Trust/gp address Date ifr team South, Central & West csu omega House 112 Southampton Road

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Trust/GP address


IFR team

South, Central & West CSU

Omega House

112 Southampton Road

Eastleigh SO50 5PB

Dear team
Prior Approval– Hallux valgus (bunions)

Patient Name/ DoB

NHS Number

Referring GP/ practice

Consultant/ Providing Trust

Date of clinic

Surgery for hallux valgus (bunions) should only be offered when all the following conditions have been met.

The patient has been previously managed by MSK or podiatry services and that all footwear options have been exhausted.

Date of previous assessment:

Brief summary of previous interventions:


Has significant functional impairment related to the hallux valgus.

Please provide details of impairment:


That the patient is fully informed and is aware of the pros and cons of surgery ☐

Please note it is the clinician’s responsibility to obtain patient consent to share this and all supporting materials with the Commissioning Support Unit. All information will be used and stored in accordance with the Data Protection Act.
Yours sincerely

Referring/Treating clinician GMC Number
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