User Guide excerpts for creating and certifying a Form 680:
14.0 Form 680 – Certificate of Immunizations (“Blue card”)
The Florida Certification of Immunization (Form 680) can be viewed and printed by utilizing the “Form 680” link located on the left-hand side of the screen. Once this link is clicked, the Florida Certification of Immunization selection criteria screen will appear (Figure 14.0-1). Users have the option of printing the form in several different formats, according to the intended use of the form and status of the patient. The computer printable Form DH680s are available to be ordered online directly from the Department of Health. To order online, go to www.flshots.com/resources/forms.html and click on the link to download and print out the order form. There is a small shipping and handling charge for online ordering.
Figure 14.0-1, Create Form 680 Once the correct options have been selected, the user will need to click on the “Create Current Form 680” button located on the bottom of the screen. Once the “Create Current Form 680” button is utilized, the Florida Certification of Immunization (Figure 14.0-2) will appear, and the user may then print the form at that time by clicking the “Print” button at the top-right of the screen. In order for this form to be legal, it must be printed on authorized “680 paper”, with the DOH watermark. This paper is available from the Bureau of Immunization or from your local County Health Department.
Figure 14.0-2, Florida Certification of Immunization
14.1 Electronically Certifying a Form 680
Certain users may also be able to create an electronically certified Form 680 if authorized by their local Florida SHOTS administrator (see section 20). If authorized, after clicking “Create Current Form 680”, users will see the completed Form 680 with two new options added at the bottom in addition to the option to print the form without electronic certification (button labeled “Print Only” in the top-right corner). These options are “Certify and Print” or “Certify Only”. Before selecting one of the certify options, the user must select the “Physician or Authorized Signature” to appear on the form from the provided drop-down list (Figure 14.1-1). The names that appear in this list are those who the local Florida SHOTS administrator has given the permission to certify a Form 680.
Figure 14.1-1, Electronic Certification Options Once the desired certify option is selected, the form will be certified and if not already printed, may be printed by selecting the “Print” option from the top-right of the displayed form. The certified form will show the embedded authorized signature as well as a unique electronic certification number and the Florida SHOTS logo. A certified 680 form is not valid without this special number and logo (Figure 14.1-2). The user that created the certified Form 680 will also be displayed on the form on the “Issued By” line even if it is the same as the authorized signature.
Figure 14.1-2, Certified Form 680
14.2 Working with previously certified Form 680s
Certified Form 680s will be permanently maintained with each patient record and may be viewed at any time by any organization. Organizations that created the certified Form 680s may also decertify the forms if needed (certified a Form 680 on the wrong patient, incorrect patient information or vaccinations, etc.). The last Form 680 that was certified for the patient will always be displayed on the From 680 creation page (Figure 14.2-1).
Figure 14.2-1, Certified Form 680 History Additional previously certified Form 680s may also be present on a patient’s record and may be listed by clicking the “Show historical Certified 680s” button (Figure 14.2-2).
Figure 14.2-2, Additional Previously Certified 680s To view a form, click “View”. If your organization was the one that certified the form you may also decertify it by clicking “Decertify”. Users will be given a warning when attempting to decertify a form as it is an irrevocable action. When viewing a previously certified Form 680, if any patient information present on the form has changed since the form you are viewing was certified, you will be presented with a warning at the top of the form (Figure 14.2-3).
Figure 14.2-3, Changes Made Since Certification To show what has changed since the form was certified, click the “Show Changes” button (Figure 14.2-4).
Figure 14.2-4, Changes Made Since Certification Users may print the previously certified form by clicking the “Print” button.
14.3 Search for Certified Form 680
Users may directly search for certified Form 680s without first searching for a patient. To do so, click the “Search for Form 680” link from the main menu (Figure 14.3-1).
Figure 14.3-1, Search for Form 680 This page is divided into two sections: “Patient 680 Search Criteria” and “My Organization 680 Search Criteria”. If the user’s organization does not have any users capable of creating certified Form 680s, they will not see the “My Organization ..” section. To search for Form 680s certified for a patient by any organization (including your own), change the search option to “By Patient (certified by any organization)”. Enter the required search criteria (last name, first name, date of birth, and sex) and click the “Retrieve Certified Form 680s meeting the above criteria”. A list of matching certified form 680s will appear below the button (Figure 14.3-2).
Figure 14.3-2, Search for Form 680 Results Users may view the Form 680 by clicking “View”, decertify it by clicking “Decertify” (if your organization was the one that previously certified it), and may also load a patient’s record in the background by clicking anywhere else on a row containing the patient. This will make it easy for you to quickly view or work on the patient’s record if needed or to verify that you are looking at the correct patient’s Form 680s. Users will get the option to continue or cancel loading the patient record after clicking on a row. Hovering over a row will show the patient’s address information in a purple pop-up box. To search for Form 680s certified by only your organization, select “By my organization only” as the search option (this is the default). By default, only the certification date range will be populated and it will contain a range going back 30 days from today’s date. This date range is the only required information when searching by Form 680s certified by your organization. Users may optionally add
patient name information to limit the results and may even enter the certification identifier number that was created when the Form 680 was certified. Click the “Retrieve Certified Form 680s meeting the above criteria” button to retrieve matching Form 680s (Figure 14.3-3). By using the “By my organization only” search, you may also print the results list as a report and/or download the results list to an Excel file by clicking either the “Print Report” or “Download to Excel” buttons, respectively. This is an effective way of monitoring and reviewing Form 680s certified by your organization on a regular interval.
Figure 14.3-3, Search for Form 680 Results
Personnel maintenance:
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Certify Form 680 – Set to “Yes” if this person’s name may be used as an authorized signature for certifying Form 680s. Users may be able to both have their name used as an authorized signature and create a certified Form 680. Work Location – Select from a list of your organization’s service sites (if your organization has more than one) which service site this person normally works at. This selection will be used as the default on screens requiring entry of service site. Create Certified Form 680 – Set to “Yes” if this person is authorized to create a certified Form 680. Users may be able to both create a certified Form 680 and have their name used as an authorized signature.
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