It is a profession –specific test that means the

nurses get a different tests to the doctors,

dentists, social workers etc…
what do you need to do???
ans: to write a letter
You may have to write …..
 REFERRAL LETTER
 DISCHARGE LETTER
 TRANSFER LETTER
 A LETTER TO ADVICE/INFORM A PATIENT ,
CARER OR GROUP
The type of the letter you write, it can be
find at the bottom of the case notes.
Subtle aspects of the tests you need to
understand ,because it is a difficult test to
prepare for…because it requires
FLEXIBILITY…
5 CRITERIAS:
 HOW WELL DID YOU COMPLETE THE TASK
 HOW APPROPRIATE IS YOUR LANGUAGE
 HOW WELL DID YOU UNDERSTAND THE CASE
NOTES
 HOW GOOD IS YOUR GRAMMAR AND
COHESION
 HOW WELL DID YOU PRESENT THE LETTER(
YOUR SPELLING ,PUNCTUATION,LAYOUT)
 Afteryou have understood the
task, you need to be able to
look at the case notes and
understand which ones are
important and which ones are
unimportant
The OET examiners purposefully put in
unimportant case notes to distract
you…

for ex: if you are writing to a doctor

about a patients diabetes- don’t
include that he or she broke their wrist
12 years ago..it is completely irrelevant.
 Physiotherapist- history of shingles
 Dermatologist- history of shingles.
 If you are writing to a cardiologist, you will not
need to include the detailed case notes of history
,because the cardiologist already knows the
information( whether it is first time or met before)
 Transform the case notes into your own words( do
not copy the Case notes directly into your letter)
 For example:
 If your case note is “ able to ambulate < 100
meters”( less than)….you could write “ Mr Chein
cannot walk more than 100 meters.
The person who you are writing, he has to
receive or to know straight away what’s the
main medical issue….
Example:
To dentist about a patient’s toothache – what
the dentist do?.... To remove the tooth ache.
“ I am referring John Smith who has presented
with severe tooth ache .I request that you
examine Mr Smith and possibly remove the
tooth.”
 REMEMBER that you are writing to a
medical professional, not writing a
text message to a friend.
 You need to expand contractions like
‘CAN’T= CANNOT
SHOULDN’T= SHOULD NOT
Use formal requests….
Can you= would you kindly…
Depends on who you are writing to…. If
you write to a Nurse/Doctor-can use
abbreviations. However if you are a
nurse and writing to a physiotherapist,
you cannot use medical jargon unless if
related to physiotherapy.
NOTE: think about what the reader will be
able to understand because you may
have to simplify your language…
 INTRODUCTORY SENTENCE
 THE MAIN ISSUE
 THE SECONDARY ISSUE
 ANY OTHER DETAILS
 THE REQUEST
 Letter head
 Date
 Dear
Re:
 Body of the letter
 Complimentary conclusion
Ms Petra McGovern
Cardiac rehabilitation clinic
St Jude’s hospital
56 Chelmsford St ( letter head)
NSW 2376

13 January ,2014 (date)

Dear Ms McGovern, (salutation)
Re: Justina Oakes, 44-years-old (reference)
Body…….of the letter….

Yours sincerely,
Susan Wilson,
Registered nurse
Use the correct salutation to begin and end the letter. A
“salutation” is a greeting.
 In Australia ,you should address all women as Ms
unless it is otherwise stated. For example- Judy
Barton , Nursing unit manager would be greeted as
‘ Dear Ms Barton.’
 Some married women choose to call themselves
Mrs. And make this very clear . For instance, (Mrs)
Sarah Jones would be greeted as ‘ Dear Mrs jones’
 You write a comma after the name of the recipient
eg; Dear Mrs Jones,
 never write “Dear Mrs sarah” or never write
 “ Dear Mam”.
A male child ( up to the age of
18) is referred to as ‘ master’.
Dear Master Jones,
A female child ( up to around
age of 18) is referred to as
‘Miss’
Dear Miss Jones,
If you are not told the name of
the recipient, you need to use
the fixed expression

Dear Sir / Madam,

Never write ‘ Dear Mam’

When a number is used to make an adjective
,we add a hyphen between the number and
words. This is because the words work
together as a single adjective. The hyphens
make the words clear.
Examples;
1) We will have a one-hour meeting about
his case
2) He came into hospital after a two-week
illness.
A hyphen can be used to indicate a range of
numbers. For example ,from one date to
another date. If you use the words ‘from….to’
, you should not use a hyphen.
examples;
 He suffered from chronic bronchitis 1990-
1995.
 He suffered from chronic bronchitis from
1990 to 1995
UK/Australian/New Zealand convention is the
format:
 Day + MONTH+ YEAR

Eg;
10 September,2013
You can also use numbers only – 10/9/2013

American system( month /day/year)

also, when you refer to a month within the letter,
always write the full word
Eg- Mrs X has an appointment at the Cardiac clinic
Next October
note: NOT ‘next Oct…..
Ave Avenue
Cnr Corner
Cres Crescent
Ln Lane
Pde Parade
Pway Parkway
St Street
ACT Australian Capital Territory
NT Northern Territory
NSW New South Wales
Qld Queensland
SA South Australia
Tas Tasmania
Vic Victoria
WA Western Australia
Note: in Australia each state has a postcode
beginning with a number for the state. Eg-
all postcodes in NSW start with a 2.
Ex- West Boronia NSW 2267.
Medical issue that will stick out. It is usually admission
diagnosis..
 Eg: I am writing to refer Mr X to you for ongoing
care and support. Mr X was admitted to the
hospital with…..he suffers from…
 I am writing to refer Mr X to you for follow –up
care…
 I am writing to transfer Mr X back to your care…
(Mr X was living in a nursing home ,went to hospital
and is now returning to the nursing home)
 I am writing to transfer Mr X for rehabilitation….
 I am referring Mr X back into your care for full
assessment of his recurring headaches…
 I am pleased to refer ….
 In a single sentence we have summarized
what is happening and what we want the
reader to do…this is the great way to start your
letter.
Remember that you explain the reason for the
letter at the beginning paragraph… and the
requesting will be written in the final
paragraph.. DO NOT FORGET TO STATE if the
referral is for urgent attention
Eg; I am writing to refer Mr X for an urgent
assessment of her swallowing problems…
Thank you for urgently seeing Mr X ,an 8 year old …
for further assessment and possible care or
management..
Mr X is being discharged from our hospital into your
care today…
Mr X was admitted into the hospital due to ……. On
the 10 may 2012….
note: you need to include two pieces of information
in your introductory sentences
Eg; he is now good… / he is perfectly alright.
He had been diagnosed to have…..
Based on ECG and blood test ,he has been diagnosed
with myocardial infarction..
Following an introductory sentence .. Then we need to specify in
more detail the main medical issue.. We can write this up into a
single paragraph that encapsulates all the relevant information
that the reader needs..
eg: On admission ,he was experiencing… fevers and rigors..he
suffered dyspnoea…he had chest pain…
She suffered from frontal headache, complained of blurred
vision… her blood pressure during her first day at the hospital ,
noted was…. During hospitalization he underwent a coronary
angioplasty… received treatment for…he was assessed for. He
was also reviewed by the physio/ occupational
therapist/dietician and started an exercise program..he has been
seen by a dietician …for …. Management… As well as this… he
has a family history of…. Heart disease….
On 12 May ,she complained of….her blood pressure showed a
slight increase/ decrease….
When you scanning the case notes that there will be
secondary issue emerging..this will be less
important than the main medical issue ,but it will
warrant its own paragraph
Eg: Mr X is also getting dizzy due to…. he was
given panadien forte( 500gm)….and had also been
requested to../he has started taking…..
Tab…daily…

Pethidine 100mg and intramuscular injection

maxolon 10mg were given..patient made no
complaints of pain…the regular medicine regime is
suggested…

After a week in hospital…he has stabilized…his

nursing management in hospital initially consisted
of…./based on nursing management…
Mr X has been on a new diet…he does insufficient
exercise…./he is doing less exercise..
A wheelie walker will be sent along with …at the hospital
he was provided …..

it is needed that he shall get all the facilities… it is

necessary that the patient shall perform ….exercises so
as to recover speedily ..
it is also suggested that…blood tests shall be followed
up…the patient was able to walk short distances with
help from his wife/ with walking frame….the patient was
suggested to walk with the help of walking sticks…

He has the habit of drinking… and he is a chain

smoker…it is suggested that he shall avoid smoking and
drinking until the time he recovers…..
Could you please educate him about…. Could you also check his
blood pressure weekly…
Would you please arrange a cardiac exercise program… and
monitor compliance …
Please encourage him to….he will need ongoing monitoring….to
maintain a healthy ….
Urgent assessment or examination of the patient is requested at
the neurology department…..
Educate the patient on the use of nebulizer/glucometer
Assess the wound…redress the wound/change the dressing..
Monitor the wound for infection
Liaise with the specialist/patient’s relatives
Check compliance with the medication/the exercise program
Ensure he / she attends her clinical appointment
Supervise personal care/showering / taking medication
Provide support to the patient
Encourage independence…
In order to handle the above mentioned effects be cautious when
driving a car, operating machinery or performing any hazardous
activities especially after taking his regular dose.
 It would be grateful for your opinion about…..if
you could please assist the patient…/if you could
arrange an appointment…
 I would be appreciated that if you could do the
further management and support..care…
 Please contact me with any queries…/ Should
you require any further information, please do
not hesitate to contact me
 It would be beneficial if you could…
 It would be appreciated if you could do urgent
assessment and treatment as you think
appropriate..
Review your verb forms used to indicate
…present ,past and future times…

Present( what the patient is doing now)

Past( what happened to the patient in the
hospital)
Future(what needs to happen for the patient in
the next days and weeks)
Note: The passive voice is used quite
frequently in formal writing..
 Examples:
Present;
Mr Davis is being transferred to Mount gold
Hospital today
Mr smith mobilizes with a stick / or a wheelie
walker/ crutches
Mr Smith is unsteady on his feet
She is independent with her ADLs/independent
with her personal care
He has hypertension and high cholesterol.
 Present perfect:

 for
 Since
For instance:
for four months, since 1983..
He has had COPD since 2008
She has had a leg ulcer for six months
he has lived alone for approximately two-
years, since the death of his wife
 Hypertension  She has had
in 2003 and hyperthyroidi
glaucoma sm since
since 1997,
[Link] hypertension
yroidism- since 2003
since 1997 and glaucoma
since 2004.
Past time ( to explain treatment whilst in hospital.
Also time ,expressions using ago

Mr X underwent a right knee arthroscopy

Mrs Y underwent cardiac monitoring in our unit
over the past three years
Mrs X came to the hospital for sleep studies this
week
Mrs Smith has been discharged today
He underwent a total hip replacement on the 19
March
She underwent treatment for cancer of the
pancreas
He noticed loss of hearing a week ago
To talk about when the patient needs care after
leaving the hospital….
For instances:
Mr X will need to have his clips/
sutures/staples/removed on 5/4/2013.
Mr Y will need to have a FBC and INR three days
after..
Mr X is for repeat MRSA swabbing next month
He will need his sutures removed in 7 days
She will need a dressing change in 3 days
She will need an INR in a week..
 Passive sentence is often used in writing as it avoids clumsy
sentences..
Examples….
he was commenced on warfarin 2mg daily( less clumsy)
The doctors recommenced him warfarin2 mg today( clumsy)
He was reviewed by the physiotherapist and given an
exercise programme to do at home
Her vital signs were monitored frequently after the episode
of chest pain
He was commenced on warfarin 2 mg daily
She was recommenced on her anti-hypertensives today
His digoxin was withheld for two days because his heart
rate dropped
He was diagnosed with anaemia
He was found to have a low sodium level which was
replaced with iv fluids
He was transfused with two units of whole blood
He was referred to ICU for a few days after an episode of
severe chest pain.
Parallel sentences often join the ideas using…
 As
 And
 Or
Make sure that parallel sentences are balanced
properly…
1: join using ‘so’
During the post operative period, Mr Hooper
experienced a significant amount of pain , so
a PCA was commenced…(principal component
analysis)
2;) Make sure that passive forms agree. In other words
,do not mix active and passive forms in the same
sentence.
For eg:
During the post operative period, anti -emetics were
given for nausea and vomiting and iv fluids
(were)administered to avoid dehydration
:
3;)There is no need to repeat ‘was’ in the past
passive… eg..Was transfused …was commenced.
Eg; his hemoglobin level decreased rapidly ,so he was
transfused with three units of blood and commenced
on iron supplements..

During hospitalization ,iv fluids were commenced and

a transdermal patch was used for her pain.
 Further examination  Further examination
revealed dry mouth, revealed dry mouth .
dentures were worn out In addition , her
on occlusal surfaces and a dentures were worn
heavy calculus deposit out on occlusal
was seen on the surfaces and a heavy
dentures. calculus deposit was
 note: verbs have been seen on the
replaced with noun dentures.
phrases  Further examination
revealed dry mouth
,worn out dentures
on occlusal surfaces
and heavy calculus
deposits on the
dentures
 Sally initially  Sally initially
presented to the presented alone
clinic on to the clinic on
27/12/17 with a 27-12-17 with a
3 – month- 3 –month-history
history of of constipation
constipation and and associated
associated using use of laxatives.
laxatives
 He has a family history of  He has a family
stroke and diabetic. history of stroke and
diabetes.
 Good hygiene should be
maintained by taking a  Good hygiene should
morning shower, using be maintained by
individual towels, taking a morning
washing clothes daily, shower, using
and to vacuum regularly individual towels,
washing clothes daily
 She diagnosed with
and vacuuming
hypertension in 1997
regularly
 She was diagnosed
with
hyperthyroidism in
1997.
 Became hypotensive/ hypertensive/
hypothermic/ tachycardic/became
confused//disoriented/aggressive/
depressed/unresponsive/ uncooperative
 Became hyponatraemic/ hypocalcemic/ anaemic
 Developed a pressure ulcer/ chest
infection/wound infection
 Complained of chest pain/angina/ numbness and
tingling/chest tightness
 Developed reduced cardiac output
 Had a hypoglycaemic attack
 Had a fall/ sustained bruising from a fall/
sustained a fractured arm from a fall..
 Others:
He was x-rayed and found to have a small
crack …the X-RAY shows…/detects
 Blood tests revealed that she had become
hyponatremic as a result of diuretic use..
 She has been started on an alternative
diuretic.
 He was commenced on nutritional
supplements..
 Both the CT scan and ultra sound indicated a
small lesion in the liver