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The document is a screening form for adult immunization, specifically for Pneumococcal, Tdap, or Zoster vaccines. It includes patient information, a series of health-related questions to assess eligibility for vaccination, and sections for patient signatures regarding understanding the vaccine information and payment verification. Additionally, it provides guidelines on contraindications based on allergies and medical history.

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Versions	Form popularity	Fillable & printable
2013	4.9 Satisfied (33 Votes)

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How do I get a 121 form in Mississippi?

Form 121 (Immunization Compliance) can be obtained from your childs doctor, county health departments, or be downloaded online.

How do I get my immunization records online in Florida?

Submit your request directly to Florida SHOTS: You can request your vaccination records directly from Florida SHOTS by filling out the Florida Department of Health form DH3203 Authorization to Disclose Confidential Information form online, electronically sign and submit it.

How do I get my DH 681 form in Florida?

Note: Please contact your local county health department for documentation required to obtain Form DH 681. See the Immunization Guidelines: Florida Schools, Childcare Facilities and Family Daycare Homes for complete information on exemptions.

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What is a Form 680 in Florida?

Students entering schools in Marion County, Florida, for the first time need the Florida Certification of Immunization form, which is also known as Form 680 or a blue card. This form must be completed by a physician or a Florida county health department.

What is a religious exemption from immunization in Florida?

How can I get a religious exemption from immunization for my child? A request for a religious exemption from immunization requirements must be presented to the facility/school on the Department of Healths Religious Exemption From Immunization (DH 681 Form).

What is the form DH 680 for immunizations in Florida?

The Form DH 680, Florida Certification of Immunization, must be used to document receipt of Immunizations and is required for enrollment into the Florida school systems, programs, childcare facilities, and family daycare homes.

What vaccines are required by law in Florida?

What immunizations are required for a child to attend school in Florida? 5 doses DTaP (diphtheria-tetanus-pertussis). 4-5 doses Polio (Kindergarten). 2 doses MMR (measles-mumps-rubella). 3 doses Hepatitis B. 2 doses Varicella (chickenpox).

Where do I get a Florida certificate of Immunization?

How do I obtain my childs certification of immunization (DH Form 680)? The DH Form 680 is available from your health care provider. Additionally, you may be able to download directly from your own computer. Ask your health care provider for the State IMM Id and Certification PIN of your childs DH Form 680.

Printing form shot 2025

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Got questions?

Can I type my electronic signature on my [KEY]?

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How do I get a 121 form in Mississippi?

How do I get my immunization records online in Florida?

How do I get my DH 681 form in Florida?

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What is a Form 680 in Florida?

What is a religious exemption from immunization in Florida?

What is the form DH 680 for immunizations in Florida?

What vaccines are required by law in Florida?

Where do I get a Florida certificate of Immunization?

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