Florida's required certificate for entry to preschool, K-12 schools, licensed child care facilities and family day care homes. It documents complete immunizations (Part A), a temporary medical exemption (Part B) or a permanent medical exemption (Part C). There is no blank form to download: clinicians generate it in Florida SHOTS, the statewide registry, and the family gives it to the school or facility.
A Florida-licensed physician or county health department completes Part A or B; the Department's guidelines also allow a public health nurse or the physician's authorized designee to sign those parts. Part C may be signed, by hand or electronically in Florida SHOTS, only by a physician licensed under Chapter 458 or 459, Florida Statutes.
Record the child's complete name, date of birth and the name of the parent or guardian. The Social Security number is optional. A computer-generated DH 680 shows the Florida SHOTS state immunization ID number, which is not a required item. Each provider issuing the form must use professional judgment about the validity of any immunization history the parent supplies.
Enter every vaccine administration date as month, day and year. If the child received more doses of a vaccine than required, the last space to the right should show the date of the last dose given. The guidelines call a written document with immunization dates vital, so ask parents to secure records from every prior provider.
Complete Part A for children who have received all required vaccinations, with the physician or clinic name and address, signature or electronic certification, and the date signed and issued. Do not use Part A for children in child care, family day care or preschool unless they are four and have completed all kindergarten immunizations.
Use when a child has received as many immunizations as are medically indicated and is still completing the series. An expiration date is mandatory and should be the date the child is past due for the next dose. At the follow-up visit, add the new doses, cross out the old date, write and initial a new one, or generate an updated form.
Use when a child cannot receive one or more vaccines for medical reasons. Document the doses the child has received, list each contraindicated vaccine, and give valid written medical reasons for each one not administered. Only a physician licensed under Chapter 458 or 459 may sign, by hand or electronically in Florida SHOTS. Complete Part A or B alongside it.
Download the current version from the source each time; forms change without notice.
Florida Certification of Immunization
Florida Department of Health, Bureau of Immunization takes this form through its online services or your EMR, so there is no PDF to fill. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Sources for this guide
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
The Department of Health does not post a blank DH 680. The certified form is generated in Florida SHOTS, the free statewide immunization registry, and enrolled private providers, county health departments and schools can print an electronically signed copy. A copy or fax of a completed, properly signed DH 680 is acceptable, though schools try to keep originals on file.
Only a physician licensed under Chapter 458 (medical practice) or Chapter 459 (osteopathic medicine), Florida Statutes, can sign Part C, by hand or electronically in Florida SHOTS. The physician must list each vaccine that is contraindicated and state valid medical reasons in writing. A child entering a Florida school for the first time with a permanent exemption needs Part A and Part C.
A Part B temporary medical exemption is valid only until the expiration date written on it, which is when the child becomes past due for the next immunization. The child must return before that date. About two weeks before it expires, the school or child care facility should send the original back to the parent for the physician to update.