which records immunizations, a Medical Records Release Form is used for documenting and granting permission to share an individual's health information between healthcare providers or with other parties. Both forms deal with personal health details and require authorization for information sharing.

• Physical Examination Form: This form is used by healthcare providers to document the results of a physical examination. Like the DH 680, it captures essential health information required for specific settings, like schools or sports, ensuring that individuals are fit for participation.

• Medication Administration Record (MAR): The MAR is used in healthcare settings to record all medications administered to a patient. It shares a common purpose with the DH 680 form in tracking health-related treatments, though the DH 680 focuses specifically on immunizations.

• Vaccine Consent Form: Before receiving vaccinations, individuals (or their guardians) must often fill out a Vaccine Consent Form. This document, like the DH 680, is integral to the vaccination process, requiring informed consent prior to administration.

• School Enrollment Form: This form often requires health information, including immunization records, to ensure that new students meet health standards for school entry. The DH 680 form directly supports this process by providing documented proof of immunizations.

• Health Insurance Portability and Accountability Act (HIPAA) Authorization Form: Similar to the DH 680 in its handling of sensitive health information, the HIPAA Authorization Form allows for the disclosure of an individual's health information under specific circumstances.

• Child Health Report: Used in childcare and school settings, this report documents a child's health history and current condition, including immunization status. The DH 680 form complements such reports by providing detailed immunization records.

• Travel Vaccination Record: Travelers to certain destinations may need to prove they have received specific vaccinations. This record, akin to the DH 680, tracks vaccinations but is focused on travel requirements rather than school enrollments.

• Consent for Treatment Form: While broader in scope, covering any medical treatment, this form shares the concept of informed consent with the DH 680’s vaccination verification and consent process.

• Daycare Registration Form: Similar to school enrollment forms, these require up-to-date immunization records for child entry. The DH 680 form is crucial in this context, providing the required immunization proof for safe daycare participation.

Filling out the Florida Certification of Immunization (Form 680) is a critical step in ensuring your child is ready for school and daycare. To make sure the process goes smoothly, here are 10 essential dos and don'ts:

1. Read the Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes to understand vaccine requirements.

2. Have your child's immunization records accessible for accurate reporting of dates and doses.

3. Complete all sections applicable to your child, including their full name, date of birth, and parent or guardian information.

4. Use the MM/DD/YY format when entering dates to maintain consistency with the form's guidelines.

5. Sign and date the certificate in the part that corresponds to your child’s immunization status (A, B, or C).

1. Do not leave any required fields blank. If a section does not apply, clearly mark it as "N/A" or "Not Applicable."

2. Avoid guessing vaccine dates or doses. Inaccurate information could impact your child's immunization status and eligibility for school.

3. Do not use pencil or erasable ink. Complete the form using blue or black ink to ensure permanence and legibility.

4. Resist the temptation to submit the form without reviewing it for completeness and accuracy.

5. Do not forget to check the expiration date if you are completing Part B for temporary medical exemptions. An invalid date can render the exemption null and void.

By following these guidelines, you can ensure that the Florida Certification of Immunization Form 680 is filled out accurately and effectively, paving the way for a smoother school entry process for your child.

Understanding the Florida Certification of Immunization, commonly referred to as the DH 680 form, is crucial for ensuring compliance with state vaccination and immunization tracking requirements. However, several misconceptions often arise regarding the form's purpose, usage, and requirements. Clarifying these misunderstandings can help streamline the certification process for parents, guardians, educators, and healthcare providers. Here are nine common misconceptions about the DH 680 form:

• Misconception #1: The child's Social Security Number (SSN) is mandatory on the form.

  In reality, providing the child's SSN is optional. The form is primarily intended to document the child's immunization status, and while the SSN can aid in record-keeping, it is not a requirement for the form's completion.

• Misconception #2: The DH 680 form is only for public school students.

  This form is essential not only for public school students but also for enrollees in private schools, childcare facilities, and family daycare homes in Florida, ensuring all children in these settings have documented immunizations.

• Misconception #3: All doses of vaccines listed must be completed for the form to be valid.

  While the form provides spaces for multiple doses of vaccines, its validity depends on the completion of immunizations as per age-appropriate schedules defined by state guidelines, not necessarily the filling of every dose field.

• Misconception #4: Parents or guardians can sign off on the certification parts of the form.

  Only a healthcare professional authorized to administer vaccines can review and certify the immunization status on the DH 680 form, ensuring the accuracy and legitimacy of the documented information.

• Misconception #5: The form must be completed and submitted every year.

  Once the form is properly filled, its validation typically encompasses the entire duration of the child's school attendance, barring any additional state-mandated vaccine requirements that may emerge due to public health updates.

• Misconception #6: Temporary medical exemptions are indefinitely valid.

  Temporary medical exemptions indicated in Part B of the form must include an expiration date. This segment acknowledges a child's current immunization schedule and anticipates the completion of necessary vaccines within a reasonable timeframe.

• Misconception #7: Physicians can only grant permanent medical exemptions based on physical conditions.

  While physical conditions are a common basis for permanent medical exemptions, valid clinical reasoning or evidence supporting the exemption from specific vaccines can also encompass a variety of other medically indicated factors as documented by a physician.

• Misconception #8: The DH 680 form does not cover vaccinations for communicable diseases beyond those required for school entry.

  The form indeed focuses on documenting vaccines primarily required for school entry as outlined by Florida statutes and administrative code, yet it allows for the inclusion and documentation of additional immunizations as recommended by the immunization guidelines.

• Misconception #9: There is no legal backing for the information provided on the DH 680 form.

  The form is established under specific Florida Statutes and the Florida Administrative Code, providing it with legal authority in documenting and tracking the immunization status of children for school and childcare attendance within the state.

Correcting these misconceptions ensures a smoother process for all stakeholders involved in the immunization documentation and verification process, promoting better public health practices within the community.

Filling out and using the Florida Certification of Immunization, commonly known as the DH 680 form, is a key step in ensuring children are ready for school entry in Florida. Understanding how to properly complete this form can seem overwhelming, but with the right guidance, it becomes a straightforward task. Here are key takeaways to help navigate the process:

• The legal authority behind the 680 form is rooted in Sections 1003.22, 402.305, 402.313 of the Florida Statutes, along with Rule 64D-3.046 of the Florida Administrative Code. This legal foundation ensures the form's compliance with state laws regarding immunization.
• It's vital to enter all appropriate doses and dates for the vaccines listed on the form accurately. This includes information for vaccines like DTaP/DTP, Polio, MMR (Measles, Mumps, Rubella), Hepatitis B, and Varicella, among others.
• The form allows for documentation of a Temporary Medical Exemption in Part B, which is crucial for children who are in the process of completing their immunizations but are not yet fully compliant. This section requires an expiration date, emphasizing its temporary nature.
• Permanent Medical Exemptions are detailed in Part C. This section is for listing vaccines that are medically contraindicated, which means they’re not safe for the child due to medical reasons. Each exempted vaccine must be accompanied by valid clinical reasoning or evidence.
• A key feature is the distinction between Certificates of Immunization for K-12, with separate parts for complete immunizations (Part A), temporary medical exemptions (Part B), and permanent medical exemptions (Part C). Understanding the appropriate section to complete is essential.
• The form offers flexibility in indicating Varicella Disease (chickenpox) immunity through vaccination records or documented history of the disease, acknowledging natural immunity in lieu of vaccination.
• Use of optional fields like the child’s SSN and State Immunization ID# is at the discretion of the parent or guardian, but they can be helpful for accurately matching records within state databases.
• Signatures and dates from a physician or authorized clinic staff are required to validate the form. This ensures that a medical professional has reviewed and confirmed the immunization records.
• Finally, the DH 680 form must be issued by an authorized entity, typically a physician’s office or authorized clinic, and it must contain all necessary information and official signatures to be considered valid for school entry.

Navigating the DH 680 form doesn't have to be a daunting task. By understanding its sections, legal requirements, and the importance of correct completion, guardians can ensure their child meets Florida's immunization requirements for school enrollment, safeguarding not just their own child’s health, but also that of their community.