Referral letter

I am referring [Mr/Mrs. Last Name of the Patient], who is suffering from

[Medical Condition/s on Admission of the Patient], for assessment and
ongoing management

I am writing to refer Ms Anne Hall, a 45-year-old schoolteacher who has features of

gastro-oesophageal reflux with possible stricture, for further investigation and a
definitive diagnosis.

I am writing to refer this 29-year-old patient, with symptoms and preliminary

investigations suggestive of hyperthyroidism, for specialist assessment.

I am writing to refer Mr.X, a 45-year-old patient who is presenting with features

suggestive of XYZ . He requires urgent medical attention.
………………………………….who is presenting with symptoms and signs suggestive of
severe depression with a possibility of bipolar disorder.

Thank you for seeing Mr. Seymour, a 60-year-old retired academic,

who is presenting with very painful left first toe consistent with
gout. Your valuable assessment would be highly/greatly appreciated

Thank you for seeing Mr. McCrae, a 51-year-old barrister, who has features
consistent with colon cancer. Your further assessment, as early as possible, would be
highly appreciated.

Thank you for seeing Mr. McCrae, a 62-year-old barrister, who has been recently
diagnosed with adenocarcinoma of the ascending colon. Your surgical assessment
would be highly appreciated.

I am writing this letter concerning Ms Eleanor Bennet, a 45-year-old divorced lawyer,

who needs (is in need of) referral for cardiac medication review as she has features
of side effects of captopril. and possible methods to improve her lifestyle.
I am writing to refer Ms. Eleanor Bennet, a 45-year-old lawyer, for a cardiac
medication review due to suspected side effects of captopril which may be
associated with her current treatment.
DX has done

Thank you for seeing …………. who has developed adenocarcinoma of the
ascending colon, confirmed by colonoscopy and biopsy. Your urgent intervention
and management of this patient would be appreciated.
"Thank you for seeing [Name], who has been diagnosed with adenocarcinoma of the
ascending colon, confirmed via colonoscopy and biopsy. Your urgent intervention and
management in this case would be greatly appreciated."

Thank you for seeing Ms Bennet, who has recently been diagnosed with acute
myocardial infarcton. She requires a review of her cardiac medications and advice on
lifestyle modification.

I am writing to refer /referring Ms Bennet, a 40-year-old widowed, who has recently

been diagnosed with acute myocardial infarction, for review of her cardiac
medications and advice on lifestyle modification.

I am referring Ms. Bennet, a 40-year-old widow, who has recently been diagnosed with acute
myocardial infarction, for a review of her cardiac medications and guidance on lifestyle
modifications."

I am writing to refer Mrs. Khaze, a 46-year-old married nurse,who has been

diagnosed with left breast cancer, for your specialist assessment and
management. She may require a mastectomy."
I am referring Mrs. Khaze, a 46-year-old nurse and mother of four, diagnosed with left breast
cancer, for your specialist assessment and management, including consideration of a
mastectomy.

I am writing to refer Mr. Cribb, a married and unemployed male who has /who
has been found to have- a renal mass, for your specialized evaluation and
management. He requires further assessment and may possibly need a CT scan.

"I am referring Mr. Cribb, a married and unemployed male who has developed
a renal mass, for your specialized evaluation and management. He requires
further assessment and may possibly need a CT scan."

I would appreciate your specialised evaluation and management, with a possible

CT scan if deemed necessary.
"I would appreciate your expert evaluation and management, with a possible CT scan if deemed
necessary."
I am writing to refer Sally, a 16-year-old high school student who is suffering
from anorexia nervosa, for your evaluation and appropriate management as you
feel.

In urgent case (diagnosis)

Thank you for evaluating/accepting / seeing Mr./Mrs. [Name], a [Age]-year-old

primigravida, who is suspected of having [Condition].Your urgent assessment and
management, with possible consideration for cholecystectomy, appendectomy, or laparotomy
Would be appreciated.

Given the urgency of the situation, we appreciate your expertise in assessment and
management

Thank you for seeing Mr. Derek Romano, a 46-year-old insurance clerk, who is
diagnosed with an acute myocardial infarction and required urgent management.

I am writing to refer Mr. Jones , a 57 year old man who was admitted to hospital
on the 18th of July, diagnosed with myasthenia gravis.

I am writing with regard to/ regarding Mr. O’Riley, a 53-year-old man who was
admitted the hospital on the 2nd of September and diagnosed with obstructive
coronary artery disease. He underwent a coronary artery bypass graft on the 4th
of September.

Discharge letter

1st paragraph (aim for writing)

GP
I am writing to update you regarding Ms. Garcia, a 20-year-old student who has
been treated successfully for bacterial meningitis. Your further follow up would be
highly appreciated
I am writing regarding Mr Smith who is being discharged from London City
Hospital on 01/01/2019 after being successfully treated for a myocardial
infarction.

I am writing regarding Mr Lionel Ramamurthy, who was

admitted on 04/02/2019 due to pneumonia. He is being
discharged back into your care tomorrow.

I am writing with regard to Mr. O’Riley, a 53-year-old man who was admitted
the hospital on the 2nd of September and diagnosed with obstructive coronary
artery disease. He underwent a coronary artery bypass graft on the 4th of
September.

I am writing to refer Mr McCarthy under your care / back to your

supervision/ back into your care, who is being discharged today
after a below knee amputation for diabetic ulcer.

I am writing to update you on Mrs Coco Thompson's condition, a 71-year-old

with a diagnosis of alcoholic liver disease, who is due to be discharged into
your care for BP and medication compliance monitoring.

Specialist

I am writing to request pulmonary rehabilitation for Ms Roberts, a 54 year-old

divorced teacher, who underwent treatment for hospital acquired pneumonia. She
was admitted following a fall at home while descending the stairs and is due to be
discharged today.

I am writing to refer/update to you on your patient, Alan

Brown, a middle school student who has recently been
admitted to Brookdale Hospital for abdominal pain and
is now in need of psychiatric assessment for
suspected depression

Transfer letter
1.“I am contacting you in regard to Mr Lionel Ramamurthy who was
admitted to Newton Hospital on May 20th 2019 with a provisional
diagnosis of renal failure.
I am referring this patient to your care for further follow-up/ Supervision,
to ensure her further management / postoperative care/ to ensure her
compliance with(to) medication/ to reinforce his sugar control
treatment and investigation.”

[Link] you for accepting this 68-year-old man who has recently
undergone post left total knee joint replacement for rehabilitation and
assessment for suitability to return to his home.

[Link] accept this urgent ICU transfer of a suspected COVID-19

patient
whose condition has rapidly deteriorated and who requires critical care
and ventilatory support.

BODY
[Link]+ family+ medical history (in acute case it goes before
conclusion)
Mr. McCrae is married and has 4 children. He is a smoker; however, there is no
family history of colorectal carcinoma, colonic polyps or inflammatory bowel
disease.

His family history is notable for RA related to his father.

Her family history is notable for breast cancer, as her sister had it.
Her family history is notable for breast cancer, as her sister passed away from it."

He has a positive family history of asthma in his father.

Her only known family history is diabetes in her maternal grandmother.
"She has a positive family history of lung disease on her father's side."
"She has a positive family history of lung disease through her mother

Apart from a family history of asthma in her mother and 15-year-old sister, she
had been otherwise well and no other significant past medical history.

Miss Hassan is generally well, takes only over the counter vitamin D and is
allergic to latex.

Regarding his past medical history, the patient reported mild on and off pain in the
right and left wrist joints.
Ms Styles was diagnosed with mild hypertension in 2011, which progressed to moderate in
2013, diabetes type 2 in 2013 and depression in 2016.

Her current medications are quinapril, 40mg and metformin, 500mg both twice a day
and gliclazide, 30mg daily

Ms Roberts has had COPD since 2005 for which she takes Flovent and Pulmicort inhalers.
(Tip: ‘has had’, in this sentence, means ‘has been suffering from’.
Alternatively, you may even write –Ms Roberts was diagnosed with COPD in 2005.

2nd
15 weeks ago, Mr. …. presented with…………….. On examination,…… My
assessment was ……………and thus, paracetamol was given/instituted
/commenced. I also advised bed rest and arranged for a review in 2 days/
scheduled review in 2 days’ time.

At that time, I felt her problem was……..;thus………was prescribed

I prescribed a proton pump inhibitor (omeprazole 20mg twice daily) and asked
to see him in 4 weeks’ time.

He is non-compliant with his regular medications including colchicine,

indomethacin, and allopurinol.
He was non-compliant with medications. I advised him to comply with Pulmicort
and quit smoking. Pantoprazole was prescribed for gastro-esophageal reflux disease.
CXR and FRE were ordered.

He is non-compliant with his regular medications including……..

His family history is notable for RA related to his father

His left first toe appeared red and moderately inflamed with no evidence of
other joints involvement. Accordingly, in addition to paracetamol and oxycodone,
compliance with his regular medications was recommended. Moreover, lifestyle
modifications regarding diet and alcohol intake were discussed.

Therefore, I advised that he avoid heavy lifting and reduce alcohol consumption. A
review consultation was scheduled for 3 months later.

therefore, some investigations were ordered including a complete blood

count, faecal occult blood test (FOBT) and colonoscopy.
2nd
His blood test came as follows: positive faecal occult blood test , mildly elevated CRP
and ESR along with anaemia and a high WBC count.
He has been advised to quit smoking.

Therefore, I prescribed ……to her. FBE, U&Es, creatinine, LFTs, full lipid profile and
HBA1C were requested.
The patient would be reviewed within 2weeks/ arranged a review meeting within 2
weeks’ time/asked him to see me within 2weeks.a follow-up meeting was set-up
within 2 weeks” time.

Two weeks later, I discussed the pathology report with the patient which
revealed…………Accordingly, metformin was changed/adjusted to 1 b.d.,while
glipizide was continued as before. Atrovastatin 20mg 1 mane was added.

In addition to the previous visit’s advice, I have recommended an urgent synovial

fluid sample in the next episode.

However, on the 16 of September, she exhibited features of pneumonia,

manifested as fever, cough and pleuritic chest pain. On examination, her
temperature was 38.4 and oxygen saturation was 94 for which 2L of
oxygen therapy was given.

Relaxation therapy and counselling started and Diazepam 10 mg at night was

prescribed based on my provisional diagnosis of early depression or schizophrenia.

During hospitalisation, Ms Roberts initially received blood transfusion, morphine,

Panadeine forte and wound dressing for a fractured femur and hemorrhage.
However, on the 16 of September, she exhibited features of pneumonia, manifested
as fever, cough and pleuritic chest pain. On examination, her temperature was 38.4
and oxygen saturation was 94 for which 2L of oxygen therapy was given. Intravenous
linezolid therapy was instituted after a chest X-ray had revealed a dense white
shadow.

On subsequent visits, his condition persistently/consistently deteriorates. An ECG

was done on x/x/xx which showed…….; therefore, xxx is ordered……and a review
visit was arranged in 2 weeks.

3rd
On today’s review, Mr Seymour’s gout episode is subsiding. X-ray result has
shown……….. Furthermore, pathologytests results have revealed …………………….

However, the patient suspects that he has RA and wants a referral to a

rheumatologist.

Miss Hassan re-attended on 13th March with worsening symptoms and new onset
…………../palpitations. Her heart rate was 92 and her ECG was normal. Blood
investigations confirmed a TSH of 0.3 (other investigations normal). The results of a
24 hour ECG are pending. Yet to obtain.

I discussed the potential diagnosis of hyperthyroidism with Miss Hassan

today.

Of note/To be noted/ it is worth mentioning that, she advised she would like
to start a family in the future. Miss Hassan is generally well, takes only over the
counter vitamin D and is allergic to latex.

3 weeks ago, she revisited the clinic with the same symptoms. There was no
improvement with body weight although she was following a healthy diet plan.
In addition, the investigations revealed………………………………...
Her ………….also persistently high and thus ……………..were
given/prescribed . Furthermore, she was advised to continue a healthy diet.

Therefore, she was advised to consider surgical management if her condition

didn’t resolve by ……………….

She urinated four times a night. Furthermore, she complained of lethargy

during the preceding seven weeks. At that time, she was overweight. Dietary
advice was given and relevant investigations arranged

On 16 December, the patient re-presented with her symptoms unchanged and

raised BP. In addition, she reported frequent headaches. Her test results
showed that her blood sugar was 11 mmol/l and that the albumin in her urine
was elevated but without any evidence of sugar

As mentioned above, Mrs. Athena presents today with worsening diabetic

symptoms. Moreover, her vision is blurred and she has sight spots.

On examination of Mr. Foster today, he is still suffering from the same symptoms
because he does not cease smoking and does not take pulmicort regularly. Tests
results were normal. He was advised to take pulmicort erratically but he forget it. He
should take it as soon as possible but must not duplicate the dose. Some strategies
regarding smoking cessation were discussed with him namely, nicotine patch,
information brochures and involvement with supporting groups. An appointment
was made within 7 weeks

Examination revealed a slightly swollen joint and there was a tender spot in
the medial aspect of the joint.

Examination findings revealed painful limited flexion and extension. However,

analgesics were prescribed and he had medical leave from his work.

All examination findings were normal/ unremarkable apart from mild obesity.

The rest of the examination findings were not significant.

Despite this treatment, he developed intermittent pain and swelling of the

joint. The x-ray showed no evidence of osteoarthritis. However, the range and
power including passive and active movements was impaired. An MRI scan
was therefore ordered and revealed a damaged medial cartilage.

She revisited the clinic on ……………… On that visit,she was recovering from
………….moreover, she had also reduced her cigarette intake. Thus, the
medications were discontinued.

Hence, some investigations were ordered and a review was arranged in 2

days.

She was also advised to come back for a review in 48 hours.

On today’s review, Mr McCrae is still feeling unwell.

Today, he reports having developed………………

On today’s visit, her condition ………..

Regarding treatment, she was advised to finish the antibiotics

Conclusion
In view of above

I suspect Mrs … might be suffering from either ……. or ………. I would

appreciate it, if you could assess her for further investigations and management

Given that
 In light of the above/ in view of above, I would be grateful if you could
evaluate Mr McCrae’s condition urgently.
Should there be any more queries, kindly do not hesitate to contact me.

Given this history and the presenting symptoms today, I believe that she is
experiencing a depressive psychosis and would appreciate your further assessment and
management.

Based on the above, I believe that this patient needs a

psychiatric consultation and would appreciate your assessment
and management of his condition.

For further information, please feel free to contact me.

It would be appreciated if you could review Miss Hassan, arrange further

investigations as necessary / AS you feel …..and give advice regarding both
further management and implications for fertility

I would appreciate it if you could assess Mrs ………. for possible surgical
management of

I would appreciate it if you could assess and manage urgently for her condition.

My provisional diagnosis is lumbar disc prolapse compounded by radiculopathy.

However, I would be appreciate if you could arrange a consultation to order an MRI
and assess his suitability for surgery.
#Of note, his wife wanted him to be discharged back to his home under her care;

# Given this history, I believe her to be suffering for……and would appreciate your
further assessment and management.

Given her current symptoms (and long history of asthma) I would be very grateful
if you could please assess and evaluate

In view of the above, I would appreciate your attention to this patient.

If you have any queries, please contact me.

In view of the above, it would be greatly appreciated if you could take over her care
and treat her as you see appropriate.

In view of the above, I would greatly appreciate your specialist managemer of ms xx

condition and treat her as you see appropriate.

As stated above, I believe that Riley is experiencing post-streptococcal nephritis with early
renal failure. Therefore, I am referring Riley to you for further assessment and management.
Please do not hesitate to contact me if you have any further queries.
Given the previous history, I would be grateful if you could advise Mr. Jones
regarding the duties he can perform and assess his workplace.
For any queries, please contact me.

Based on the above, I believe that this patient needs a psychiatric consultation
and would appreciate your assessment and management of his condition.

Urgent

………………………………………..If you see Mr…………….at your

earliest convenience for further investigation/ for an endescopy/ for possible
arthroscopic examination…………..as I am concern about the possibility of
……………………………

DISCHARGE
As for the discharge plan, Ms Tailor needs help in maintaining her behavioural
control given her current substance abuse, and to provide therapy if needed.
Please be advised that her condition may relapse if she shows poor compliance with
her medications or consumes substances.
Her current medication is risperidone; 4 mg orally at night, and advised was given to
take 1 mg of risperidone if notices agitations or psychosis.

Writing notes

 Time is 45 minutes : 5 minutes reading and 40 minutes writing.

 Number of words should be 180-200 words +/- 10 words.
 Each paragraph should contain at least 2 sentences.
 The diseases are written in full and small letters if composed of one or two
words, ex: diabetes mellitus, gout.
 The diseases are written in abbreviation and capital letters if composed of
three or more words, ex: UTI, URTI.
 Investigations are written in abbreviation and capital letters, ex: CBC.
 Drugs are written capital for trade names, ex: Ventolin.
 Drugs are written small for generic names, ex: paracetamol.
 In short cases, use the long version of introductory and conclusion
paragraphs, but in long cases, the short versions are used.
 Don’t forget to use capital letter after full stops and small letter after
commas.
 Avoid too long sentences.
 Avoid mixing tenses in the same paragraph, except body 1.
 Use passive.
 Use formal terms, ex: tell  inform , start  commence.
 Don’t write details in introductory and conclusion paragraphs.
 Use (an) for an X-ray and an MRI.

The ideal letter should have 6 parts :

1. Address.
2. Introductory paragraph.
3. Body 1 : social and medical history.
4. Body 2 : visits.
5. Body 3 : final visit.
6. Conclusion paragraph.

FORMATE

1-Address format:
Dr Sara Adams
Psychiatrist Dear Dr Adams,
177 Main Road
Newtown Re: Mr Jones Walter D.O.B.
07/03/1986
17/01/2016
Or Dear Sir/Madam,
Admitting Officer
123 Second Avenue Re: Mr Jones Walter, 30 years of
Newtown age

17/01/2016

2- Introductory paragraph:
long introduction:
I am writing this letter to refer Mr Walter, a 30-year-old patient (teacher), who
is presenting with signs and symptoms suggestive of gout. I would be glad if
you could manage his condition as you think appropriate. (38 words)
Short introduction:
Thank you for seeing Mr Walter, a 30-year-old patient (teacher), who is
presenting with features consistent with gout. Your further management is
highly appreciated. (25 words)
Other sentences that can be used in this paragraph:
His condition is getting progressively worse.
His condition is getting much better.
His condition needs your further management.
His further evaluation is highly appreciated.

3- Body 1: (social and medical history)

Ms Adams is married with three children. However, she does not smoke, she is
a heavy drinker. Regarding her medical history, she is ………. Please note, her
father had ………. .
Use present t.

4- Body 2: (different visits)

On 02/12/2016(first visit), the patient initially presented complaining of ………
; consequently, blood tests were ordered which unfortunately revealed ……….
A month later (second visit), she attended the clinic for ……… . later on (other
visits but not the last), she …………. .
Use past t.
5- Body 3: (today′s visit)
Today, the patient came reporting that ……… . Thus, ……….. .
Use past t.
6- conclusion paragraph:
Long conclusion:
My provisional diagnosis is gout. Therefore, I am referring this patient for
further management of her condition. For further queries, please do not
hesitate to contact me. (27 words)
Yours sincerely,
Doctor
Short conclusion:
In view of the above, I am referring this patient for further management of her
condition. For further queries, contact me. (21 words)

Yours sincerely,
Doctor

OET writing template

1. Address
Dr Lisa Smith Doctor’s name/Admitting officer (if doctor’s name not given)
Endocrinologist specialty
City Hospital
New town

10/02/2018 Today’s date

Dear Dr Smith, Dear (doctor’s name)

Re: Mrs. Priya Sharma DOB 08/05/1952 (or aged 35 years)
Re:(patient’s name) DOB/age (if DOB not present)

2. Introduction (25-30 words)

Mainly 2 sentences
1. Thank you for seeing Mrs. Sharma (family name)
(I am writing this letter to refer you Mrs…),
2. a/an 42-year-old accountant,
3. whose features are consistent with
(whose features are suggestive of)
(who has recently developed)
(who is presenting with symptoms and signs suggestive of).
Who is a long time sufferer of……../
who has been suffering from……uncontrol
who I suspect has developed acute cholecystitis/ appendicitis.
4. Your further management would be highly appreciated
(I would be grateful if you could manage her condition as you think
appropriate).
2. Body 1 Social and Medical History (45-50 words)
Mainly present tense
1. Mrs. Sharma is married (widowed) with two children,
2. Regarding her medical history she suffers from…..
(she has medical history of)
(whose medical records show that she has a long history of)
(her past medical history reveals that)
(her past medical is unremarkable apart from...
3. for which she has been taking (Which has been managed accordingly).
[Link] note, (It is worth mentioning that) the patient has an allergy to...

4. Body 2 In between visits (45-50words) Mainly past

1. On 15/01/2018, 2. the patient attended my surgery with
(presented with)
(came complaining of) a two days history of…
2. ;thus (therefore),
3…….one month later, he developed…. later, ...
On subsequent visit he reported his condition Deteriorate/ improved/
static/ stable/ progressed/ worsened …..
As a result, x-ray/USG was recommended ………..
And review visit was scheduled in 2 weeks’ time.

5. Body 3 Final visit (today) (45-50 words)

Mainly past
Today, Ms Sharma came complaining of …..
Her examination revealed ….. Thus, ….

6. Conclusion
1. In view of the above, /in light of the above,
(My provisional diagnosis is)… ; therefore,
I am referring this patient for further management of her condition.
I am referring this patient for further evaluation and management of her
condition."
"I am referring this patient for specialized care regarding her condition.
3. For any queries, please contact me. (please do not hesitate to contact
me for any assistance you require regarding this patient).
Should you need any further information, please

Yours sincerely,
Doctor ……
Some used expressions and sentences:
 Mrs .. Is a widowed woman with 4 children, but she lives alone.
 Mrs … is a single woman whose medical history is unremarkable except for
allergy to certain drugs as …..
 Mr …. Is a single man who is known to be smoker.
 Ms … is a single non-smoker patient who has history of ….
 Ms …. Is a single woman who used to live with her boyfriend with no family
in Australia. (November 2014)
 She does not smoke nor drink.
 However he does not smoke, he is a heavy drinker.
 He is a heavy smoker and he drinks as well.
 She has osteoarthritis along with aortic valve replacement. (March 2015)
 The patient was referred upon his request. (May 2014)
 As a result, he was commenced on …..
 Adherence to Pulmicort is reinforced. (October 2014)
 Eventually, she agreed on the referral to a psychiatrist. (November 2014)
 Please informing about the possibility of surgery is highly appreciated. (July
2014)
 She has osteoporosis and dementia, for which has been prescribed …..
 She was non compliant to her treatment.
 Your advice on the duties that can be done is highly appreciated. (June 2015)
 But unfortunately his condition achieved no improvement.
 Fortunately, the asthma was controlled by ….
 The patient regrettably presented with worsening symptoms.
 His medical history is unremarkable apart from being overweight.
 It is worth mentioning that ….
 The patient presented complaining of ….
 The patient came reporting that …..
 The patient attended the clinic for …..

On the next day/ after three day his condition deteriorated/

improved/settled/got stable.

 Remember to use the joining words as: ; therefore, ; however, ; hence , ;

consequently , ; in addition, ; then, ; thus , ; moreover ,
Semicolon;
Colon: On examination:
His examination is unremarkable: he had tonsillar hypertrophy, his BP was
90/60, urinalysis confirm haematuria
3. Common signal words which can help you present information
clearly and logically include:

 Time: At that time, On review today, On consultation today, Recently, Over

the past 3 weeks....,
 Location: During hospitalization, Initial examination at my clinic
revealed...,On examination....
 More information: In addition, Moreover, Also, Apart from this.
 Contrast: However, Despite, Although.
 Result: Therefore, Consequently, As a result, For this reason...
 Emphasis: Please note, May I remind you, My main concern is...., What
concerns me most is.....
 Sympathy: Unfortunately, Regrettably, Fortunately.
 Subject: In terms of her social history..,With regard to her medication..,
Regarding her medical history
 Advice: It is important to..., I recommend that you....., Please ensure that....
 Chronology: Firstly, Secondly, Finally.

Signal words and phrases

They link sentences together so that the information flows smoothly and is easy to read.
Common signal words/phrases which can help you present information clearly and logically
include:
Additional information: Moreover, Also, In addition, Apart from this, Furthermore
Advice: I recommend that you....., It is important to..., Please ensure that.....
Contrast: Despite, However, Although
Emphasis: My main concern is...., Please note, May I remind you,
What concerns me most is.....
Location: Initial examination at my clinic revealed..., During hospitalisation, On
examination....
Order: Firstly, Secondly, Thirdly, Finally
Result: As a result, Therefore, Consequently, For this reason...
Sympathy: Unfortunately, Regrettably,
Subject: Based on the test results....., Regarding her medical history....., In terms of her social
history..., With regard to her medication...., Her medical history shows..., The risk factors
include....., Treatment to date includes...
Time: On review today, On consultation today, On 19/08/10..., At that time, Recently, Over
the past 2 weeks...., Three weeks later, On her next visit, During, Since that time, Initial
examination...
 MODEL ANSWER

REFFERAL
(Post streptococcal pneumonia + ARF)

Dr. F. Shaw
201 Albert Street
South Cottingham

20th March 2014

Dear Dr Shaw,
Re: Riley Precious

Thank you for seeing Riley, a four-year-old boy with a provisional diagnosis of
poststreptococcal nephritis with early renal failure.

Riley first presented to me on 25th February 2014 with a history of sore throat, husky voice,
fever and irritability. I made a diagnosis of tonsillitis and prescribed penicillin V 250mg q.i.d
for seven days.
Three weeks later (18.03.2014), Riley returned to the surgery and his father reported that
he had noted that his urine was discoloured four days previously. Riley was also lethargic.
His blood pressure was 90/60 and his urinalysis revealed macroscopic haematuria. His
throat examination was consistent with tonsillar hypertrophy. His father was advised to
increase his oral fluid intake and return to the surgery today (20.03.2014).

On examination today, Riley’s blood pressure has elevated to 110/90. Although Riley is
asymptomatic, his urea and creatinine are slightly elevated. Moreover, there is a marked
elevation in AOST (+++), and his mid-stream urine sample has 4 x 10 red blood cells of renal
origin. However, his FBE is normal.

As stated above, I believe that Riley is experiencing post-streptococcal nephritis with early
renal failure. Therefore, I am referring Riley to you for further assessment and management.
Please do not hesitate to contact me if you have any further queries.

Yours sincerely,
Dr Smith

Referral
Ms Jane Graham
Newtown Occupational Therapy
10 Johnston St
Newtown

20/06/2015

Dear Ms Graham,
Re: Mr. Barry Jones, DOB: 01/04/1972

I am writing regarding Mr. Jones, a-44-year-old forklift driver, who wants to

return to work after a back injury. Your assessment of his workplace would be
highly appreciated.

Mr. Jones, who is married, is a father of three. His work requires prolonged
sitting and occasional heavy-lifting.

On 21/03/2015, Mr. Jones initially presented with lower back pain following
heavy lifting. His X-ray revealed no abnormalities; therefore, he was referred
to a physiotherapist and was given sick-leave for 30 days. On the subsequent
visits, he came complaining of persistent pain along with stiff movement
despite his compliance with exercises. Thus, he was given another 30 days
off work
 Today, Mr. Jones' condition showed mild improvement as his range of
movement is increasing gradually. He also reported that the pain becomes
worse when sitting, lying down or walking for 30 minutes. Apart from that, he
was bored and wanted to return to work. Thus, I advised him to return to work
as long as he would take breaks regularly and would not lift heavy objects.

Given the previous history, I would be grateful if you could advise Mr. Jones
regarding the duties he can perform and assess his workplace.

For any queries, please contact me.

Yours sincerely,
Doctor

Miss Maryam Hassan is a patient in your Dr Pilar Dalfo

general practice who is concerned about poor City Hospital
sleep. Newtown
PATIENT DETAILS:
Name: Miss Maryam Hassan DOB: 27.05.89
20.03.19
(Age 29) Address: 42 West Street,
Easthampton
Social background: Single, no children Works Dear Dr Dalfo,
in fashion design, sometimes has to work long Re: Miss Maryam Hassan DOB: 27.05.89
hours Family history: Mother died aged 63
due to traffic accident Father fit and well I am writing to refer this 29-year-old patient, with
Maternal Grandmother diabetes ?Type 2 Nil symptoms and preliminary investigations suggestive of
else significant Medical history: Nil significant hyperthyroidism, for specialist assessment.
Appendicectomy aged 12 (in France) Allergic
to latex Never smoked, nil alcohol Goes to Miss Hassan initially presented on 27th February 2019 with
gym 3x per week Current Drugs: OTC vitamin poor sleep, dry eyes and occasional benign headaches.
D No other prescribed, OTC, or recreational Recent weight loss was noted at this appointment (2kg in 2
27/02/19 Discussion:
months) although this coincided with a recent increase in
Concerned re: poor sleeping. Requested
sleeping tablet. Poor sleep hygiene and recent
exercise. Her BMI, physical examination and vital signs were
stress at work discussed. Long time at all normal. She was advised on sleep hygiene measures and
computer in evenings Occasional headaches simple eye drops.
and dry eyes after computer use Slight weight
loss (2kg over 2 months, puts down to recent Miss Hassan re-attended on 13th March with worsening
gym membership) No concerning features of symptoms and new onset palpitations. Her heart rate was
headaches O/E: Full physical exam: NAD 92 and her ECG was normal. Blood investigations confirmed
Weight 62kg, Height 174cm BMI 20.5 BP a TSH of 0.3 (other investigations normal). The results of a
125/82 RR 18, HR 85 bpm Advised sleep 24-hour ECG are pending.
hygiene, reduced screen time in evening,
reduce caffeine. Advised risks>benefits for
I discussed the potential diagnosis of hyperthyroidism with
sleeping tablet. For review in 2 weeks if not
Miss Hassan today. Of note, she advised she would like to
better. Advised OTC artificial tears prn start a family in the future. Miss Hassan is generally well,
13/03/19 Worsening sleeping pattern, despite takes only over the counter vitamin D and is allergic to
improved sleep hygiene and cessation of latex. Her only family history is that of diabetes in her
caffeine. Has noted occasional palpitations. maternal grandmother.
Dry eye sensation worsening, although some
It would be appreciated if you could review Miss Hassan,
temporary relief with OTC drops, O/E: eyes
arrange further investigations as necessary and give advice
NAD BP 132/89 RR18, HR 92 bpm (regular)
ECG today: NSR at 88 bpm Pathology regarding both further management and implications for
requested: Full profile, TSH. 24 hour ecg, fertility.
Review 2 weeks 18/03/19 Pathology report Should you have any further questions, please do not
received: TSH 0.3 (low). FBC, U&E, creatinine hesitate to contact me.
within normal range. Pt phoned to come in. 24 Yours Sincerely
hour ECG results pending. Doctor
20/03/19 Pathology report reviewed with
Miss Hassan Symptoms no better. Advised
possible diagnosis of hyperthyroidism and
need for specialist referral.
Concerned around future fertility, wants to
start a family in a few years, advised will need
to await investigations

Writing Task: Using the information in the

case notes, write a letter of referral to Dr
Dalfo, an endocrinologist at City Hospital, for
additional investigations and management.

Discharge letter:
 In introduction :
I am writing this letter to update you with the status of Ms …
provide details about the condition of Mr ….
to inform you about …..
to discharge Mr … into your care.

 In body 1 :
The GP already knows the patient, so no need to mention social and past
medical history, so give less details in this body, or it is better to omit.
Example discharge letter: (May 2015)

1, TO GP
Dr Lorna Bradbury
Stillwater Medical Clinic
12 Main Street
Stillwater

23/05/2015

Dear Dr Bradbury,

Re: Ms Isabel Garcia D.O.B. 01/01/1995

I am writing this letter to update you with the status of Ms Garcia, a 20-year-
old university student, who is presenting with symptoms and signs suggestive
of meningitis. I would be glad if you could further follow up her close contacts
and manage their condition as you think appropriate.

Ms Garcia is a single woman whose medical history is unremarkable except for

allergy to certain washing detergents. Please note, her mother died of breast
cancer.( We can omit this paragraph, as GP is informed her history)

Today, the patient presented complaining of neck stiffness, photophobia and

rash. Consequently, blood tests and lumbar puncture were done which
unfortunately revealed that the patient had bacterial meningitis. Thus, she
initially commenced ceftriaxone and dexamethasone; in addition, she was
prescribed benzylpenicilline after the blood culture appeared.
The patient′s close contacts as family members and friends should seek
medical attention for the possibility of having any sign of meningitis as well as
giving the recent close contacts chemoprophylaxis. It is worth mentioning that
the Department of Human Services was also notified.

In view of the above, I am referring this patient who has just been treated for
further follow up of her and her close contacts. For further queries, please do
not hesitate to contact me.

Yours sincerely,
Doctor

Dr. Lorna Bradbury

Stillwater Medical Clinic
12 Main Street
Stillwater

23rd May 2015

Dear Dr. Bradbury,

Re: Ms. Isabel Garcia DOB: 1/1/1995

I am writing to update you regarding Ms. Garcia, a 20-year-old student who has been
treated successfully for bacterial meningitis. Your further follow up would be highly
appreciated.

Ms. Garcia was referred with suspected meningitis for urgent management. At that
time, she was presented with painful stiff joints, headache, neck stiffness, photo-
phobia and rash. On examination, she was afebrile and was unable to touch her chin
to chest while lying supine. In addition, petechial rashes over abdomen and legs
along with a bruise on her left arm was found. Therefore, suspecting meningitis,
required blood tests with lumber puncture were ordered.

After receiving blood test results where white cell count and CRP were significantly
raised, empirical antibiotic ceftriaxone with dexamethasone were started with a
proper dosage schedule. Moreover, benzylpenicillin was added when bacterial
meningitis was confirmed through lumbar puncture and culture results. the patient
was responded to the treatment, discussion regarding immunization was had with
her family. Furthermore, the services was notified.
 In view of the above, the patient needs your further follow-up and it would be highly
appreciated if you could arrange chemoprophylaxis for people in recent close contact
along with advice for seeking urgent medical attention if there any signs of unusual
illness.
Yours sincerely,
Doctor
Word length 205
Name: Mr Jacob McCarthy Dr. Shannon Meccam
Next of kin: Barbara McCarthy (76,
spouse)
Medical Director Knox Skilled Nursing Facility
Admission date: 06 April 2018 25 Harrowfield Avenue
Discharge date: 26 April 2018
Diagnosis: Right below knee 26/04/2018
amputation (BKA) status post right
foot diabetic ulcer
Past medical history: Benign prostatic Dear. Dr. Meccam,
hyperplasia, diabetes mellitus Type 2 Re: Jacob McCarthy (aged 82)
(non- compliant with medication),
age-related dementia, essential
hypertension, peripheral vascular Mr McCarthy was admitted on 6 April 2018 with a right
disease, osteoarthritis diabetic foot ulcer. A vascular surgeon was consulted, who
Social background: Retired recommended that he undergo right below the knee
construction worker Wife primary
amputation, which was performed without complication.
carer Moderate cognitive impairment
Needs assistance with medication and
activities of daily living (ADL’s) On Following surgery, Mr McCarthy was placed on IV
admission: Long history of antibiotics and pain medications, these have been
noncompliance with diabetic
medication. Admitted for infected
successfully transitioned to oral antibiotics. His wound has
right diabetic foot wound of at least been healing well and his repeated blood cultures have
two weeks, did not notice injury → been negative.
diabetic neuropathy. Obvious signs –
gangrene, pus, abscess. Fever, chills, R
foot non-weight bearing. Blood Mr McCarthy is now stable and can be discharged to your
cultures positive for gram-positive facility for further care. He will continue to need assistance
cocci. for ADLs as well as a wheelchair for mobility. His surgical
Medical progress: Given IV antibiotics,
site should be assessed for infection and his dressings
vascular surgeon consulted to assess
wound. Recommended BKA. Surgery must be changed daily. He should also receive frequent
performed without complication. turning to prevent pressure ulcers.
Transitioned to oral antibiotics and
opiates. Currently afebrile – wound is
clean, dry, intact. Requires assistance
Of note, his wife wanted him to be discharged back to his
for ADLs + wheelchair for mobility. home under her care; however, we feel that given his
Nursing management: Monitor dementia and decreased mobility following the
surgical site for infection/drainage. amputation, this would not be considered a safe
Check for fever/chills + other signs of
infection. Encourage oral fluids, discharge. Our physiotherapy and occupational therapy
nutrition. Assist with ADLs and staff agreed with our assessment. We feel that after some
mobility. Change dressings daily. time at your facility he may show sufficient improvement
Ensure good urination and bowel
to return home. If you have any queries, please contact me
movements. Frequent turning – avoid
decubitus ulcers.
Assessment: Good progress made,
pain under control, no further
infection noted. Blood cultures now
negative. Mobility severely reduced
after amputation – requires assistance
for ADLs and routine care.
Discharge plan: Discharge to Skilled
Nursing Facility for acute care and -
physiotherapy. Can reassess later for
stability with home nursing vs. long-
term care facility. Continue antibiotics
and pain medication. Will need to
follow-up with vascular surgeon in 2
weeks. Of note, wife wanted discharge I am writing to refer Mr. McCarthy, who is being
to home in her care physiotherapy discharged today after a good recovery from a right below
and occupational therapy assessment
knee amputation (BKA), for your acute care.
indicate this would not be a safe
discharge.
Mr. McCarthy is a retired construction worker, whose wife
Medical Writing Task Using the is the primary carer. He has been suffering from age-
information given in the case notes,
write a discharge letter to Dr. Shannon
related dementia, essential hypertension, peripheral
Meccam, Medical Director of Knox vascular disease and a seven-year-history of uncontrolled
Skilled Nursing Facility, 25 Harrowfield diabetes mellitus type 2.
Avenue, Knox

On 06/04/2018, Mr. McCarthy was admitted for a two-

week-history of an infected right diabetic foot wound after
a long history of noncompliance with his diabetic
medications. On examination, there were fever, chills,
gangrene, pus and abscess. His blood cultures were
positive to gram-positive cocci. Iv antibiotics were
commenced and a right BKA surgery was performed
without complications. Now, his wound is clean, dry and
intact, he is afebrile and his blood cultures are negative

Mr. McCarthy will be discharged today on oral antibiotics

and opiates for pain management. He requires assistance
for activities of daily living and routine care as his mobility
was severely reduced after the amputation. Please note,
he has a follow-up appointment with the vascular surgeon
in two weeks. It is worth mentioning that his wife asked to
discharge him home but her request was refused as it
would not be safe for the patient.

In view of the above, it would be highly appreciated if you

could take over Mr. McCarthy’s care including later
assessment for his stability with home nursing V.S long-
term care facility. Please do not hesitate to contact me for
 any further queries

2, TO SPECIALIST

Dr Super Mario
Chest Physician Flinders Clinic
89 Grange Road
Flinders Park

21/09/19

Dear Dr Mario,
Re: Ms Julia Roberts, DOB: 15/03/1965
I am writing to request pulmonary rehabilitation for Ms Roberts, a 54-year-old
divorced teacher, who underwent treatment for suspected pneumonia. She was
admitted following a fall at home while descending the stairs and is due to be
discharged today.
Ms Roberts has had COPD since 2005 for which she takes Flovent and Pulmicort
inhalers. During hospitalisation, Ms Roberts initially received blood transfusion,
morphine, Panadeine forte and wound dressing for a fractured femur and
hemorrhage. However, on the 16 of September, she exhibited features of
pneumonia, manifested as fever, cough and pleuritic chest pain. On examination, her
temperature was 38.4 and oxygen saturation was 94 for which 2L of oxygen therapy
was given. Intravenous linezolid therapy was instituted after a chest X-ray had
revealed a dense white shadow.
Apart from chest pain while coughing, Ms Roberts has progressed well, and her ECG
was normal. However, following her discharge, it is important to continue inhalers
and oral iron supplements. Please note, she needs to review her condition including
blood examinations with her GP in a week’s time. /2 weeks’ time.
Your further pulmonary rehabilitation sessions would be greatly appreciated.
Should you have any queries, please do not hesitate to contact me.

Yours sincerely,
Doctor
Ms Georgine
Ponsford Resident Community Nurse
Community Retirement Home
103 Light Street Newtown.

10 February 2019

Dear Ms Ponsford,

Re: Mr Lionel Ramamurthy, aged 63

I am writing regarding Mr Lionel Ramamurthy, who was admitted on 04/02/2019

due to pneumonia. He is being discharged back into your care tomorrow.

On admission, Mr Ramamurthy had fever, severe shortness of breath, wheezing and

chest and abdominal pain due to persistent cough. He was mobilising with a pick-up
frame and required assistance with ADLs. He appeared weak and could walk only
short distances that led to worsening of SOB.

During hospitalization, Mr Ramamurthy was encouraged to have proper nutrition,

including oral fluids, and to ambulate as per physiotherapist’s review. Chest
physiotherapy, including deep breathing and coughing exercises, were initiated. He
was maintained in a sitting position more than lying to ensure postural drainage.

Currently, Mr Ramamurthy has made good progress with normal inflammatory

markers and has gained weight by 1.5kg after a dietitian review. However, he is slow
but can perform ADLs independently. He still has slight chest and abdominal pain.

In your care, it would be appreciated if you could provide Mr Ramamurthy with good
nutrition, including oral uids, eggs, fruits and vegetables, and monitor his diet. Please
keep him warm and administer paracetamol for chest and abdominal pain.
If you have any queries, please contact me.

Yours sincerely,
#Thank you for accepting this 40-year-old women with a
presumptive diagnosis of depressive phycosis.

#I felt, that time, her problem was ……. Therefor, organized

counselling with social worker.
She returned on ……..with worsening symptom, for that reason I
instituted treatment with….

#CBC test results have been within normal values apart from low Hb
(91) and high Hct (34%) beside positive FOBT.

#He will continue to need assistance for ADLs as well as a

wheelchair
for mobility.

#Of note, his wife wanted him to be discharged back to his home under her care;

# Given this history, I believe her to be suffering for……and would appreciate your
further assessment and management.

Given her current symptoms (and long history of asthma) I would be very grateful
if you could please assess and evaluate

#If you have any queries, please contact me.

Hospital: St. Mary’s Public Hospital, Dr. Giovanni DiCoccio
32 Fredrick Street, Proudhurst Proudhurst Family Practice
Patient Details: Ms Bethany Tailor
231 Brightfield Avenue
Next of Kin: Henry Tailor (father, 65)
and Barbara Tailor (mother, 58) Proudhurst
Admission date: 01 March 2018
Discharge date: 18 March 2018 19/03/2018
Diagnosis: Schizophrenia
Past medical history: Dear Dr. DiCoccio,
 Hypertension secondary to
fibromuscular dysplasia  Primary
hypothyroidism Levothyroxine 88 Re: Bethany Tailor, 35 years of age
mcg daily
Social background: Your patient, Ms Tailor, admitted herself on 1 March 2018
 Unemployed, on disability with decompensated schizophrenia. She is now ready for
allowance for schizophrenia. 
discharge and follow-up at your clinic.
History of polysubstance abuse,
mainly cocaine and alcohol. Last On admission, she was experiencing significant thought
used cocaine 28/02/18: Admission disorder, including thought blocking and latency. She was also
01/03/2018:  Patient self-admitted: exhibiting delusions and experiencing auditory command and
decompensated schizophrenia visual hallucinations.
Medical background:  Not During her stay in hospital Ms Taylor was placed back on her
compliant with medications. 
Admitted for auditory command
medications, and her mental condition has stabilised and she
hallucinations telling patient to harm is able to focus on her activities of daily living. Her insight is
self.  Visual hallucinations – shadow now good and judgment fair. Her nursing management in the
figures with grinning faces.  hospital focused on compliance with her antipsychotic
Delusion – personal connections to medications, behavioral control, and therapy. Since 10 March,
various political leaders.
she has not reported visual or auditory hallucinations.
01/03/2018 –  agitated and
aggressive, responding to internal Ms Tailor is on oral Risperidone 4mg nightly. Additional oral
stimuli with thought blocking and risperidone 1mg can be administered as needed twice daily
latency. for agitation or psychosis. She will be discharged from the
 Commenced antipsychotic meds hospital to her apartment where she lives alone. She will
(rispoderone). follow-up with you in order to continue her treatment of
10/03/2018:  Patient ceased
chronic schizophrenia and to avoid non-compliance of her
reporting auditory or visual-
hallucinations.  Less disorganised medications or substance abuse. If you have any queries,
thinking.  No signs of thought please contact me.
blocking or latency.  Able to Yours sincerely,
minimise delusions and focus on Doctor
activities of daily living. Nursing
management:  Assess for objective
signs of psychosis.  Redirect patient
from delusions.  Ensure medical
compliance.  Help maintain
behavioral control, provide therapy
if possible. Assessment:  Good
progress, chronic mental illness, can
decompensate if not on medications
or abusing substances. Insight good,
judgment fair.
Discharge plan:  Discharge on
Risperidone 4g nightly by mouth.  Dr Giovanni DiCoccio
Risperidone 1 milligram available Proudhurst
twice daily p.r.n for agitation or Family Practice 231 Brightfield Avenue
psychosis.  back to apartment with Proudhurst
follow-up at Proudhurst Mental
Health Clinic
Date: 18/03/2018
Writing Task: Ms. Bethany Tailor is a Dear Dr DiCoccio,
35-year-old patient in the psychiatric Re: Ms Bethany Tailor [, age: 35 years]
ward where you are working as a I am writing to update you regarding Ms Tailor, a 35-year-old
doctor Using the information given woman, who is being discharged today after being treated for
in the case notes, write a discharge
decompensated schizophrenia. Your further follow up [follow-
letter to the patient’s primary care
physician, Dr. Giovanni DiCoccio, up] care would be highly [greatly] appreciated.
Proudhurst Family Practice, 231
Brightfield Avenue, Proudhurst On 01/03/2018, Ms Tailor admitted herself with the
complaints of audio-visual hallucinations along with delusions.
In addition, she exhibited agitation as well as aggression
including response to internal stimuli with thought blockage
and latency. Please note, she was non-compliant with
medications. Hence, she was commenced on risperidone [it is
correct] [Mention the date of this events…. 10/3/2018]

During her hospitalization, Ms Tailor’s condition gradually

improved with [her]being able to focus on her daily activities
and cessation of audio-visual hallucinations as well as
delusions. During her nursing management, she had
maintained behavioral control and showed compliance to her
medications. [Her nursing management in the hospital
focused on assessment for signs of psychosis, redirecting her
from delusion and compliance with her antipsychotic
medications, behavioral control as well as therapy.] Please
note, she had good insight and her ability for judgement was
fair. [Therefore, her assessment revealed good prognosis….
Add this]

Today [,]Ms Tailor is being discharged on oral Risperidone 4g

at every night including 1mg twice daily in case of agitation or
psychosis along with advice to follow up at Proudhurst Mental
Health Clinic. However, her medications for all other medical
conditions should be continued. [Please note, her condition
can decompensate if not on medications, and if she is on
abusing substances….missed this vital info] I would be grateful
if you could monitor Ms Tailor and provide special attention
to avoid relapse of her condition. Should there be any
queries, please do not hesitate to contact me.
 Yours Sincerely [,]
Doctor

Criteria Details Score Total

Purpose- Purpose fulfilled with minimal error 2.5/3 25.5/38 Content-
All relevant information not included 3/7
Consciousness and Clarity- Summarization was not done properly 4/7
Genre and style Criteria- fulfilled with minimal error 6/7
Organization and layout- Proper organization and layout were not fully maintained
5/7
Language -Few punctuation errors and grammatical mistakes 5/7

(335/500) Grade C+

OET Transfer Letter Example

[Sender’s Address]
[Date]
[Receiver’s Address]
Dear [Receiving Department’s Name],
Subject: Transfer of Mrs. Maria Joseph
I am writing to request the transfer of Mrs. Maria Joseph, a 56-year-old male patient
under our care, to your cardiology department. Mrs. Joseph has been diagnosed with
coronary artery disease, and after a recent episode of chest pain, it has become
necessary to provide specialized cardiological assessment and care.
Mr. Brown’s medical records, including diagnostic tests and current medications, are
attached for your reference. We kindly request that you accommodate this transfer
at your earliest convenience and provide us with the date and time of the transfer.
If you require any additional information or have questions, please do not hesitate to
contact me.
Yours sincerely,
[Your Signature]
OET writing mastering using different tenses

In the OET Writing sub-test, you write a letter, usually to another healthcare
professional. In order to produce clear and accurate letters, you need a strong
understanding of English tenses

1. Present Simple
Usage: The present simple tense is used to describe habits, routines, facts, and
general truths.

Examples in OET Writing:

‘Mr Smith has chronic asthma.’
‘Ms Fedele lives alone and uses a wheelchair.’
‘She has a history of severe chest pain.’

2. Present Continuous
Usage: The present continuous tense is employed to describe actions that are
ongoing at or around the moment of speaking or writing. It can also be used to
indicate future plans or arrangements.

Examples in OET Writing:

‘Mrs. Jones is experiencing severe back pain.’
‘She is currently taking two tablets daily.’
‘Ms Klim is responding well to the new treatment regimen.’

3. Past Simple
Usage: The past simple tense is used to describe actions or events that took place
and were completed in the past. (This could be long-term past or just a few moments
ago.)

Examples in OET Writing:

‘On examination, her abdomen was tender on palpation.’
‘She reported a sharp pain in her abdomen yesterday.’
‘He presented at the clinic with shortness of breath and a persistent cough.’
'Her blood pressure was elevated at 140/90.'

4. Present Perfect
Usage: The present perfect tense is used to describe actions or events that happened
at an unspecified time in the past and have relevance or connection to the present
moment. It can also describe experiences or changes that have occurred over time.

Examples in OET Writing:

‘Since her last visit, Mrs Baxter’s pain levels have reduced from an 8 to a 4.’
‘Mrs. Green has shown significant improvement since starting the treatment.’
‘She has expressed concerns about potential side effects.’

5 Past perfect
Upon further questioning, he admitted that he had had a heart attack six months
earlier.
"Upon further inquiry, he admitted that he had had a heart attack six months
earlier."
Further, he admitted that he had sustained an injury to his right knee six months
earlier."

Why is a strong grasp of tenses important in OET writing?

In the OET Writing sub-test, the clarity and accuracy of information are paramount.
Using the appropriate tense ensures that the reader understands the patient's
current condition, medical history, and recommended future actions. Misuse of
tenses can lead to confusion, misinterpretation, and potential risks to patient care.
For instance, writing, ‘The patient experiences chest pain’ (present simple) instead
of, ‘The patient experienced chest pain’ (past simple) can change the entire context
of the situation. The first sentence suggests an ongoing issue, while the second
sentence indicates a past event.

INTRODUCTIONPRESENT)
Referral from a GP to specialist:
● I am writing to refer Mr. Bond, a 32-year-old engineer, who is presenting
with symptoms and signs suggestive of/consistent with (, whose features
are suggestive of. . . . .)
● Thank you for accepting/seeing/assessing Mr. Bond as a new patient at
your clinic.
● I am writing to request an urgent review of Mr. Bond, who is having an
acute
exacerbation of asthma.

Referral from a specialist to a GP:

● I am writing to refer Mr. Bond back to your care after confirming his
diagnosis of
pneumonia.
● I am writing to update you regarding Mr. Bond who was referred with
suspected
meningitis.
● I am writing to update you regarding Mr. Bond who is being discharged
today after a total knee replacement surgery.
● Thank you for seeing (for any target).
● Your patient , Mr. James Bond , admitted himself (was admitted) to the
surgical
ward/psychiatric ward on 01/03/2019 with decompensated schizophrenia.
He is now
ready for discharge and follow-up at your clinic.

● When admitted, Sally had been suffering from painful periods . . . .

You should include the target of the letter:
● Thus/Therefore, your further assessment and management would be
highly appreciated.
● Your further follow-up/management would be highly appreciated.

Body 1: Social, past medical history, family history, and allergy

(PRESENT)
● Mr. Bond is married with three children. He drinks alcohol socially and
does not smoke.
● Regarding (in terms of) his medical history, . . . . . .His past medical
history is
unremarkable apart from (disease), for which he is on (medication).
● His father died of liver cirrhosis at the age of 50.
● Kindly note that/it is worth mentioning that the patient is allergic to.
Her only family history is that of diabetes in her maternal grandmother

Body 2: Previous visits (HAD)

● Chronologically arranged: Firstly , . . . . . . Secondly , . . . . . Finally
,.......
● Mr. Bond first/initially presented to me on 12/04/2019 complaining of
(with complaints of)
.................
● Initial examination on 12/04/2019
● On 03/07/2019, the patient initially presented with …....; therefore,
ibuprofen was started.
However, three weeks later, the patient attended with a new complaint
of . . . . As a
result, . . . . . Consequently, investigations were ordered. At that time ,
● The patient’s condition had improved/worsened.
● Therefore, he was advised to stop smoking.

Body 3: Today visit (HAS)

● On today's review/visit/consultation, Mr. Bond’s condition/case has
worsened/deteriorated (i.e., progression of the case ).

Conclusion (PRESENT)
● My provisional/presumptive diagnosis . . . . Therefore, I am referring this
patient for
further management and possible (intervention). Should there be/Should
you have+any
further queries, please feel free to contact me.
● In view/light of (based on) the above symptoms and signs, I believe the
patient needs
urgent admission for further investigation and stabilization. I would
appreciate your
urgent attention to his condition.
● If there is attached data: I have attached a copy of his pathology report
results.
● In view of the above, I would appreciate your urgent attention to this
patient.
● I would be grateful if you would take over Mr. Ali’s care.
. . . . . . Yours sincerely/faithfully,
. . . . . . Doctor

GENERAL RULES
● Transfer letter:
Thank you for accepting this 68-year-old man who has recently undergone
left total knee joint replacement for rehabilitation and assessment for
suitability
to return to his home.
● Re: Bethany Tailor (aged 35),
● Initially, she presented to me on 22/10/17 after she had discovered a
left breast lump 6 weeks previously which was not increasing in size
● Since August 2017, the patient has presented to the ER on 3 occasions
with a range of injuries including bruising, fractured and burns.
Appropriate medical treatment has been provided each time.
● He has managed to lose 8 kg of weight.
● In introduction : Symptoms and signs of . . . . In conclusion : Provisional
diagnosis and
management plan. For example in MS, the patient is presenting with
variable neurologic
symptoms and signs (introduction). For MRI and steroids (conclusion).
● He is a non-smoker and a non-drinker . He is a heavy smoker and
drinks alcohol as well .BHe is a non smoker and a light drinker.
● He presented to me = presented at my clinic.
● I advised him to lose weight, to stop smoking cigarettes and to come
for a review visit
within one month.
● I am writing to refer this patient, who is due to be discharged today, for
ongoing
physiotherapy.
● She suffers from edema as well as/along with bladder incontinence.
● On the next review visit , he had made no improvement , with increased
cough .
● The dose was augmented .
● She looked anxious and was having trouble sleeping. Apart from this ,
no abnormalities were found on cardiovascular, respiratory and rectal
examination.
● Regarding his medical history, he has DM and HTN. In addition, he is
epileptic and uses phenytoin to control the attacks.
● Include only remarkable findings in vital signs and physical
examination.
● Cohesion
● HAD BEEN -- ONLY IF 2 EVENT, ONE ENDED THE OTHER
(e.g., she had been waiting for 2 hours when the doctor finally arrived )

Mrs. Martin has been a patient at my clinic for the last 10 years.
● On review after ten day , the patient has made no improvement.
● When he came back for the next visit on . . . .
● The patient initially presented on (first came to see me on) . . . with a
4-month-history of thirst and lethargy, Furthermore, she complained of
dizziness during the preceding 7
weeks. The patient re-presented on . . . .

● I am writing to refer . . ., who has been recently diagnosed with left

breast cancer
● Consequently, investigations were ordered which revealed . . . .
● Although Mrs. Welshman is a mother of five adult children, she lives
alone
● She is 8 weeks pregnant
● Apart from a history of typhoid fever 8 years ago, he has no significant
medical or family history.

● Mr. Saad is being discharged from our hospital into your care today.
● Mr. Saad is a married doctor.
● Could you please follow up and act on her TFT, digoxin levels, and MSU
result
● That resulted in his absence from college.
● A long-term sufferer of obesity.
● There were no other remarkable findings.
● Her mother died of acute myocardial infarction and her sister, who is a
patient of yours, has a similar condition.
● He is currently diabetic and hypertensive .
● His temperature reached 40.
● The patient chose not to have surgery.
● I believe that the severity of her condition warrants admission for
further management.
● He was advised to rest for 2 weeks, reduce weight and increase
exercise.
● She has a strong family history of diabetes
● She was diagnosed with NIDDM in 1994
● Her lipids have improved, with cholesterol falling from 6.2 to 3.2.
● Mr. Saad has been a smoker for 25 years.
● It is important to mention that he only speaks English.
● A full set of blood tests was requested. The results revealed . . .
● He has not smoked since 1996.
● In addition, the same previous signs of left ventricular failure were
observed
● An appointment in 2 weeks was made
● The patient's condition had partially improved.
● He presented with night cough .
● The patient had lost her appetite , causing her to lose almost 5 kg
within the course of 15 days.
● Regarding her family history, her mother died of laryngeal carcinoma,
while her father died of COPD.
● Please note, the patient has expressed a wish for immediate
reconstructive surgery.
● Her last PT taken on 09/02/2019 was 2.1
● His discharge medications include: metformin, 1000 mg; lisinopril, 10
mg and
atorvastatin, 10 mg at night.
● She has been diabetic and hypertensive since 2001 and 2004
respectively .
● Family history of asthma in/related to her mother and 15one-year-old
sister.
● Blood pressure was mildly elevated at 150/90 mm Hg.
● Her general examination was normal . (if vital are Ok)
● Enlarged tonsils with lymphadenopathy were found .
● She first experienced the problem in the year 2003.
● Diazepam was prescribed based on my provisional diagnosis of
anxiety.
● In addition to previous examination findings, there were . . . .
● At that time, . . . .
● As arranged with your receptionist , I am referring this patient
● . . . However, . . . . .
● . . . ; however, . . . .
● Few if countable (a few ways of . . . ) and little if uncountable (little eye
contact).
● After confirming her diagnosis as . . .
● She is the first child of a family of 5,
● He is an overweight smoker.
● Her weight had dropped from 69 kg to 61kg. She had lost a further 11
kg over the last
two months due to loss of appetite.
● If infertility: Every couple alone
● He was concerned about having rheumatoid arthritis.
● I discussed the possibility of surgery; however, he indicated he did not
want an
operation.
● Despite my management, her symptoms have continued to worsen.
● To be referred sooner than later.
● A married computer programer.
● Please note, a copy of his test results has been attached for your
convenience.
● If the patient with her husband: Thank you for seeing my patients/this
couple/Mr. And Mrs.
Died of . . . . at the age of . . .
● I advised him to = I suggested/recommended that . . .
● He was overweight at 85 kg with respect to his height of 170 cm.
● When the results become available, I will forward them to you.
● Mr. Seymour lives alone and he is a heavy drinker
● His mother suffers from DM.
● She has a history of dyspepsia (2004).
● He is febrile (38.9°C).
● During her stay at hour hospital from 01/05/2019 to 18/05/2018, the
patient’s condition continued deteriorating.
● She was severely febrile with a temperature of 40.
● If signs are repeated >> the same previous signs were observed .
● A patient of mine/yours.
● The symptoms follow a constant course.
● He is keen to resolve the issue as it is affecting his ability to work.
● His BP is elevated at 180/110 mm Hg.
● I am referring this patient up on his request.
● Compliant with . . .
● Bearing in mind that . . .
● Whose symptoms and signs are suggestive of depression with possible
bipolar disorder .
● Therefore, blood and urine tests were ordered.
● Many symptoms -- use “ additionally ”
● She has been a heavy smoker for 30 years.
● In the words of the patient , the problem increases . . .
● Advise to = Advice on . . . . . . . .
● Passive format = more formal.
● I would appreciate it if you could provide . . . .
● Diagnosed with = Diagnosis of

‫ ●أ‬On ● In
● In the morning and at night.
● In the morning . . . At evening

● Abbreviations:
- S taphylococcus aureus.
- Medical abbreviations are Ok (e.g., CT, MRI).
- Other abbreviations (e.g., kg, gm) should not be used.
● She was delivered vaginally at 38 weeks’ gestation

● In terms of his medications, . . . . . . . .

● Do not include doses of medications except in discharge letters and
uncontrolled
diseases .
● A child presented with his mother
● Despite this treatment, . . .
● The latter medication, . . . .
● When he came for the next visit on . . . . , he
● He is overweight with a BMI of . . . .
● He has nausea, vomiting , and diarrhea (Oxford comma).
● She had developed severe anemia ; for which, a blood transfusion was
given.
● It is worth mentioning that
● A trial of . . . . . .
● Follow-up of . . .
● Sick-leave and follow-up.
● Should you have any further queries, please do not hesitate to contact
me.
● He was brought in by his family
● Please keep me informed of his/her outcome
MODEL ANSWER
(Post srtepto coccal pneumonia + ARF)
Dr. F. Shaw
201 Albert Street
South Cottingham
20th March 2014

Dear Dr Shaw,

Re: Riley Precious

Thank you for seeing Riley, a four year old boy with a provisional diagnosis of
poststreptococcal nephritis with early renal failure.
Riley first presented to me on 25th February 2014 with a history of sore throat, husky voice,
fever and irritability. I made a diagnosis of tonsillitis and prescribed penicillin V 250mg q.i.d
for seven days.

Three weeks later (18.03.2014), Riley returned to the surgery and his father reported that
he had noted that his urine was discoloured four days previously. Riley was also lethargic.
His blood pressure was 90/60 and his urinalysis revealed macroscopic haematuria. His
throat examination was consistent with tonsillar hypertrophy. His father was advised to
increase his oral fluid intake and return to the surgery today (20.03.2014). On examination
today, Riley’s blood pressure has elevated to 110/90. Although Riley is asymptomatic, his
urea and creatinine are slightly elevated. Moreover, there is a marked elevation in AOST
(+++), and his mid-stream urine sample has 4 x 10 red blood cells of renal origin. However,
his FBE is normal.

As stated above, I believe that Riley is experiencing post-streptococcal nephritis with early
renal failure. Therefore, I am referring Riley to you for further assessment and management.
Please do not hesitate to contact me if you have any further queries.

Yours sincerely,
Dr Smith
 Letter Writing
Custom Sentence Styles
Introduction
I am referring [Mr/Mrs. Last Name of the Patient], who is suffering from [Medical
Condition/s on Admission of the Patient], for assessment and ongoing management.
I am writing to refer [Mr/Mrs. Last Name of the Patient], who is suffering from [Medical
Condition/s on Admission of the Patient] with [Detail of Medical Condition/s].
I am pleased to refer [Mr/Mrs. Last Name of the Patient], who is suffering from [Medical
Condition/s on Admission of the Patient], for [type of care required].
I am writing to refer [Mr/Mrs. Last Name of the Patient], who has [Medical Condition/s on
Admission of the Patient].
I am referring [Mr/Mrs. Last Name of the Patient], who will be discharged home after being
diagnosed with [Current Medical Condition/s of the Patient] ([Stage of Medical Condition]).
I am writing to refer [Mr/Mrs. Last Name of the Patient], who is having [Medical
Condition/s on Admission of the Patient].
I am writing to refer [Mr/Mrs. Last Name of the Patient], who is suffering from [Medical
Condition/s on Admission of the Patient] and needs a [type of assessment] assessment for
further management.
I’m writing to refer the above patient, a [age] year old [male/female], who presented today
with a [Medical
Condition/s on Admission of the Patient].
I am writing to refer [Mr/Mrs. Last Name of the Patient], a [age] year old [professional
details of the
patient], who is suffering from [Medical Condition/s on Admission of the Patient] in [body
location].
I am writing to refer this patient, who was initially presented with [Current Medical
Condition/s of the Patient]
on the [date] for which [he/she] was treated with [medication/s].
[He/She] requires an urgent [type of assessment] due to a high risk of [probable medical
condition/s].
[Priority Medical Condition of the Patient] was noted which required immediate attention.
Medical History
The patient has a history of [Past Medical Condition/s of the Patient] and has been
attending our hospital for various ailments since [Year].
[She/He] was prescribed [Medication] for [Past Medical Condition/s of the Patient] due to
[Lifestyle of the Patient].
[Time Period] later, [his/her] symptoms were unchanged and [Medical Condition] was
suspected.
In addition, [he/she] was treated with [Medication] for [Medical Condition].
On review [Time Period] later, [Medications] were commenced due to the side effects of
[Medication/s].
After returning from [Place] in [Year], [he/she] experienced features of [Medical Condition],
which was aggravated by close contact with [trigger].
Subsequently, [he/she] was prescribed [Medication] and also referred to an [type of
Specialist].
[Time Period] later, [he/she] was commenced on a course of [Medication] for [his/her]
[Medical Condition].
[Time Period] ago, [he/she] complained of failed [Medication].
[His/Her] symptoms have not resolved even though [he/she] followed [Medication].
Moreover, [New Medication] was trialed to help [him/her] [type of function] for [Time
Period].
Initially, [he/she] was presented on [Date] with [Physical Conditions of the Patient],
especially during
[activity].
After [his/her] [type of state], [he/she] noticed [observation].
Examination revealed [Medical Condition/s of the Patient].
[He/She] was advised to use [aid/s] and [Medical Procedure/s] in future, if the conditions
further deteriorate.
[Mr/Mrs. Last Name of the Patient] again visited on [Date] in a [type of state] condition,
complaining of
[symptom] in [Location] for [Time Period] and [medications] were not helpful.
Examination showed that [his/her] temperature was [value] °C, pulse [value] bpm and BP
[value].
[Body Part] were infected up-to [Location] and [type of change] in [Location].
In view of these developments, I prescribed [him/her] [medication] ([value] mg for [Time
Period]) along with
[medication] and to review after [Time Period] or earlier depending on [his/her] conditions.
[He/She] first attended my clinic on [Date] complaining of [Symptom] for [Time Period].
The patient was given [Medication] ([number] times a day) and advised to stop taking [Past
Medication].
While reviewing [Time Period] later, [his/her] [symptom] was persistent all the time,
especially at [time of a
day], however, it resolves by [type of treatment].
In addition, [he/she] reported loss of [value] kg over [Time Period] and was [feeling of the
Patient].
The patient was initially presented on [Date] with [Time Period] history of [symptom/s].
[He/She] had no [symptom/s] and did not have any kind of significant past or family history.
Since, there were no abnormalities detected; I advised [him/her] to take [Medication] on
[number] hourly basis.
[She/He] was re-presented to me on [Date] with distressing [symptom] associated with
[symptom/s].
 Examination showed that pulse [value] bpm, BP [value] and no [type of abnormality].
A stat dose of [medication] injection was given and advised to review after [Time Period] if
there was no
improvement.
The patient was diagnosed with [Past Medical Condition/s of the Patient] in [Year], for
which [he/she]
underwent [Medical Procedure] in [Year] after [Medical Procedure].
[He/She] was in remission from [Year] to [Year] until a [symptom] in [his/her] [Location]
was detected with
[Additional Details].
[He/She] is also a patient of [Medical Condition of the Patient] (noted in the year [Year])
and [Medical
Condition of the Patient] (noted in the year [Year]).
In addition, [he/she] is suffering from [Current Medical Condition/s of the Patient], and
[he/she] is allergic to
[allergen].
The patient ambulates with a cane and contact guard.
It has been observed that [he/she] is often [Current Observation/s regarding the Patient];
this could be linked
to [his/her] [Current Medical Condition/s of the Patient].
Just recently, [he/she] complained of a severe [Medical Condition of the Patient] and, since
then, it has been
recurring episodically.
The [Medical Condition of the Patient] began approximately [Time Period] ago and it is
localized to both
[Location] areas.
Apart from this, patient had [Number] episodes of [Medical Condition of the Patient] during
[activity].
[His/Her] medical history reveals that [he/she] has been suffering from [Past Medical
Condition/s of the
Patient] since [Year].
Also, [Past Medical Condition of the Patient] was noted in the year [Year].
However, the patient has suffered [Number] episodes of [Medical Condition of the Patient],
during the [Time
Period].
The first one happened while [he/she] was [activity] (this was around [Time period] ago)
and the second while
[he/she] was [activity] (just [Time period] ago).
During these episodes, no [Physical Condition] occurred and neither did any [Other Physical
Condition].
Please note that [Mr/Mrs. Last Name of the Patient] is a [Medical Condition of the Patient]
patient as well.
The general condition of the patient can be stated as follows: [Physical Conditions of the
Patient].
[He/She] also wears [apparel]; [he/she] is continent of [urination/defecation], but
incontinent of
[urination/defecation].
[His/her] medical history reveals the following information: [Past Medical Conditions of the
Patient].
For several years, the patient has been suffering from [Medical Conditions of the Patient]
related problems as well.
 [Medical Condition of the Patient] is also a part of [his/her] medical history which seems to
be prevailing.
[Mr/Mrs. Last Name of the Patient] is able to move around with [his/her] walker, although
[Current Medical
Condition/s of the Patient].
[He/she] also had an [medical condition] that was associated with [other medical
condition].
[He/she] has been [type of addiction/drug abuse] for the past [number] years and was
advised to quit [type of
addiction/drug abuse].
Please note that, [high risk factors of the patient].
I have to mention, the patient was recently diagnosed with [medical condition/s].
The patient had a [time period] history of [Medical Condition/s] which was not responding
to [medication].
The patient’s [Body location] was [type of medical care given] for the first time after he had
[activity] on
[date] and then again on [date].
No infection was noticed on [date] and, as the wound was healing, the patient was able to
make movements as well.
Please, take a note that [Mr/Mrs. Last Name of the Patient] is a patient of [medical
condition].
Please, take a note that [Mr/Mrs. Last Name of the Patient] is a patient of [Medical
condition/s] as well.
[He/She] has been suffering from [medical condition] for about [time period] now.
[Mr/Mrs. Last Name of the Patient] has been a patient of [medical condition] too since
[year].
In regards to [his/her] medical history, [Mr/Mrs. Last Name of the Patient] has been living
with [medical
condition/s] since [year], which has been managed by a [type of treatment] only.
[He/She] was also diagnosed with [medical condition] in [year] and has had [medical
condition] for the past
[time period].
[He/She] has been suffering from [Medical condition/s] problems since [year].
Apart from a problem related to [Medical Condition/s of the Patient], which occurred once
and [another
Medical Condition/s of the Patient], [Mr/Mrs. Last Name of the Patient] has no previous
medical history.
Also, note that [Mr/Mrs. Last Name of the Patient] has [medical conditions] problems too.
There is no history of [Medical Condition/s] in [his/her] family.
Prior to this diagnosis, [Mr/Mrs. Last Name of the Patient] had always been in good health
and [he/she] had no
medical history; this is the first time that [he/she] has ever been admitted into hospital.
[He/She] has been drinking alcohol excessively for approximately [time period] and
[he/she] is also a chain
smoker; it has been suggested that [he/she] should avoid smoking and drinking completely
whilst [he/she] is in
recovery.
[He/She] suffered from [symptoms] for about [time period] and complained of [physical
conditions].
[He/She] denied any family history of [Medical Condition/s].
Current Condition
Today, [his/her] [Symptoms] are suggestive of [Medical Condition]..
On [Date], [his/her] condition was improved, examination revealed no abnormality and
[symptom] was also reduced..
On reassessment today, [Mr/Mrs. Last Name of the Patient] is suffering from [symptom]
and reports that[he/she] is [details of drug abuse].
After examination, [his/her] BP was [value] and [his/her] pulse was [value].
[Tests] were ordered and these confirmed the diagnosis of [Medical Condition/s of the
Patient].

As a divorced elderly [gender], who lives alone with no one to take care after [him/her], I
believe that [he/she] needsto be visited [number] times a [Time Period] to monitor [his/her]
compliance with the diet plan and medication ([medication] - [value] mg, [number] times a
day). .
On [Date] after [Time Period] of distressing [symptoms], [he/she] was found in a [type of
state] on urgent home visit, complaining of weakness in [Location], impaired level of
[senses].
On examination pulse [value] bpm, BP [value], increased [symptom] and reflexes were
normal.
I believe [he/she] has been suffering from [medical condition] and needs emergency
hospital admission.
[Mr/Mrs. Last Name of the Patient] wishes to die at home with [his/her] [Friends and
Family] who also live
in [place].
Upon discharge, the patient and [his/her] family need your help in [type of special care] on
[number]-hourly
basis, daily [type of special care] and assistance with care.
[He/She] also requires [Additional need/s of Patient].
The family needs your help in explaining [nutrition] that [Mr/Mrs. Last Name of the Patient]
can tolerate.
As you know, in [his/her] case the most important treatment is psychological support for
[him/her] and [his/her]
family, and [religious/ friendly] care from [his/her] [local religious head/ peer group], as
[he/she] has
strong links with [his/her] [local religious center/peer group].
The patient is taking a prescription for [Current Medical Condition/s of the Patient] and I
recommended the
same prescription for [his/her] new symptoms.
On [Date], [he/she] was brought at first by [person who admitted the patient] with
complaints of [chief
symptom/s] in [his/her] [body location] of [time period] duration, [other symptom/s if any].
The [person who admitted the patient] reported that [Mr/Mrs. Last Name of the Patient]
has a poor [living
situation/s].
[He/she] was diagnosed to have [medical condition/s] and prescribed [medication/s] along
with advice about
healthy life style was also given.
After [time period] [he/she] came back for a follow up.
The patient was still complaining of the same symptoms plus [additional symptom/s].
[Type of disorder] disorder was suspected and the plan was [treatment].
 Today [he/she] was brought in by [his/her] [relative] who reports that the patient had a
[medical condition/s].
On examination, I found that [he/she] had [observation/s].
[He/she] was given [medications] and advised to [type of treatment].
The patient was re-presented on [date] with complaints of persistent worsening of [his/her]
symptoms along with
[significant symptom/s].
[He/she] was concerned about [his/her] [physical condition] ([specifics]).
While [his/her]review on [date], [he/she] reported [symptom/s] at [time of day].
At that time, [type of test/s] were done which indicated [medical condition/s] and
[discovery] at [body
location].
[Mr/Mrs. Last Name of the Patient] was diagnosed to have a [medical condition/s] and was
commenced on
[medication/s].
[He/she] was also advised regarding the possibility of [type of medical procedure] if the
repeat [test/s] suggested
[medical condition].
Today, the patient is asymptomatic and wishes to stop [his/her] medications.
[He/she] was initially presented to me on [date], complaining of difficulty in [physical
activity].
The clinical examination was unremarkable, except for an increased [vital sign/s] ([value]).
[Mr/Mrs. Last Name of the Patient] seemed to have [medical condition/s], due to either
[first assumption]
or [second assumption].
The patient has visited me [number] times, and all were emergencies.
On [his/her] first visit, [he/she] complained of [symptoms] and whilst examination, [test/s]
showed [results].
I arranged an appointment with the patient to start [type of treatment] but [he/she] did not
attend.
On [date], the above patient presented with [symptom/s] on the [body location].
I wrote a course of [medication] for the patient, and arranged another appointment with
the patient, but [he/she]
refused to attend.
Today the patient presented with a [symptom/s] on the [body location].
My clinical examination showed [observation/s].
The [test/s] shows a well-defined [result/s].
Immediately, I drained [type of infection/s] using an [type of apparatus].
I am referring [Mr/Mrs. last name of the patient] for [further medical procedure].
[She/He] found it difficult to [physical activity] and had a decreased range of movement on
[his/her] [body
location]; apart from that, the examination was normal.
At this time, [medical tests] showed [symptoms] consistent with [Medical Condition].
I commenced [him/her] on [medication] ([quantity], [number] times a day).
At first, [his/her] response was good but unfortunately, [he/she] suffered a further
[symptom/s] on [date].
[Medication] was recommenced at this time but caused significant [medical condition].
I therefore commenced [medication] and changed [him/her] on to [medication] ([quantity],
[number] tabs
daily).
 Unfortunately, [his/her] [symptom/s] has continued to worsen and the change in [type of
treatment] was not
helpful.
I would appreciate your opinion regarding [his/her] future management and would be
interested to know if [he/she]
would be a suitable candidate for a [type of treatment].
[Time period] later, [he/she] came with complaints of [symptom/s] for [time period] and
appeared to be very
[physical appearance].
Patient’s [relative] reported that [he/she] refuses to [activity] and has [symptom/s] since
[time period].
Examination was unremarkable; [he/she] had [medical condition/s], [vital sign/s - value/s]
and [test/s]
confirmed significant [observation/s].
I planned follow up after [time period] and advised the [relative] to give more [type of diet]
to the patient.
In addition, I also sent [test/s] requests for the patient.
On review today, investigation showed a [observation/s], a significantly [significant
observation/s], whereas no
abnormal changes noted in [test/s].
Patient’s [vital sign] also has [increased/decreased] to [value].
I believe the patient has [assumption] and that [he/she] is at risk of developing [medical
condition/s].
The patient [details of accident] and badly injured [his/her] [location].
It was profusely bleeding and [he/she] was unable to [activity] properly.
On [date], [he/she] tripped over and fell down, badly injuring [his/her] [body location].
The patient has been able to walk short distances with help from [his/her] [relative], [Name
of relative].
The patient has complained about [symptoms] whilst [activities] (which was in fact normal
in the beginning due to
[reason]).
Apart from this usual [symptom/s], there is nothing significant to report.
By [date], the [location] had healed well.
The patient was advised to [activities] with the help of [type of assistance].
[His/her] [relative], [Name of relative], requested a greater number of visits in order to help
speed up [his/her]
recovery.
Please, get in touch with [Name of relative] on [his/her] number: [phone number] to assist
[him/her] with
helping [his/her] [relative] recover.
On examination it was noted that the patient was suffering from [Medical Condition/s]
([type of stage] stage and
there were [type of complications] complications).
The patient complained of weight loss too (lost approx. [Quantity] of body weight).
The patient was kept in the hospital for [time period].
During this time, the patient did not complain of any [symptom/s] and no [Medical
procedure/s] was performed
as there was no need for it.
The patient’s condition was normal at the time of discharge from the hospital on [date].
[His/Her relative] requested for a nurse to come to their house for her personal care too.
On diagnosis, [observation/s] were noted which called for immediate action.
 [Type of medical procedure] was performed successfully and the patient was shifted to a
specialized [type of
ward] rehabilitation ward on [date], when the condition was noted to be normal.
Rehabilitation treatment was initiated and was offered mobilization (the patient was
encouraged to do exercises which
promote strength and recovery).
By [date], the patient was able to walk short distances with the help from [his/her]
[relative].
Since, [he/she] requires extra help; [his/her] [relative] wants a [type of medical
professional/specialist] to
come to their house to assist [his/her] in gaining much more mobility (for [his/her] speedy
recovery).
[His/Her] [relative] is not able to assist [him/her] as [he/she] [himself/herself] walks with a
walking stick.
Please, send a [type of medical professional/specialist] from your agency to the patient’s
house to help the patient
recover sooner.
Please, contact [his/her] [relative] on the number: [number], and their address is: [address].
[Mr/Mrs. Last Name of the Patient] condition has been deteriorating since [date], when
[he/she] suffered
[Medical condition/s].
Over the [time period], [he/she] has developed advanced [Medical condition/s] and is now
[symptoms].
Apart from this, [he/she] is edentulous for both upper and lower teeth and sometimes
refuses to wear dentures due to
[his/her] confusion.
In addition, [his/her] appetite has increased recently (gained [quantity] over the last [time
period]) and [his/her]
current weight is [quantity] (BMI of [value]).
[Mr/Mrs. Last Name of the Patient] also complains of [physical condition/s].
[He/She] has no allergies to medication or food.
[His/Her] vital signs and blood sugar level were all within normal limits.
The patient was facing difficulty in [activity] because of the injury to the [location].
It took almost [time period] for the patient to return to the normal condition.
The patient showed signs of recovery and was given discharge on [date].
[He/She] has got spectacles but [he/she] is not used to wearing that.
The patient requested for personal care by the nurse too.
Strict post medical treatment is required.
The patient is a [widow/widower] and has [Details of the Patient’s relative], the one who
brought [him/her]
to the hospital.
[He/She] also has [Details of the Patient’s relative] who visits regularly.
The patient was prescribed [Medication] ([Quantity]) and advised to continue the use of
[other medications].
There will strictly be no contact with [hazardous interactions] and dressing on the
[Location] site is requested to
be done [time period].
Follow-up [name] tests are recommended as well.
It is suggested that the patient should not perform [activity] and that the patient should
avoid [other activities]
until they have made a full recovery.
 The patient was suffering from [symptom/s] ([assumption]).
Other changes that which were noted include [other symptom/s].
The patient had difficulty in [activities] for [time period].
It took more than [time period] for the patient to get recovered to a certain extent.
By [Date], the patient began to show some signs of improvement.
[He/She] was able to walk with the help of [his/her relative] who used to come regularly to
see [him/her].
The patient was doing well.
Apart from casual complaints of [symptoms], there were no problems.
[His/Her relative] needs someone to come to their house to care for [him/her] personally.
[He/She] is [his/her] mother’s [number] [son/daughter] ([Mother] also has got another
[son/daughter]
[details]).
No complications were noted or reported.
The patient has made no complaints about any pain and [he/she] was well at the time of
discharge from the hospital.
Daily observation is needed and the prescribed medicine should be taken for [time period]
as well.
[He/She] has been diagnosed with [Current Medical Condition/s of the Patient] and
[his/her] [Location] region is the most affected area.
[He/She] stayed at the hospital for observation for about [time period] but [he/she] is doing
perfectly well now and [his/her] condition is improving.
[He/She] was given [Medication] ([Quantity]) whilst [he/she] was here and it is requested
that [he/she] continues to take the same medication for [time period].
[His/Her] [vital sign], during [his/her] [number] day at the hospital, was noted as [value].
[He/She] was given [medication/s] and was told to take bed rest for [time period].
On [Date], [he/she] again complained of the [symptoms].
[He/She] also vomited [five] times and complained of [physical conditions].
[His/Her] [vital sign] also showed a slight increase from [value] to [value] and the condition
was assessed as [medical condition/s].
[Medication/s] [Quantities] were prescribed.
The patient did not stay at the hospital due to personal reasons but the next day [he/she]
was brought to the hospital again.
[He/She] had fallen down and become unconscious due to the same [medical condition/s].
Urgent examination of the patient is requested at the [name of department] department.

Conclusion
I would be grateful if you take over further management of [Mr/Mrs. Last Name of the
Patient].
After the discussion with the client, I am referring [him/her] to you for [Reason for
Reference].
Please do not hesitate to contact me if you require any further information.
Therefore, I would be grateful if you could visit [him/her] at home to monitor [his/her]
compliance with the diet plan
and medication.
I would appreciate your assessment and management of [Mr/Mrs. Last Name of the
Patient].
I would like to request that you look into this case.
Please, do let me know if you require any further details about the patient.
Please, do let me know if you would like to know any further details about the patient.
 Please, do let me know if you require any more information about the patient or have any
further queries.
Please, do let me know if you would like to know any further details about the patient.
Please, do let me know if you require any further information or have any queries.
I think [he/she] has [assumption/s] associated with [cause/s], and I believe [he/she] needs
further [type of
assessment] assessment and [type of medical procedure].
In my opinion, [he/she] needs a further assessment for [medical procedure].
If you need more information, please do not hesitate to contact me.
Reports on the medical history of the patient and the results of the tests conducted are
attached to this letter for your
reference.
Reports on [his/her] medical history are attached here.
The patient was well at the time of discharge and the reports on the tests that were
conducted here ([name/s] test),
medical history of the patient and the prescribed medicine are attached to this letter for
your perusal.
I would like to request that you look into this case.
Therefore, I would be grateful if you could visit [him/her] at home to monitor [his/her]
compliance with the diet plan
and medication.
I would appreciate your assessment and management of [Mr/Mrs. Last Name of the
Patient].

The problem commenced after an upper respiratory tract infection two weeks ago for which she
self- prescribed an over-the-counter Chinese herbal product with unknown ingredients.
She ceased smoking 15 years ago. She drinks socially (mainly spirits),
I have recommended that Ms Hall reduces her coffee and alcohol intake and immediately stops
taking the over-the counter product. In addition, I have prescribed Pantoprazole 40mg daily

Her only family history is that of diabetes in her maternal grandmother