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Surgery ………………………………… Date ………………………………… Please return during office hours to: Duty Team Leader, Badger House, 121 Glover Street, Birmingham B9 4EY Fax: 0121 766 5135 For further information Tel: 0121 766 2120 Please telephone Badger to confirm receipt For BADGER use only: Data added to the system Date: Initial: Surgery has contacted to confirm receipt Author or Department Operations Issue Date October 10 Version V1.1 Date: Initial: Document Ref OPS-F-018 Approved By B.Moss Approval Date October 10 Next Review October 18 Page 1.