(Book) OET WRITING.. All You Need To Know PDF

All you need to know for your
Success in Writing sub-test
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CONTENTS
Description of OET writing test format
Assessment Criteria
Overall task fulfilment
Appropriateness of language
Comprehension of stimulus
Linguistic Features
Control of Presentation Features
Test take’s guide to Writing sub-test
Format of Referral Letter
Starting and Ending the Writing Task
Format of Letter providing Information
How to writing Paragraph 1 ( introducing the PT- expressions to describe symptoms)
How to writing Paragraph 2 (explain treatments)
How to writing Paragraph 3 ( explain complications and adverse incidents)
How to writing Paragraph 4 (requesting ongoing care- polite requests)
Sample referral letter
Sample Letter which informs the public
10 case notes + 10 sample letter related
OET Grammar
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BEFORE TO START
Description of OET
Test format
OET assesses listening, reading, writing and speaking.
There is a separate sub-test for each skill area. The Listening and Reading sub-
tests are designed to assess the ability to understand spoken
and written English in contexts related to general health and medicine. The sub-
tests for Listening and Reading are common to all professions.
The Writing and Speaking sub-tests are specific to each profession and are
designed to assess the ability to use English appropriately in a
relevant professional context.
Writing sub-test
The Writing sub-test usually consists of a scenario presented to the candidate,
which requires the production of a letter of referral to another professional. The
letter must record treatment offered to date and the issues to be addressed by the
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other professional. The letter must take account of the stimulus material
presented.
The body of the letter must consist of approximately 180-200 words and be set
out in an appropriate format. For certain professions, other professional writing
tasks of equivalent difficulty may also be set, e.g., responding in writing to a
complaint, or providing written information to a specified audience in the form
of a letter.
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How the test is scored
You will receive a Statement of Results which shows your grade for
each of the four sub-tests, from A (highest) to E (lowest). Each of the
four sub-tests is assessed in a specific way.
Writing and Speaking

Your performances on the Writing and Speaking sub-tests are each
rated by at least two trained Assessors at the OET Centre. Audio
files and scripts are assigned to Assessors at random to avoid any
conflict of interest. Your test-day Interlocutor is not involved in the
assessment process.
Writing and Speaking Assessors are monitored for accuracy and
consistency, and the scores they award are adjusted to take into
account any leniency or severity. If two Assessors award different
scores to your performance, your script and/or audio file will be
referred to at least one other senior Assessor not previously involved
in your assessment.
For the Writing sub-test, each Assessor scores your performance
according to five criteria: Overall Task Fulfilment, Appropriateness of
Language, Comprehension of Stimulus, Linguistic Features (Grammar and
Cohesion), and Presentation Features (Spelling, Punctuation, and Layout).
The five criteria are equally weighted.
Grade B for Writing requires a high level of performance on all five criteria.
For the Speaking sub-test, each Assessor scores your performance
according to five criteria: Overall Communicative Effectiveness,
Intelligibility, Fluency, Appropriateness, and Resources of Grammar
and Expression. The five criteria are equally weighted. Grade B for
Speaking requires a high level of performance on all five criteria.
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Assessment Criteria –WRITING
Your writing will be rated by at least 2 assessors who will use the criteria below
to determine your writing level. Therefore, study this information carefully so
that you can develop the skills to write at A or B level.
Overall Task Fulfilment

• Always aim to write between 180~200 words. Short letters don’t allow
you enough sentences to demonstrate your ability. Long letters may mean you
have not summarised or focussed on the main issue.
• Read the task question carefully, and make sure your letter has a clear
focus. As a rule, recent case history is more important than older case history.
• State the purpose of the letter clearly in the introduction and focus on
important information and minimise less relevant detail.
• Make your conclusion specific to the situation
• Use your own words as much as possible – don’t simply copy sections
from the case notes.
Think about this:
• Is the letter of the required length?
• Has your letter responded to the task question?
• Does your letter focus on the important points such as chief complaint,
your main concern, important social factors and reason for writing?
• Is the language in your letter original?
Appropriateness of Language
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• Organise the information clearly into paragraphs. Remember, the
sequence of information in the case notes may not be the most appropriate
sequence of information for your letter.
• Always keep in mind the reason for writing – don’t just add information
randomly.
• Avoid informal and casual expression and maintain a formal tone.
• Do not overuse medical terminology including abbreviations and

acronyms
Think about this:
• Is the letter organised into paragraphs?
• Is the information logically presented?
• Is the expression of suitable formality?
• Is the vocabulary and expression of a suitable standard?
• Have the abbreviations and acronyms been written in full?
Comprehension of Stimulus
• Read the information carefully and plan the content of the letter
before beginning to write. 15 minutes planning and 25 minutes writing is a good
model.
• Don’t let the main issue become hidden by including too much
supporting detail.
• Base your letter from today’s perspective. That means, include all the
relevant history, but in summary form, eliminate less important detail and focus
your attention on the current situation.
• Show clearly the connections between information in the case notes if

these are made; however, do not add information that is not given in the notes.
Think about this:
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• Have the key points been mentioned and grouped appropriately?
• Have you identified and emphasised the reason for writing the letter.
• Have you selected relevant information and omitted non-relevant

information?
Linguistic Features
• Show that you can use language accurately and flexibly in your writing.
• Ensure you use correct verb tense and form as this an essential
requirement
• Make sure you demonstrate a range of language structures – use

compound and complex sentences as well as simple sentences.
• Use connecting words and phrases to link ideas together clearly e.g.
however, therefore, at that time.
• Is your grammar of sufficient standard? Key areas are:
o Verb usage
o Sentence structure
o Article usage
o Word form
• More than 5~7 errors in the letter will reduce your chance of getting a B
grade or higher.
Control of Presentation Features

• Follow standard letter format for referral letters
• Use correct punctuation including commas and capital letters

appropriately
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• Check for spelling mistakes and for spelling consistency through your
writing e.g. misspelling the patient's name is not good!
• Organise the letter into clear paragraphs and leave a blank line between
paragraphs to show the overall structure of the letter.
Think about this:
• Is the letter formatted appropriately?
• Is the punctuation correct?
• Have you used capitals correctly?
• Are there a lot of spelling errors?
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What is the Writing sub-test?
WRITING SECTION 1
The Writing sub-test takes 45 minutes. It is profession specific. You
take this part of OET using materials specifically for your profession
– a nurse does the task for nursing, a dentist does the task for
dentistry, and so on. In each test, there is one task set for each
profession based on a typical workplace situation and the demands
of the profession.
The task is to write a letter, usually a letter of referral. Sometimes,
and particularly for some professions, a different type of letter is
required: e.g., a letter of transfer or discharge, or a letter to advise
or inform a patient, carer, or group.
With the task instructions, you receive stimulus material (case notes
and/or other related documentation), which includes information to
use in your response.
The first five minutes of the test is reading time. During this time,
you may study the task and notes but may not write, underline or
make any notes.
For the remaining 40 minutes you may write your response to the
task. You receive a printed answer booklet in which you must write
your response. This also has space for rough work. You may write in
pen or pencil.
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Test taker’s guide to the Writing sub-
test
Do
• Take time to understand the task requirements
• Use your own words to paraphrase or summarise longer pieces
of information from the case notes
• Make sure you understand the situation described in the case
notes
• Think about how best to organise your letter before you start
writing
• Use the space provided to plan your letter (though a draft is
not compulsory)
• Use the five minutes’ reading time effectively to understand
the task set
» What is your role?
» Who is your audience (the intended reader)?
» What is the current situation?
» How urgent is the current situation?
» What is the main point you must communicate to
the reader?
» What supporting information is necessary to give to
the reader?
» What background information is useful to the reader?
» What information is unnecessary for the reader?
Why is it unnecessary?
• Explain the current situation at the start of the letter (e.g.,
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perhaps an emergency situation)
• Use the names and addresses given
• Set out the names, addresses, date and other information
to start the letter clearly
• As you write, indicate each new paragraph clearly, perhaps
by leaving a blank line
Don’t
• Include everything from the case notes – select information
relevant to the task
• Simply copy chunks of text from the case notes
• Write notes or numbered points
General
• Have a spare pen and pencil ready, just in case
• Fill in the cover pages for the task booklet and the answer
booklet correctly
• Fill in your personal information on the answer sheet correctly
• Take a sample test under test conditions beforehand so you
know what it feels like
• Practise writing clearly if you have poor handwriting
• Write clearly and legibly
Checking at the end

• Make sure your letter communicates what you intend
• Make sure you meet the basic task requirements:
» length of the body of the text approximately 180-200
words
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» full sentences, not note form
» appropriate letter format
• Check for any simple grammar and spelling errors that you may
have made
• If a page is messy, use clear marks (e.g., arrows, numbers)
to show the sequence in which the parts of your text should
be read
• Cross out clearly anything you do not want the assessors to read
Marking the test

The test is assessed by looking at several criteria but
most importantly, your letter is assessed as to its ability
to organise information logically and communicate it
clearly.
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Set 1
Overall task fulfilment
1. Have you followed the instructions of the task?
You will know what your role is and you will know
who you are writing to as this is stated in the writing
task. For example, you may be a Charge Nurse on a
ward writing to a community nurse or a manager of a
nursing home. Understanding the task instructions is
one of the most important aspects of the test.
Initially you may write:
I am writing to refer Mr X to you for care and support.

I am writing to refer Mr X to you for follow-up care.
I am writing to transfer Mr X back to your care. (Mr X

was living in a nursing home, went to hospital and is
now returning to the nursing home)
I am writing to transfer Mr X for rehabilitation.
Remember that you explain the reason for the letter at

the beginning but only as a summary. The details of
what you are requesting will be written in the final
paragraph. Do not forget to state if the referral is for
urgent attention.
I am writing to refer Mr X for an urgent assessment of
her swallowing problems.
2. Are you writing the correct type of letter?

If you are writing a referral letter, it may be to a nursing
home or to a community nurse. For example, you may
be transferring a patient back to a nursing home or
writing a letter to a GP requesting a service.
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An alternative letter is an ‘informational’ letter, e.g. a
school nurse or occupational health nurse writing to
inform about a health issue.
Who are you writing to?
What is the reason for writing? Explain the main

purpose of your letter at the start, e.g.
*discharge letter for a patient going home and
needing nursing support
*transfer letter for a patient going to a nursing home
*discharge letter for a patient going home and
needing follow-up care by their GP
Be clear about the level of urgency of your letter e.g.

-‘The patient will need to have an INR in two days’
time’.
-‘The patient requires suture removal in a week’
What treatment did the patient receive?

The patient has a surgical history
Think about the sort of information you’ll talk about.
Name of the operation
Does the patient have a wound?
Does the patient need sutures /clips / staples removed?
Does the patient need help with their personal hygiene?
The patient has a medical history

Does the patient need help with personal hygiene?
Does the patient need help with mobility?
Does the patient need education or help to use a
glucometer or CPAP machine for example?
The patient has a mental health history
Does the patient need encouragement to continue
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treatment?
Has the patient started a new medication?
What is the discharge plan? What new medication has
been prescribed or what medication has been restarted?
What physiotherapy has been started? What equipment
has been supplied?
What complications did the patient suffer? Were there
any abnormal events during the operation or in the postoperative period? What
happened?
What are the post-op instructions? When will sutures or
clips be removed? When does the patient need a dressing change? When does
the patient need a blood test?
Is the letter the correct word length?

The letter must be 180 – 200 words. It is very important that you stick to the
word limit. You are going to write around four paragraphs in your letter. Each
paragraph will therefore contain around 45-50 you will write a topic sentence to
start the paragraph and write two or three sentences to support the topic
sentence. Words. This means that you will write a topic sentence to start the
paragraph and write two or three sentences to support
the topic sentence.
Appropriateness of language
Type of language:
*Professional letters use a formal style of writing. The
passive voice is more common in writing than it is in
speaking.
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*Informal language such as slang, colloquialisms and
jargon is often used in informal letters. The only time
you may use informal language is if it is clear that you
are writing to a well-known colleague. Never use
‘gonna’ (for ‘going to’) or ‘wanna’ (for ‘want to’).
*Informal SMS texting is never used in formal letters.

As the OET writing test is a test of your ability to form
correct sentences using appropriate language, you will
need to use formal language. For example, ‘keep an eye
on’ (spoken) is the same as ‘monitor’ (written)
Organisation of your material
1. Who are you writing to?

Use the correct salutation to begin and end the letter. A
‘salutation’ is a greeting.
* If the recipient’s name and title is given in the task
information, you should use them.
* In Australia, you should address all women as Ms
unless it is otherwise stated. For example, Judy Barton,
Nursing Unit Manager would be greeted as ‘Dear Ms
Barton,’
* Some married women choose to call themselves Mrs.
and make this very clear. For instance, (Mrs) Sarah
Jones would be greeted as ‘Dear Mrs Jones,’
* You write a comma after the name of the recipient e.g. Dear Ms Jones,
* Never write ‘Dear Mrs Susan,’ or ‘Dear Mr John,’
* Never write ‘Dear,’ or ‘Dear Mam,’
Full stop after Mr, Mrs or Dr?
Australia tends to follow British usage which differs
from American usage.
The rules are as follows:
1. If the abbreviation ends with the same letter as the
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whole word, no full stop is used.
2. If the abbreviation ends with a letter which doesn’t
end the whole word, a full stop is used.
3. The invented title 'Ms' has widely displaced 'Miss' to
describe a feminine form which does not indicate
marital status. A full stop is not used.
How do you address a child in a letter?

A male child (up to around the age of 18) is referred to
as ‘Master’. There is no abbreviation:
‘Dear Master Jones,’
A female child (up to around the age of 18) is referred
to as ‘Miss’. E.g. ‘Dear Miss Jones,’
These days, it is acceptable to address a child by his/her
first name, e.g. Dear John, Dear Jenny,
What if you are not told the recipient’s name?
If you are not told the name of the recipient, you need
to use the fixed expression 'Dear Sir / Madam,'
Never write ‘Dear Mam,’
A note about ‘dear’
When speaking, the expression ‘dear’ is used as a term
of endearment. The expression is an old-fashioned term
which is mostly used by older people these days. It is
not generally considered appropriate for younger people
to use. For example, ‘Would you like a piece of cake, dear?’
Using a hyphen with numbers

Rule 1: If you write out a number from 21 – 99, you
need to separate the numbers using a hyphen.
Use a hyphen when you write out a fraction.
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For example:
⅔ two-thirds
⅕ one-fifth
¾ three-quarters
⅝ five-eighths
Rule 2: When a number is used to make an adjective,

we add a hyphen between the number and words. This
is because the words work together as a single
adjective. The hyphens make the words clear.
1. 'We’ll have a one-hour meeting about his case'. but

'The meeting will last one hour'.
2. 'He came into hospital after a two-week illness.' but
'The illness lasted two weeks.'
3. 'Jimmy is a five-year-old with a lot of energy.' but
'Jimmy is five years old.'
4. 'Tomorrow you’ll do a ten-minute stress test.' but
'The stress test lasts ten minutes.'
* Look at example 1.
‘We’ll have a one-hour meeting about his case.’
If I had written ‘We’ll have a one hour meeting about
his case.’ it may have meant ‘We are only having one
meeting (lasting an hour) about this case. No further
meetings’.
* Look at examples 2 and 3. Notice that we say:
2. a two-week illness (‘week’ is singular) but
The illness lasted two weeks.(‘weeks’ is plural)
3. a five-year-old (‘year’ is singular) but
Jimmy is five years old. (‘years’ is plural).
Rule 3: A hyphen can be used to indicate a range of
numbers. For example, from one date to another date. If
you use the words ‘from.... to’, you should not use a hyphen.
He suffered from chronic bronchitis 1990 – 1995.

He suffered from chronic bronchitis from 1990 to 1995.
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Examples:
1a He has gained five kilos since June.
1b He had a five-kilo weight gain since June.
2a The shifts on this unit are 12 hours long.
2b They are 12-hour shifts on this unit.
3a He is on 24-hour monitoring at the moment.
3b The monitoring is being undertaken over 24 hours.
What does a paragraph look like?

Generally a paragraph has one idea only. This may
be:
one point of a single idea with supporting evidence
several points of a single idea
Paragraphs start with a topic sentence. Most often

this is the first sentence of the paragraph. The topic
sentence should tell you what the paragraph is about. It
should contain at least one key term. You can think of
the topic sentence as a summary of the paragraph.
After the topic sentence you will need to develop the paragraph to support the
main idea. In a paragraph of 35-40 words, you will probably add 2-3 sentences
to support the topic sentence.
Some examples of supporting sentences:
-give examples
-add facts or figures
-use a study as an illustration
-define terms
The outline of a referral letter

Think about the purpose of a referral letter – it is
written so that the reader of the letter has a general idea
of what has happened to a patient including a summary
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of the treatment recently received. The reader of the
referral doesn’t have to read through the discharge
summary (in the case of the OET, the stimulus material)
to get a clear idea of what s/he has to do. You are
referring a patient on to someone so they can continue
care or do something specific for the patient.
To make your letter clear and easy to understand, you
need to structure it in a way that is expected – you need
to set out the letter using a standard referral letter
format.
Format of a referral letter
Name and title of recipient
Name of hostel / community centre/GP Practice
Address
[leave a line]
Date (day month year)
[leave a line]
Dear [correct salutation],
Reference [Re: Mr Bill Brown, aged 82]
Paragraph 1: Why are you writing the letter?
I am writing to refer Mr X for ongoing care and support . Mr X was admitted to

the hospital with ...... / after a
(heart attack /car accident / hypoglycaemic attack / dog
bite. He suffers from ....
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Paragraph 2: What treatment in hospital?
During hospitalisation, he underwent ....... / received
treatment for .../ was assessed for...
He was also reviewed by the physio /occupational
therapist / dietician and started an exercise programme
/weight loss programme / Quit Smoking programme.
Paragraph 3: What complication occurred?
Whilst in hospital, Mr X had an episode of chest pain
which was treated with GTN spray/developed a wound
infection / chest infection which has now resolved.
Paragraph 4: What do you want the receiver of the letter
to do? (discharge plan)
Could you please.... Would you also..... Please ...... It
would also be beneficial if you could.... Finally, could
you .....
Closing sentence. (stock sentence)
Yours sincerely,
[your name]
[title]
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Starting and ending the writing task
The words in the beginning and ending of the referral
letter do not count towards the 180 – 200 word limit.
The setting out of the address, date and salutation are in
a standard form. Once you know how to set out a letter,
it is a matter of filling in information from the stimulus
material.
The order of the initial set up is as follows:
1. Name of the person you are writing to – usually with
the person’s title e.g. Ms Susan Rodriguez
2. Title of the recipient – this is usually found at the
end of the writing task e.g. Mr Tom Smith, Head
Physiotherapist.
3. Address of the recipient – this should be written in
two lines:
Number of house/apartment + Street name + St/Rd/Ln
etc
Suburb name + state + postcode
4. Leave a space
5. Date - you will often be asked to put in the date of
the test e.g. [today's date].
Use the Australian / NZ date format
6. Leave a space
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7. Dear [salutation] – using correct format e.g. Dear
Ms, Dear Mrs, Dear Dr + last name + comma
8. Leave a space
9. Reference information: Name of patient being
referred and his/her age
Writing the date
UK/ Australian /New Zealand convention is the format:
day + month + year
e.g. 10 September, 2013
You can also use numbers only: 10/9/2013.
However, using numbers has the potential to be
confusing if you are not careful. If you accidentally use
the American system of writing dates (month/day/year)
it can be confusing. E.g. Writing 11/9/2013 means 11th
September, 2013 (UK/ Aus / NZ) but 9th November,
2013 (U.S)
It’s best to stick with one convention only when writing
a letter.
Also, when you refer to a month within the letter,
always write the full word e.g.
‘Mrs X has an appointment at the Cardiac Clinic next
October.’
(not ‘next Oct’)
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Writing the address:
These days we do not use a comma at the end of each
line of the address. Look at the address above and
notice how it is written.
We write the address in the order:
Number of the flat / Number of the house etc + street
name + abbreviation of the type of street. E.g.
4/11 Hughes St (Flat 4, building number 11 in
Hughes street)
6-8 Long Rd (building 6 to 8 in Long Road)
Some common abbreviations for types of streets:
AveAvenue
CnrCorner
CresCrescent
LnLane
PdeParade
PwayParkway
RdRoad
StStreet
Writing the suburb and postcode
The second line is in the format:
Suburb + state + postcode. (no commas in between)
E.g.
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West Boronia NSW 2267
Fairfields Qld 4599
Summerfield Vic 3666
You write the abbreviation of the suburb as below.
Abbreviations of Australian states and territories:
ACT Australian Capital Territory
NT Northern Territory
NSW New South Wales
Qld Queensland
SA South Australia
Tas Tasmania
Vic Victoria
WA Western Australia
Note: In Australia each state has a postcode beginning
with a number for the state e.g. All postcodes in NSW
start with a 2. The American term 'zipcode' has the
same meaning as postcode.
If the stimulus material only gives you the suburb and
the postcode, just write that. If you know the state from
the postcode, you can write it. For example, if you see a postcode starting with a
3, you may know that this is a
postcode for Victoria.
What about writing an address in New Zealand?
Addresses are written in a slightly different way in New
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Zealand. You should be aware of the differences in case
your stimulus material relates to a case study from New
Zealand.
The following format is used to write addresses in New
Zealand:
Mr John Smith [ title and full name of person]
63 Brown Street [street names should be spelled in full]
Epsom [name of suburb]
Auckland 1023 [city must be used but not the province]
[postcode must also be used]
Postcodes of government regions in New Zealand
The reference information

Write Re: [name of the patient], [age]. ‘Re’ means
‘regarding’ or ‘referring to’.
This focuses the receiver of the letter on the content of
the letter. It should focus you on the person you are
writing about.
The salutation
This is a section many people have difficulty with. In
English, the convention is to address people as follows:
1. Addressing a friend – first names are used. E.g. Dear Susan, (Notice the
comma after the name)
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2. Addressing someone you do not know but whose
name you know. Use Mr / Mrs / Miss / Ms + their last

name e.g. Dear Mr Blogs, (Notice that there is a comma
after the name)
3. Addressing someone you do not know and whose
name you do not know – 'Dear Sir / Madam,' (Notice the comma)
A common mistake is to use the person’s first name with Mr /Mrs /Miss /Ms.
For example, ‘Mr Bill’ instead of ‘Mr Smith’ ( the person’s name is Mr Bill
Smith). It is incorrect to do this.
Another mistake is to address a person you do not know
as ‘dear’ e.g. ‘Hello, dear’. The word ‘dear’ has several
meanings. In the case of salutations, we use it:
1. to start a letter e.g. Dear Mr Smith / Dear Mary /
Dear Sister Brown,
2. as an old-fashioned term of endearment. These days
it is usually only the elderly who use this term. E.g.
‘Hello, dear. How are you feeling?’
The ending of the letter

You can use a stock ending for your letter which is easy
to learn and re-use. You are concluding the letter and
making yourself available if the person needs more
information. You can use sentences like:
Thank you for accepting this referral. Should you need
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more information please contact me.
Yours sincerely,
These days, ‘Yours sincerely’ (capital Y) is used rather
than ‘Yours faithfully’.
Formerly, ‘Yours faithfully’ was used if you did not
know the person you were writing to. ‘Yours sincerely’
was only used for friends. It is now quite acceptable to
use ‘Yours sincerely’
The ending
Yours sincerely,
Vincenzo Capri
Charge Nurse
Watford General Hospital
[Your name and title] Your title will be found at the top
of the stimulus material. E.g. ‘You are a Registered
Nurse on AAU at Watford General Hospital....’
The ending would be:
Yours sincerely,
Vincenzo Capri (put your name here)
Registered Nurse
AAU Watford General Hospital
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Set 2 Letter providing Information
An alternative letter task is to write a letter to inform a
person or a group of people about a health issue. For
example,
- a school nurse writes a letter to parents and students to
inform them about a lecture which they were unable to
attend. Health issues may be burns, impetigo, head lice
for example. The stimulus material may be in the form
of an overview of the lecture or a poster.
- an occupational health nurse informing staff about the
availability of a vaccine e.g. flu vaccine. Information
may include a FAQ (frequently asked questions) section
or information with available appointment times.
The information letter differs from the referral letter in
the following ways:
1. You may not need to write an address section at
the top of the letter.
2. You may have to guess the most sensible date to
add. For example, if the letter is talking about a lecture you gave on March 21,
you would have to date the letter after March 21 so it makes sense – you are
writing to inform after the lecture.
3. The salutation may be a general salutation, e.g. Dear Parents, Carers

and Students,
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If it seems that you are writing to a group in general, you can write: ‘To whom
it may concern,' instead of
'Dear…..,'
4. The organisation of your paragraphs still has to be
logical and well organised, however, you are not
describing a patient and his/her treatment, you are
summarising information.
So, you need to structure the information into logical
paragraphs. E.g.
Paragraph 1: description of types of burns and how they
are assessed.
Paragraph 2: First Aid and treatment
5. The letter ends in the same way as a referral letter
with the stock phrase offering any further help or
information if needed.
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Set 3 How to Writing Paragraph 1
Introducing the patient
What is the reason for writing? Explain the main
purpose of your letter at the start, e.g.
-discharge letter for a patient going home and
needing nursing support.
-transfer letter for a patient going to a nursing home
-discharge letter for a patient going home and
needing follow-up care by their GP.
Be clear about the level of urgency of your letter e.g.
‘The patient will need to have an INR in two days’
time’.
‘The patient requires suture removal in a week’.
Expressions to describe symptoms

became hypotensive / hypertensive / hypothermic/
tachycardic
became confused / disoriented / aggressive/depressed
/unresponsive/uncooperative
became hyponatraemic /hypocalaemic / anaemic
developed a pressure ulcer / chest infection/wound infection
complained of chest pain / angina / numbness and
tingling in the fingers / chest tightness
31
developed reduced renal function/reduced cardiac
output
exhibited poor glycaemic control/fluctuating bgls
had a hypoglycaemic attack
had a fall/sustained bruising from a fall/ sustained a
fractured arm from a fall
suffered from bouts of diarrhoea and vomiting/ episodes
of urinary / faecal / double incontinence / constipation
/faecal overflow /faecal impaction
'Unfortunately, Mr Browne had a fall on March 26 and
sustained considerable bruising to his left arm. He was
X-rayed and found to have a very small crack on his
ulna which fortunately only required immobilisation
with a collar and cuff.'
32
Set 4 How to writing Paragraph 2
Explaining treatment
What treatment did the patient receive? Decide whether
to use a time line sequence or a simple description.
Treatment received
-Chest infection treated with antibiotics and chest
physio.
Mr Turner was treated for a chest infection with
antibiotics and chest physio.
Mr Turner was admitted with a productive cough which
was treated with antibiotics and chest physio.
Whilst in hospital, Mr Turner’s chest infection was
treated with antibiotics as well as chest physio.
-Furosemide dose increased from mane to bd.
Mr Turner’s Frusemide dose was increased to twice a
day to better manage his oedema.
The oedema in Mr Turner’s lower legs was managed
with an increased dose of Furosemide.
Mr Turner was also treated for oedema and now takes
Furosemide twice a day.
-Started nutritional supplements and monitoring by
33
hospital dietician
Mr Turner’s decreasing weight and loss of appetite was
reviewed by the dietician. He has been started on
nutritional supplements and ongoing review.
Mr Turner has been seen by the dietician and started on
nutritional supplements to assist with his recent weight
loss.
Mr Turner has lost weight and was commenced on
nutritional supplements.
34
Explaining complications and adverse
incidents
What complications did the patient suffer? Were there
any abnormal events during the operation or in the postoperative period? What
happened?
Complications may include change in condition, change
in responsiveness or change in infection status. Think
about the expressions you may need to review for:
electrolytes (high or low levels)
diabetes (high or low bgls)
blood pressure, pulse and temp (high or low)
neuro signs (alert, confused, loss of consciousness)
development of infection
breathing changes
became hypotensive / hypertensive / hypothermic/
tachycardic
became confused / disoriented / aggressive/depressed
/unresponsive/uncooperative
became hyponatraemic /hypocalaemic / anaemic
developed a pressure ulcer / chest infection/wound
infection
complained of chest pain / angina / numbness and
tingling in the fingers / chest tightness
35
developed reduced renal function/reduced cardiac
output.
exhibited poor glycaemic control/fluctuating bgls

had a hypoglycaemic attack
had a fall/sustained bruising from a fall/ sustained a
fractured arm from a fall
suffered from bouts of diarrhoea and vomiting/ episodes
of urinary / faecal / double incontinence / constipation
/faecal overflow /faecal impaction.
Look at these examples,
'Unfortunately, Mr Browne had a fall on March26 and

sustained considerable bruising to his left arm. He was
X-rayed and found to have a very small crack on his
ulna which fortunately only required immobilisation
with a collar and cuff.'
'During her hospitalisation Mrs Redfern became
increasing confused and uncooperative. Blood tests
revealed that she had become hyponatraemic as a result
of diuretic use. She responded well to a one litre fluid
restriction and the stopping of her diuretics. She has
been started on an alternative diuretic and does not
require fluid restriction any more.'
'Mr Blackmore developed a wound infection whilst in hospital. The wound is

located on his left hip and became infected during frequent episodes of faecal
incontinence. Wound management has therefore been extremely difficult,
36
however, frequent pad checks and prompt cleaning of faecal matter have made a
difference.'
'Whilst on our ward, Mr White suffered from three
episodes of diarrhoea and vomiting and was isolated in
a side room. He has had no further episodes for the past
48 hours and is therefore fit for discharge.'
'During her stay in hospital, Mrs Gold’s glycaemic
control was noted to be poor. She had a hypoglycaemic
attack (bgl of 1.7) two days ago which she claims is
unusual. It was noted that she had missed her last
appointment at the Diabetes Clinic as she claimed that
she was ‘managing fine without their help.'
37
Requesting ongoing care
The final paragraph of the referral letter usually
contains a request for something to be done. You may
be requesting that a Community Nurse visit your patient
or that a geriatric assessment team assess your patient’s
home environment to advise on home aids. This
information is often found in the ‘Discharge Plan’
section of the stimulus material.
If there is no discharge plan, you may notice other
information in the stimulus material which points to a
need for aftercare. For example, patient will need
follow up at Plaster Clinic. Poor diet – patient may need
help with shopping and cooking on discharge.
Remember that you may be writing to a colleague,
another healthcare professional or a relative of the
patient. It is important to work out who you are writing
to before you plan the letter. This will help you direct
the information in the right way.
You need to decide on the level of language you are
going to use. Referral letters use formal language,
however, there are levels of formal language which can
38
be used. You may like to include ‘softeners’ or polite
phrases rather than demand a service.
Polite requests
You can use these expressions in the last paragraph to
introduce what you are asking to be done.
Could you please…..?
Would you please….?
It would be beneficial if you could…..
Please……
Think of some of the things you are likely to request:
Revise these expressions:
educate the patient on the use of the nebuliser / CPAP
machine / glucometer
assess the wound
redress the wound / change the dressing
remove the sutures /clips/staples
monitor the wound for infection
liaise with the GOP /specialist /patient’s relatives
check compliance with his medication / the exercise
programme / the nicotine patches
ensure s/he attends his/her clinic appointment
supervise personal care / showering / taking medication
provide support to the patient
39
encourage independence.
Set 7 Sample referral letter: post heart attack

You are a Registered Nurse on the Cardiology Unit at
St Jude’s Hospital where Mr Oakes was admitted after a
heart attack. Refer Mr Oakes to the Nurse in Charge,
Ms Petra McGovern, at the Cardiac Rehabilitation Unit
for cardiac rehabilitation.
Patient: Mr Samuel Oakes
Age: 44 years
Admission date:10 January, 2014
Discharge date: 13 January, 2014
Allergies: Aspirin, penicillin
Presenting problem: Myocardial infarction 10/1 -
sudden, crushing chest pain, Brought in by ambulance
from work.
Past Medical Problems:
weight gain over past 5 years. Now mildly obese – 90kg
Hypertension - takes anti-hypertensives
family history of heart disease (mother had 3 heart
attacks – died young)
40
Repair of inguinal hernia age 20
deaf in left ear – wears hearing aid
Social History:
High stress job - executive at IT company
poor diet – eats out a lot, high fat intake
moderate to high alcohol intake – socialises with work colleagues 2-3

times/week
non-smoker
intermittent exercise – tends to join a gym for a month
then quits.
Medical treatment:
10/1 O/A Bloods taken for cardiac markers and ECG –
ST elevation
11/1 Coronary Angioplasty with i/o stent
Bloods taken → high cholesterol levels identified. Pt
worried about taking statins.
12/1 Commenced anticoagulant daily (clopidogrel as
allergic to aspirin). Agreed to commence Simvastatin
40 mg daily. Chest pain – relieved by GTN spray, ECG
– no extension of MI
13/1 Nil chest pain. Obs. stable – BP stabilising.
Consult with hospital dietician re weight loss
programme.
Discharge Plan
41
1. Cardiac Rehab for post MI education
especially.statins – encourage patient to keep taking
statins -needs to understand side effects and interactions
(e.g. grapefruit).
Check BP weekly. Report increased BP
2. Cardiac rehab – develop cardiac exercise programme
– monitor compliance with programme
3. Encourage adherence to weight loss programme –
weekly wt. until follow up at Cardiac Clinic.
4. Cardiac Clinic appt 6wks – to be sent to patient
Writing task: referral letter
Write a referral letter to Ms Petra McGovern at the
Cardiac Rehabilitation Clinic, St Jude’s Hospital, 56
Chelmsford St, Nowton NSW 2376.
1. Reading the stimulus material
Who are you writing to? (look in the task at the end)
Why are you writing to this person? (refer for ongoing
care and support, ask for community nurse visits, ask
for home assessment of patient, monitor compliance
with medication etc)
Who is the patient? What age? (elderly, a child)
Notice any relevant information for your paragraphs.
What are your paragraphs going to be about?
42
1. Introduction of patient, Brief outline of problem and
past medical health
2. What treatment in hospital/clinic etc?
3. Any problems in hospital?
4. Requests for after care
2. Making a plan
Now make a plan, including information from the
stimulus material which fits in with your paragraphs.
Keep in mind the number of words you need to write. If
you decide to write 3 paragraphs, each will be around
60 words. If you have 4 paragraphs, they will need to be
shorter.
You will probably find that the first paragraphs are
around 3 or 4 sentences long. The final paragraph may
be a bit longer.
43
Sample referral letter
Ms Petra McGovern
Cardiac Rehabilitation Clinic
St Jude’s Hospital
56 Chelmsford St
Nowton NSW 2376
13 January, 2014
Dear Ms McGovern,
Re: Samuel Oakes, aged 44
I am writing to refer Mr Oakes who is recovering from

a myocardial infarction. Mr Oakes was admitted to
hospital following sudden, crushing chest pain. Based
on an ECG and blood test, he has been diagnosed with
myocardial infarction with high cholesterol levels. He
also has hypertension which is controlled by
medication.
During hospitalisation, he underwent a coronary

angioplasty. He has started taking Clopidogrel and
Simvastation 40 mg daily. In addition, he has been seen
by a dietitian for weight loss management. Mr Oakes
works in a high stress occupation and has a poor diet. In
addition, he does insufficient exercise and has a
moderate to high alcohol intake. As well as this, he has
a family history of heart disease.
Could you please educate him about statins and their

interactions as part of his cardiac rehab? Could you also
check his blood pressure weekly? Would you please
arrange a cardiac exercise program for him and monitor
44
compliance with the program? Please encourage him to adhere to the weight
loss program and weigh him weekly before his next clinic appointment in six
weeks’time.
Should you have any further questions, please do not

hesitate to contact me.
Yours sincerely,
Vincenzo Capri
Registered Nurse
Referral letter notes
1. Notice how the address is written.

Ms Petra McGovern
Cardiac Rehabilitation Clinic
St Jude’s Hospital
56 Chelmsford St
Nowton NSW 2376 (write suburb + state +
postcode)
13 January, 2014
Dear Ms McGovern, (Put a comma after the

salutation)
Re: Samuel Oakes, aged 44

[Para 1 – introduce patient, relevant history and reason
for being there]
I am writing to refer Mr Oakes who is recovering from
a myocardial infarction. Mr Oakes was admitted to
hospital following sudden, crushing chest pain.Based on
an ECG and blood test, he has been diagnosed with
myocardial infarction with high cholesterol levels. He
45
also has hypertension which is controlled by
medication. (53 words).
[para 2 – what happened in hospital?]
During hospitalisation he underwent a coronary angioplasty. He has started

taking Clopidogrel and Simvastation 40 mg daily. In addition, he has been seen
by a dietitian for weight loss management. . Mr Oakes works in a high stress
occupation and has a poor diet. In addition, he does insufficient exercise and has
a moderate to high alcohol intake. As well as this, he has a family history of
heart disease. (70 words)
[para 3 – what do you want the community nurse to

do?]
Could you please educate him about statins and their
interactions as part of his cardiac rehab? Could you also
check his blood pressure weekly? Would you please
arrange a cardiac exercise program for him and monitor
compliance with the program? Please encourage him to
adhere to the weight loss program and weigh him
weekly before his next clinic appointment in six weeks’
time. (63 words)
[standard ending which can be used each time – not

included in word count]
Should you have any further questions, please do not
hesitate to contact me.
Yours sincerely, [Yours sincerely acceptable these

days]
Vincenzo Capri
Registered Nurse
46
Set 8 Sample letter which informs the public
As with a referral letter you need to follow the same
steps before writing your letter. You have the same
word limit of 180-200 words so you need to keep an
eye on the word count of each paragraph.
There are some differences in the way you need to set
out the letter.
1. You probably will not need to write an address at the
top as you may be writing to a group of people. For
example, in the sample letter below, you are writing to
‘Parents, Carers and Students’.
2. Think about a logical date to use. In the case of the
sample letter, you are writing after a lecture on 21
March so the date needs to be after this date.
3. The writing task may give you some guidance about
how to write the salutation? In this case, it says to say
‘Dear parents, carers and students,’
If you are not given any guidance, you can use the
following:
* Dear Albob staff, (Occupational Health Nurse writing
to staff of a factory)
47
* Dear staff and students, (School Nurse writing to staff
and students of a school)
* Dear Ms Smythe, (Clinic Nurse writing to a patient with information about a

vaccination programme)
* To whom it may concern, ( A general letter to anyone
who is affected by an issue)
4. The stimulus material may be in the form of Fact
Sheet (e.g. Impetigo, Conjunctivitis, Flu Vaccination),
notes from a lecture (First Aid for Burns, CPR in the
community) or similar format. You may be able to use
the points in the stimulus material to structure your
paragraphs.
1. Reading the stimulus material
- Who are you writing to? (look in the task at the end)
- Why are you writing to this person? (to inform
about….?)
- Who is the intended receiver of the letter?
- Notice any relevant information for your paragraphs.
What are your paragraphs going to be about?
2. Making a plan
Now make a plan, including information from the
stimulus material which fits in with your paragraphs.
Keep in mind the number of words you need to write. If
you decide to write 3 paragraphs, each will be around
48
60 words. If you have 4 paragraphs, they will need to be
shorter.
You will probably find that the first paragraphs are
around 3 or 4 sentences long. The final paragraph may be a bit longer.
Information letter: Stimulus Material
These are the notes about a lecture that you gave to
parents and students of Watford State High School on
21/3/2014 about the First Aid treatment for burns.
You are the school’s Registered Nurse. Write a letter to
inform any parents or students who did not attend the
school meeting, about what you said in the lecture.
Note: You can address the letter as ‘Dear Parents,
Carers and Students,
LECTURE: First Aid for Burns.
1. Types of burns
* thickness of burns / 1st, 2nd, 3rd degree
* caused by petrol, chemicals, electricity, steam, hot
Water 2. First Aid for major burns
* Move person away from danger (take care if an
electrical fault)
* Remove clothing and jewellery if possible (possible
swelling) / leave if stuck to skin
* Call emergency number / stay with patient until help
arrives
49
* Wash burn with lukewarm water / tap water OK/ keep
flushing until emergency services arrive
* Rehydrate patient –use water / no alcohol!
3. Important!
* Do not put butter on burn –this is an 'old wives' tale'
* Do not wash with cold water (drops patient's
temperature too much)
* seek urgent medical attention for chemical burns to
the eyes.
Example informational letter

2 March, 2014
Dear Parents, Carers and Students,
I am writing to inform those of you who did not attend
the school meeting yesterday about the First Aid for
burns. Burns may be caused by fire, chemicals,
electricity or steam and are classified as first, second or
third degree burns depending on the depth and
appearance of the burn. First degree burns are mild
burns and do not usually require emergency treatment.
Second and third degree burns are more serious and
usually need medical attention.
Move the person who has a major burn away from
50
danger and call the emergency number immediately.
Remove clothing around the burn if it is not stuck to the
skin. Also remove any jewellery before the tissues
around the burn swell.
Use lukewarm water to wash the burn. It is acceptable
to use tap water but make sure that it is not cold water
as the patient’s temperature may drop too much. Never
put butter on a burn as this is not correct treatment.
Cover the area with a clean cloth and keep flushing with
water until emergency services arrive. Give drinks of
water, never alcohol to the patient. Finally, seek urgent
medical attention if there are chemical burns to the
eyes
Please contact me at school if you would like more
information.
Yours sincerely,
Vincenzo Capri
Registered nurse
51
Set 9 Case Notes and Sample Letters
WRITING TEST 1
Time allowed:
Reading Time : 05 Minutes
Writing : 40 Minutes
Read the case notes and complete the writing task which follows.
Case Notes:
Mr Benjamin is a 63 – year-old patient in “Care Well Hospital” where you are
acting as a Charge Nurse.
Patient Details:
Marital Status Widower (8 years)
Admission Date 5 September 2009 (Care Well Hospital)
Discharge Date 9 September 2009
Diagnosis THR – Total Hip Replacement, Higher BP
Social Background Lives in Abrina Nursing Home, 19-21 Victoria Street
ASHFIELD NSW 2131.Had been there for 2 years before coming to Care Well
(2 months ago). Has no children, Worked in a bank as an accountant before
quitting at the age of 60.No Pension
Hobbies: reading, writing, chess
Brother, Peterson, visits daily
No severe signs of dementia have been observed yet
Medical Background
2005 – Osteoarthritis requiring total hip replacement surgery
2003 – Blood Pressure (management ongoing)
Medications Aspirin (100mg)
52
Ramipril 5mg
Nursing Management and Progress
Dressing Daily
Recommend stretching exercises
Follow up FBE and UEC tests
Assessment
Good Condition – post operation
Walks with aid in the beginning but now walks perfectly with wheelie-walker
Appeared disoriented during post operative recovery - possibly anesthetic
Hb dropped (71) post operatively, transfused three units of packed RBCs
Hb normal on discharge (112)
Discharge plan
Pain reliever recommended was Panadeine Forte (6tablets / day)
Exercise recommended
Equipment required: wheelie-walker, wedge pillow, toilet raiser.
Hospital is providing Wheelie-walker and wedge pillow.
With help from local medical supplier, raiser hired for 2 weeks.
Writing Task
Using the information in the case notes, write a letter to Ms Susanna Bates,
Senior Nurse at Abrina Nursing Home 19-21 Victoria Street ASHFIELD,
NSW 2131, who will be responsible for Benjamin's continued care
at the Nursing Home.
Nursing Writing Tests 1 - 5
In your answer:
• Expand the relevant notes into complete sentences
• Do not use note form
• Use letter format
The body of the letter should be approximately 180-200 words.
END OF WRITING TEST1
Sample Letter 1
Ms Susanna Bates
Abrina Nursing Home
19-21 Victoria Street ASHFIELD
NSW 2131
53
(Today‟s date)
Re: Mr Benjamin Baker, 63 years old
Dear Susanna Bates
Mr Benjamin is being discharged from our Hospital into your care today. He underwent
Total Hip Replacement Surgery (THR). He is now good and able to walk short distances
by using his wheelie-walker.
He was recommended Panadeine Forte (6 tablets / day). His HB dropped post

operatively.Three packs of RBCs were transfused. His HB is normal now (112). It is
requested that he shall be monitored for Anemia. He is a patient, facing BP problems
as well.
We are sending a wheelie walker with the patient. At the hospital he was provided
wedge pillow and toilet raiser (toilet raiser is hired for 2 weeks with help from our
social community). It is needed that he shall get all these facilities when he is under
your care. It is necessary that the patient shall perform stretching exercises so as to
recover speedily. Dressing is needed to be done daily. It is also suggested that FBE and
UEC tests shall be followed up.
His condition at the time of discharge was good. He was able to walk little distances.
Please contact me with any queries.
Yours sincerely
Charge Nurse
WRITING TEST 2 Writing WRITING TEST 2

Time allowed:
Case Notes:
54
Patient History Shirley Decosta is a two-week old baby.
(Her mother has been discharged from the maternity hospital)
Social History Mother: Ritz Decosta
DOB: 9/8/1983
Husband: Joseph Decosta, 42 years
Occupation: Taxi Driver
Other Children: Shelley Decosta, 9 years
Nursing Notes Normal delivery
Breastfeeding the baby
Weight Taken: At the time of birth: 3009 gm
At the time of discharge: 3022 gm
No health problems or signs of illness
Discharge Date: 22 April, 2011
WRITING TASK:
Using the information in the case notes, write a letter to Ms Susanna Bates,
Child Health Nurse, at Royal Women Hospital, CNR Grattan & Flemming St,
Parkville, VIC 3052, who will provide follow-up care in this case.
In your answer:
Sample Letter 2
Ms Susanna Bates
Child Health Nurse
Royal Women Hospital
CNR Grattan & Flemming St
Parkville, VIC 3052
(Today‟s date)
55
Re: Shirley Decosta
Dear Susanna Bates
Shirley Decosta, a two week‟s old baby, is being discharged from our Maternity
Hospital into your care today. Her delivery was normal. No health related problem was
observed.The baby was perfectly alright with no disease or weakness of any kind at all.
She is her mother‟s second daughter (Ritz Decosta also has got another daughter who
is nine years old).
Her mother, Ritz Decosta, has regularly been breastfeeding the baby as required or
suggested by the doctors. The weight of the baby taken at the time of the birth was
about 3009 gm. The weight of the baby at the time of discharge was about 3022gm.
This considerable increase in weight was normal as because of the suggestive care
provided by the mother.
No complications were noted or reported. The baby and the mother were healthy and
have been performing well. The regular medicine regime is suggested.
It is requested that the care shall be taken when the baby is there with you.
Yours sincerely
Charge Nurse
WRITING TEST 3
Time allowed:
Case Notes:
Hospital Royal Perth Hospital
56
Patient Details Alfred Billy
52 Years old
Marital status: married
Wife (Maria Jennifer) to be contacted in case of emergency
Address: Arillon City Arcade 207 Murray Street, Perth
Admission Date 21/03/2010
Discharge Date 5/05/2010
Diagnosis Skin cancer – BCC (Basal Cell Carncinoma) (neck)
Nodular basal-cell carcinoma
Past Medical No prior hospitalization, no medical history
History Medications
Social Truck driver
History/Supports Lives with his wife
Habit of consuming alcohol in excess (for the past 30 years)
Cigarette smoker
Dark skinned
Religion: Protestant
Medical Progress Skin biopsy has been taken for pathological study
Pain reliever panadein forte 500mg
Nursing No complications noted
Management Perfectly well at the time of discharge
No complaints of any pain
Discharge Plan Daily observation
Medicine to be taken for one more week
Writing Task
You are the charge nurse on the hospital ward where Mr. Alfred Billy has
recently
undergone an operation. Using the information provided in the case notes,
write a referral letter to the Community Nurse Head at “Care Well Hospital,”
Birmingham, who will be attending to Mr. Alfred Billy, following his
discharge.
In your answer:
57
The body of the letter should be approximately 180-200 words

Sample Letter 3
Community Nurse Head
Care Well Hospital
Birmingham
(Today‟s date)
58
Re: Mr Alfred Billy, 52 years old
Dear Community Nurse Head
Mr Alfred Billy is being discharged from our hospital into your care today. He has been
diagnosed with basal cell carcinoma and his neck region is the most affected area.
There is no history of carcinoma in his family.
Prior to this diagnosis, Mr Billy had always been in good health and he had no medical
history;this is the first time that he has ever been admitted into hospital. He stayed at
the hospital for observation for about a week but he is doing perfectly well now and his
condition is improving.
He was given panadien forte (500 gm) whilst he was here and it is requested that he
continues to take the same medication for a few more days. He has been drinking
alcohol excessively for approximately 30 years and he is also a chain smoker; it has
been suggested that he should avoid smoking and drinking completely whilst he is in
recovery.
The patient has made no complaints about any pain and he was well at the time of
discharge from the hospital. Daily observation is needed and the prescribed medicine
should be taken for one more week as well.
Yours sincerely
Charge Nurse
WRITING TEST 4
Time allowed:
Case Notes:
Patient: Maria Joseph is a 39-year-old woman who has been a patient at the
hospital you work at as a head nurse. Apart from typical childhood illnesses
such as
chicken pox, she had always been healthy and had no previous history of
59
medical
conditions.
10 / 5 2011
Subjective:
Frontal headache for 6 hrs. Mild assoc, suffering from nausea,
no vomiting, patient with blurred vision but not aura. No other symptoms
noticed. She has no family history of migraines.
Objective:
P96, BP 130/ 70. Normal Cervical Spine Movement, examination normal.
Assessment: Probably due to excess tension or personal stress
Plan: Advised to rest. Given analgesia (paracetamol (500q4h))
14/5 /2011
Subjective Complained of continuous headaches (left sided and frontal),
blurred
vision, throbbing headache (left sided). Vomited 5 times during the last three
hours. Complaining of slight paraesthesia.
Objective Distressed, P 103, BP 150/90, Normal peripheral nervous system
Assessment Severe Migraine Possibility
Plan: Stat- Pethidine 100 mg, intramuscular injection Maxolon 10 mg
15 / 5 / 2011
Home Visit
Subjective Fell down at home due to severe left sided headache, injured her
right
arm, bruises on left leg, slurred speech, half unconscious.
Objective P 100, BP 150/90, extension 4/5 power, left leg knee flexion 4/5
Assessment Probable intracranial pathology, space occupying lesions.
Plan Urgent assessment in Emer. Dept.
Writing Task
Using the information given above, write a letter to the neurologist,
who will be attending the patient in the emergency department.
In your answer:
END OF WRITING TEST 4
60
Simple letter 4
The Neurologist (name not mentioned here)
Emergency Department of Neurology
XYZ Hospital
(Today‟s date)
Re: Maria Joseph, 39 years of age
61
Dear (name here)
Maria Joseph was admitted into the hospital due to severe headaches on the 10th of May
2011. She suffered from a frontal headache for about 6 hours and complained of blurred
vision, but not aura. She denied any family history of migraines. Her blood pressure, during
her first day at the hospital, was noted as 130 / 70. She was given analgesia (Paracetamol)
and was told to take bed rest for a few days.
On the 14th of May, she again complained of the same continuous headache (left sided and
frontal) and blurred vision. She also vomited five times and complained of slight
paraesthesia. Her blood pressure also showed a slight increase from 130 / 70 to 150 / 90
and the condition was assessed as a severe migraine. Pethidine 100 mg and intramuscular
injection Maxolon 10 mg were prescribed.
The patient did not stay at the hospital due to personal reasons but the next day she was
brought to the hospital again (on the 15th of May). She had fallen down and become
unconscious due to the same excruciating headache.
Urgent assessment or examination of the patient is requested at the neurology department.

Yours sincerely
Charge Nurse
WRITING TEST 5
Time allowed:
Case Notes:
You are Joanna Andrews, a senior nurse working with „Your Health
Care Agency‟. Stephen Mabel is the patient. Read the case notes below
62
and complete the writing task which follows.
Name Stephen Mabel
Address 8 Stuart Street, Perth, WA 6000
Phone 0422 678 144
Date of Birth 18 June, 1972
Social Background
Married – Wife, Sandra Mabel, aged 39. They live together
Stephen Mabel works as an accountant for a company in Perth.
Medical History Cerebrovascular accident (CVA) approximately 2 years ago.
Agile, mentally active, speech slightly slurred,
complaining of severe illness,
walks with a limp, impaired balance
12/7/2011
Experienced a severe headache in the morning, fell down the stairs and badly
injured his left knee. GP requested „Your Health Care Agency‟ to help with
dressing
and assisting him in taking showers daily.
15/7/2011
Left knee – redressed, no infection noticed.
Stephen was able to walk short distances with the help from his wife, Sandra.
He complained of usual pain while walking, apart from this there is nothing
different to report and he is making good progress.
19/7/2011
Knee healed well.
Patient was advised to walk with walking sticks.
Patient‟s wife, Sandra, requested more home visits in order to continually
improve
his mobility.
WRITING TASK
Using the information provided in the case notes, write a letter to the
Ms Physiotherapy Center 588 Hay Street Subiaco, ((08) 9388 2877) on
behalf of Sandra, requesting a home visit to help her husband make
improvements with
his walking.
In your answer:
63
Sample Letter 5
Ms Physiotherapy Center
588 Hay Street Subiaco
Ph: ((08) 9388 2877)
(Today‟s date)
Re: Mr Stephen Mabel, Left Knee Injury
Dear Head Nurse
64
Mr Stephen Mabel is being discharged from „Your Health Care Agency‟ into your care
today.
The patient fell down a staircase and badly injured his left knee. It was profusely
bleeding and he was unable to walk properly. On the 12th of July, as per the guidelines
from the local area general physician, his wife, Sandra, contacted us and asked for
daily „home visits‟ (for assisting her husband with dressing and taking showers daily).
The patient’s left knee was dressed for the first time after he had showered on the 12th
of July and then again on the 15th of July. No infection was noticed on the 15th of July
and, as the wound was healing, the patient was able to make movements as well. The
patient has been able to walk short distances with help from his wife, Sandra.
The patient has complained about pain whilst walking (which was in fact normal in the
beginning due to the pressure on the injured area). Apart from this usual pain, there is
nothing significant to report. By the 19th of July, the knee had healed well. The patient
was advised to walk with the help of his walking sticks. His wife, Sandra, requested a
greater number of visits in order to help speed up his recovery.
Please, get in touch with Sandra on her number: 0422 678 144 to assist her with
helping her husband recover.
Yours sincerely
Charge Nurse
WRITING TEST 6
Time allowed:
Case Notes:
Mrs. Emily Ryan is a 59-year-old patient under your supervision at the
hospital where you are working.
Patient Details:
Marital Status: Widow (3 years)
Admission Date: 4 April 2013 (New Life Hospital)
Discharge Date: 15 June 2013
Diagnosis: Enlarged spleen (viral infections, splenomegaly),
65
high blood pressure
Social Background: Lives at ASPE House, 168 Lavender Hill London
One daughter – married, works as a lecturer
Hobbies: painting, reading
Brother, J. Pereira (66), very supportive, visits regularly
Medical Background:
2009 – food poisoning – spent one month at the hospital (New Life)
2006- – High blood pressure
Medications: Aspirin 100mg (recommenced post-operatively),
pneumococcal (pneumovax), meningococcal and haemophilus influenzae
type b (Hib) vaccines.
Nursing Management and Progress:
Dressing on surgery site - daily
No contact with water
Also, follow-up FBE tests at New Life Hospital
Assessment: In good condition. No signs of bleeding, pain or fever.
However, she still walks with support. Blood pressure normal on discharge.
Discharge Plan: Monitor medications (penicillin injection as directed),
avoid travelling, avoid vigorous exercise.
Writing task:
Using the information in the case notes, write a letter to Anna D Souza,
Senior Nurse at Old Age Nursing Home, 155 Commercial Street, London,
who will be responsible for Mrs. Emily Ryan’s continued care at the nursing
home.
In your answer:

66
Sample Letter 6
Anna D Souza
Old Age Nursing Home
155 Commercial Street
London
(Today’s date)
Re: Mrs. Emily Ryan, 59 years old
Dear Anna D Souza
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Mrs. Emily Ryan, who was admitted into our New Life Hospital, was diagnosed with an
infected spleen. A severe viral infection (splenomegaly) was noted which required
immediate attention.
The patient is a widower and has one daughter who is married and works as a lecturer,
the one who brought her to the hospital. She also has a brother who visits regularly.
Apart from a problem related to food poisoning which occurred once and high blood
pressure (the patient still has high BP), Mrs. Ryan has no previous medical history. The
patient was prescribed aspirin 100 mg (post-operatively) and advised to continue the
use of pneumococcal (pneumovax), meningococcal and haemophilus influenzae type b
(Hib) vaccines. There will strictly be no contact with water and dressing on the surgery
site is requested to be done daily. Follow-up FBE tests are recommended as well.
It is suggested that the patient should not perform vigorous exercises and that the
patient should avoid travelling until they have made a full recovery.
Please, contact me with any queries.
Yours sincerely
Charge Nurse
WRITING TEST 7
Time allowed:
Case Notes:
You are Shelly Kate, a qualified nursing sister, working with the STAR Nursing
Care Agency. Natasha Dobby is a patient in your care. Read the case notes
below and complete the writing task which follows.
Name: Natasha Dobby
Address: 201/275 Alfred St, North Sydney, NSW 2060
Phone: +61 2 9126 9264
Date of Birth: 2 August 1952
Social Background
Married – husband Patrick Dsouza, aged 73. He is a retired professor.
They live together in their own house.
Medical History:
Osteoporosis patient– first signs noted in 2009
16 July 2012
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Tripped over a loose rug – injured hip
16 July 2012
Admitted at the hospital (time: 12:45 pm)
Diagnosed – hip fracture or broken hip (intracapsular)
17 July 2012
Underwent surgery – successful
18 July 2012
Shifted to specialized geriatric-orthopaedic rehabilitation ward.
Rehabilitation treatment initiated.
Offered mobilization (exercises to help promote strength and recovery).
23 July 2012
Patient doing well. Walking, with help. Requires extra care.
25 July 2012
Discharged from the hospital
Her husband wants someone to come to their house to help her with gaining
mobility and with performing exercises to help speed up the recovery process. He is
not really able to assist her with walking because he uses a walking stick himself.
Writing Task
Using the information in the case notes, write a letter to Mrs. Margaret, Head Nurse
at Dowell Hospital, Ground Floor, 111-117 Devonshire St, Surry Hills, NSW 2010 to
request that a physiotherapist is sent to the patient’s house to help her with her
recovery.
In your answer:
¨ Do not use note form in the letter.
¨ Expand on the relevant case notes to explain the patient’s background and
medical history and the assistance requested.
¨ The letter should be 15-20 lines long.
¨ No more than the first 25 lines will be assessed.
69
Sample Letter 7
Mrs Margaret
Dowell Hospital
Ground Floor, 111-117 Devonshire St
Surry Hill
NSW 2010
(Today’s date)
Re: Mrs Natasha Dobby, 62 years old
Dear Margaret
Mrs Natasha Dobby, who underwent hip fractured surgery on 17th of July, is being
discharged into your care. On 16th of July, she tripped over and fell down, badly
injuring her hip. On diagnosis, broken pieces were noted which called for immediate
action. Surgery was performed successfully. The patient was shifted to a specialized
geriatric-orthopedic rehabilitation ward on 18th of July when the condition was noted to
be a bit normal.
70
Rehabilitation treatment was initiated and was offered mobilization (the patient was
encouraged to do exercises which promote strength and recovery). By July 23, the
patient was able to walk short distances with the help from her husband. She requires
extra help. Her husband wants a physiotherapist to come to their house to assist her in
gaining much more mobility (for her speedy recovery). Her husband is not able to
assist her as he himself walks with a walking stick.
Please, send a physiotherapist from your agency to the patient’s house to help the
patient recover sooner. Please, contact her husband on the number: +61 2 9126 9264.
Her addressed is added too. Her Address: 201/275 Alfred St, North Sydney, NSW
2060. Natasha Dobby has been a patient of Osteoporosis too since 2009.
Yours sincerely
Shelly Kate
WRITING TEST 8
Time allowed:
Read the case notes and complete the writing task which
follows.
You are Daniela Nichole, a qualified nursing sister, working with Apollo
Health
Agency. Catherine Tracy is a patient in your care.
Name: Catherine Tracy
Address: PO Box 2106, Level 1, 52 Brisbane Street, Tamworth
NSW2340.
Phone: (02) 6766 5110
Date of Birth: 14 November 1963
Social Background
Widow – lives with her daughter, Katie, who visits the hospital regularly.
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Admitted into the hospital due to high BP – 1992
Blood sugar patient for the past year
Date: 19 September 2009
¨ Admitted into the hospital due to a serious injury to the backbone
¨ Injury to the spinal cord noted - suffered from pain and an intense
stinging
sensation, caused by damage to the nerve fibers in the spinal cord.
¨ Loss of movement
¨ Loss of bowel and bladder control
¨ Difficulty with balance and walking

Date: 25 Oct 2009
Showing signs of recovery
Walking with the help of her daughter
Date: 12 Nov 2009
Patient doing well. Occasional complaints of back pain.
Date: 15 Nov 2009
Her daughter wants someone to come to their house to personally care
for her.
Writing Task
Using the information in the case notes, write a letter to Ms Kenzy Jaida,
Head Nurse at Royal Perth Nursing Agency, 6 Selby Street, Shenton Park,
Western Australia, 6008 to request that a nurse is sent to the patient’s
house to
help her with her recovery.
In your answer:
72
Sample Letter 8

Kenzy Jaida
Royal Perth Nursing Agency
6 Selby Street
Shenton Park
Western Australia, 6008
(Today’s date)
Re: Mrs Catherine Tracy, 51 years old
Dear Kenzy Jaida
Mrs Catherine Tracy was admitted into our “Apollo Health Agency” due to serious injury
to herbackbone on 19th September, 2009. The patient was suffering from pain or an
intense stinging (sensation must have been caused due to the damaged nerve fibres in
the spinal cord). Other changes that which were noted include loss of movement and
loss of bowel or bladder control.
The patient had difficulty in balancing or walking properly for a couple of days. It took
more than a week for the patient to get recovered to a certain extent. By Oct 25, the
patient began to show some signs of improvement. The patient was able to walk with
the help of her daughter who used to come regularly to see her.
73
The patient was discharged from the hospital on 15th November. The patient was doing
well. There were no problems (apart from usual complaints of pain in the neck which
would perhaps take some more time to go off). Her daughter wants someone to come
to their house to care for her personally.
Please, note that Catherine Tracy has BP and sugar problems too.
Yours sincerely
Daniela Nichole
WRITING TEST 9
Time allowed:
follows.
You are Molly Tia, a qualified nursing sister, working with ERR Health
Agency.
Elma Edith is a patient in your care.
Name: Elma Edith
Address: 213/354 Eastern Valley Way, Chatswood, NSW 2067
Australia.
Phone: 0427 694 010
Date of Birth: 19 February 1967
Social Background
Widow – lives with her husband. Her husband is disabled.
Medical History:
Admitted to the hospital due to high levels of abdominal pain
High blood pressure was identified – 1994 (but controlled now)
Date: 9 August 2009
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Admitted into the hospital due to jaundice
Treated successfully
Date: 17 June 2010
Admitted to the hospital due to nausea, vomiting and right upper
quadrant
abdominal pain
Diagnosed as cirrhosis (early stage)
Lost 3 k g body weight
Kept in the hospital for 20 days
Condition is normal
No need for surgery
Post medical care or treatment is required
Date: 7 July 2010
Patient is doing well.
Date: 8 July 2010
Her husband requested for a nurse to come to the house for her personal
care.
Writing Task
Using the information in the case notes, write a letter to Ms Christina
Dakota,
Head Nurse at Mavin Nursing Agency, Level 24, 1 Market Street, Sydney,

NSW 2000 to request that a nurse is sent to the patient’s house for
personal care.
In your answer
¨ Do not use note form in the letter.
¨ Expand on the relevant case notes to explain his background and
medical history
and the assistance requested.
¨ The letter should be 15-20 lines long.
¨ No more than the first 25 lines will be assessed.
75
Sample Letter 9
Mrs Christina Dakota
Mavin Nursing Agency
Level 24, 1 Market Street
Sydney NSW 2000
(Today’s date)
Re: Mrs Elma Edith, 47 years old
Dear Christina Dakota
Mrs Elma Edith was admitted into our “Health Centre” on 17th June 2010 on complaints
of nausea, vomiting and quadrant abdominal pain. On examination it was noted that
the patient was suffering from cirrhosis (early stage / there were no complications).
The patient complained of weight loss too (lost almost 3 Kg body weight).
The patient was kept in the hospital for 20 days. During this time, the patient didn’t
complain of any pain. As there was no need of any surgery, so it had not been
performed.
The patient’s condition was normal at the time of discharge from the hospital on 8th of
July. Her husband requested for a nurse to come to their house for her personal care
too.
Please, take a note of this too that Elma Edith is a patient of high BP. She has been
suffering from BP problems for about 10 years now.
Strict post medical care or treatment is required.
76
Yours sincerely
Molly Tia

WRITING TEST 10
Time allowed:
follows.
You are Chelsea Jade, a qualified head of nursing, working with Supra Health
Care Agency. Reyna Sally is a patient in your care.
Name: Reyna Sally
Address: 198 Harbour Esplanade, Suite 405a, Docklands VIC 3008.
Phone: 03 9999 8388
Date of Birth: 09 Jan 1961
Social Background
Widow – lives alone
No children
Jennifer Amana, her neighbor, is very friendly, visits her in hospital daily
Medical History:
Underwent an operation for appendicitis (appendix removed) – 1981
Diagnosed as diabetic – 2003
Admitted to the hospital due to severe pain in the stomach- 12 Feb 2005
(Diagnosed as food poisoning – cleared)
Patient was discharged after a week at the hospital – 18 Feb, 2005
12 April, 2005.
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Admitted to the hospital due to severe abdominal pain, weakness, nausea
Symptoms went after a course of medication was taken
Discharged after a week
12 July, 2009.
Admitted to the hospital due to an injury to the left knee and ankle, as well as
an
injury to the head
Fell down the stairs
Not used to wearing spectacles
Suffered from pain and an intense stinging sensation, and inflammation of the
skin
Walks with difficulty now
20 July, 2009.
Shown signs of a successful recovery
Personal nursing care has been requested
Writing Task
Using the information in the case notes, write a letter to Ms Nichole Davidson,
Head Nurse at Old Age Nursing Home, Town Hall, 90-120 Swanston Street,
Melbourne VIC 3000, to request that a nurse is sent to the patient’s house to
help
with her recovery and with personal care.The
body of the letter
should be approximately 180-200 words.
78

Sample Letter 10
Mrs Nichole Davidson
Old Age Nursing Home
Town Hall, 90-120 Swanston Street
Melbourne VIC 3000
(Today’s date)
Re: Mrs Reyna Sally, 53 years old
Dear Nichole Davidson

Mrs Reyna Sally was admitted into our “health care home” on 12th July, 2009 due to
injuries to her left knee, ankle and to the head (She has got spectacles but she is not
used to wearing that. The patient fell from the stairs and injured herself badly).
At the time of admission the patient was complaining of pain or intense stinging
sensation of the inflammation of the skin. The patient was facing difficulty in walking
because of the injury to the knee. It took almost 8 days for the patient to get well to
the normal condition.
The patient showed signs of recovery and was given discharge on 20 July, 2009. The
patient requested for personal care by the nurse too.
Please, take a note of this too that Reyna Sally is a patient of BP as well. She has been
suffering from BP problems since 2003.
Strict post medical care or treatment is required.
79
Yours sincerely
Chelsea Jade
Supra Health Care Agency
Set 10 OET Grammar
Getting B, B, B, B (or even higher) in the OET or Band 7 in IELTS Academic

requires . . .
• correct grammar
• correct spelling
• appropriate words
• more sophisticated vocabulary • correct punctuation
• verbal and written fluency
• quick comprehension skills
• nerves of steel
If you are a skilled health professional - a high achiever, then ...
You will know how much hard work is involved in stepping “up” to a higher
level.
You read widely – not just literature to do with your discipline – but general
everyday matters
You use English when involved in everyday conversations as you go about your
daily life
You know what this or means -
If you do all of the above – as well as recognising symbols instantly – then you
are well on your way to mastering English at a high level.
Remember, letters/characters – are also symbols, which need to be instantly
recognisable, and the quicker you can do this – the better.
THIS LITTLE BOOKLET INTRODUCES YOU TO THE FINER POINTS OF
USING LOTS OF USEFUL STUFF WHICH ARE ELABORATED ON AT
THE ONLINE WRITING LAB WEBSITE (LOCATED AT PURDUE
UNIVERSITY IN THE U.S.A.) It also provides you with many useful self-
testing exercising with
80
a health-professional flavour – and the answers are all located in the back of the
book - so you can check yourself !
1. What makes an English sentence, a sentence ?

An English sentence consists of a Subject, a Verb and an Object.
If you don’t have a subject, a verb and an object in a sentence – then you don’t
have an English sentence - what you do have is a “fragment” - and you will
never get a high score by writing fragments.
Dr Jones was held up in traffic so he called the Clinic to reorganise his day.
(S) (V) (V) - - - ( O ) - - - -
Can you see a subject ? a verb word ? and an object ? (the reason for writing
this sentence in the first place?)
What about ...
Temperature was very high at 39oC. (V) - - (O) - -
His/The temperature was very high at 39oC. Much better! - (S) - (V) - - (O) - -
Exercise: Is it a sentence, or not?
(Circle “Y” for yes; “N” for no. Answers are given at the end of the book)
1.1 1.2 1.3 1.4 1.5 1.6 1.7
1.8
1.9
1.10
She rushed at him with the scalpel in her hands. Surgery had finished; lights
were turned off. BP was 160/90 – very high.
Make sure you fast before your Barium Meal. Before a Barium Meal, fast.
Yes / No
Yes / No
Yes / No Yes / No
Yes / No Yes / No
Yes / No Yes / No
Yes / No Yes / No2.
81
Skeletal survey and urinanalysis test were ordered. Endoscopy was not
recommended because of it could damage the oesophagus.
On examination, vital signs were BP 120/80, P 70/min.
regular, rest of the examination was clear.
Accordingly, Paracetamol/Codine mixture was added to the prescription.
During hospital stay, surgical debridement of wound as well as daily dressing
was undertaken.
Adjectives and adverbs
Adverbs describe the verb, the doing word : how fast / how much / to what
degree of speed or skill did someone run, teach, grow old, spend money,
recover from illness – and so on. And adverbs nearly always have “ l y “ at the
end.
The patient is recovering slowly.
The doctor carefully explained the surgical procedure.
Adjectives describe a noun. A car - a black car. The elderly patient is recovering
slowly.
The Sri Lankan doctor carefully explained the surgical procedure.
It’s a good idea to write adjectives next to the noun; adverbs next to the verb.
Of course – one needs to ask the question: Why bother? Do we need them?
Well – yes – because they make your writing more descriptive and come in
handy when trying to write concisely – and at the same time give details – about
a patient.
Can you pick the adverbs (ADV) / the adjectives (ADJ) / the nouns ? (Answers
are given at the end of the book.)
2.1 Unfortunately, the patient had uncontrolled pain with persistant numbness
in the lower right leg. [3 adjectives and 4 nouns]
2.2 His feet need to be examined by a podiatrist regularly. [Adverb or
adjective?] [2 nouns / 1 verb / + ADV or ADJ?]
These two sentences, written without adverbs or adjectives, would end up:
2a The patient had pain with numbness in the leg.
2b His feet need to be examined by a podiatrist.
By adding adjectives and adverbs, you add richness, detail, a deeper
understanding of one’s particular patient - - which is valuable stuff for the
specialist - - and your chances of getting a pass in the OET or a Band 7 score in
IELTS.
82
Exercise: Include the (bracketed) word in the appropriate place in the sentence.
Answers are given at the end of the book).
2.3 (chronic)
2.4 (Indian)
2.5 (high)
2.6 (amazed)
2.7 (nervous)
2.8 (widowed)
The patient is suffering from diahhorrea. I attended the Doctor yesterday.
The baby has a temperature.
The patient looked at the xray result: no cancer! The new triage nurse made
some silly mistakes.
I am referring the above male, a 54 year old Engineer.
3. Articles “a” “an” “the” - or nothing at all

In English, most objects in a sentence require an article in front of them.
But not always !!! Articles are NOT used before medical conditions / diseases*
or proper/collective nouns.
“a” and “an” are both indefinite articles .... The only difference being, “an” is
used when the next letter is a, e, i, o, u. However - the word “x ray”, for
example, starts with an “ x “ - yet we would say The patient had an xray. Why?
Because xray sounds like ‘ex ray’ which begins with an “e” - so use “an”.
Another example: If you use a University-publication, make sure you put it
back. Why not “an” before the “u” in University? Because it sounds like ‘You-
ni-versity” and “y” does not need ‘an’. Confused? Keep going!
Note the use of articles in these examples:
The patient had an appendectomy in 2001.
The operation was a success.
The patient was walking on Day 2 after the hip replacement.
Mrs Jones first had cancer in 2002. As a child she had measles and mumps.*
Exercise: Circle the correct option : “a” “an” “the” or [ no article at all ] in the
following sentences. Answers are given at the end of the book.)
3.1 a / an / the / --- patient is still recovering.
3.2 Expert opinion seems to be that a / an / the / --- Western medication is a /

an / the / --- best thing for you at
83
a/
3.3 a/
3.4 a /
3.5 a /
3.6 a/
3.7 sentence.
an / the / --- thistime.
I can understand why you are anxious, but there is no need to be.
an / the / --- medical team here in this Hospital is excellent. Don’t worry!
The patient reports having a / an / the / --- measles and
an / the / --- mumps as a child but good health in her adult life.
an / the / --- cancer and only found out yesterday.

You need to exercise empathy when talking to Mrs Jones. She has
an
You need to exercise empathy when talking to Mrs Jones. She has / the / ---
liver cancer and only found out yesterday.
These days, having a / an / the / --- cancer is not necessarily a death
You need to cut down on surgary foods as they are exacerbating a / an / the
pimples on your face.
3.8 /
---
Harry has terrible acne and is using a / an / the / --- soap which his
3.9
Doctor recommended. a / an / the / --- soap seems to be helping.
3.10 She lives with her parents and two brothers and studies at a / an / the / ---
Melbourne University.
4. Apostrophes
APOSTROPHES are little marks, like a comma but written above the line, and
have three uses:
Use No.1 To show a letter has been left out.
I’ve done it. Instead of: I have done it!
Use No.2 To show something belongs to someone (singular possessive). The
apostrophe goes before the “s” The nurse’s mask was a blue colour.
Can you see a subject? You can?
84
Amazing! This author can’t !!
Amazing! This author can’t !!

Use No.3 To show things belonging to more
The apostrophe goes after the “s” . The nurses’ masks were blue.
DO YOU NEED TO KNOW ABOUT THE APOSTROPHE ? Yes! Because
your patient’s name [singular possessive] might be Mr Blackmore. You might
want to write:
On review, Mr Blackmore’s vital signs had changed for the worse.
Now ... what about a patient whose name is, say, Mrs Jones – her name ends in
an “s”. On review, Mrs Jones’ vital signs had changed for the worse.
Although Mrs Jones is only one person – and the vital signs belong to her –
strictly speaking you should write Mrs Jones’s vital signs ... however, for the
past few decades, this convention has changed and now singular possessive
apostrophes for names ending in “s” – adopt the apostrophe after the ‘s’. If you
read Christian articles, you will see Jesus’ name written with the apostrophe
after the “s”.
Another little word that connotes possession is “ its “ . Note there is NO
apostrophe. If you write “ it’s “ - it is equivalent to It is Confused? Keep going !
Here
are some examples of using the possessive apostrophe as well as the
word possessive way:
Mrs Brown’s medication was increased to four-hourly. Mrs Jones’ medication
was increased to four-hourly.
Using possessive apostrophes – continued
The patient’s medication was increased to three times a day.
its in a
The patient’s history was noted and filed in the filing cabinet.
The dog’s owners were very happy with their dog’s new-found mobility.
The Physiotherapist’s exercise regime was closely followed by the patient.
The horse had calmed down. Its fever had passed and it was on the road to
recovery. The Nurses’ Station is manned 24 hours a day.
A Hospital needs to closely monitor hygiene levels otherwise its reputation will
suffer.
Note that “its” used possessively – has NO apostrophe.
Ah – English ! At times it’s not easy !
85
Exercises: Apostrophes* Do the following sentences require an apostrophe?
(Answers are at the end of the book.) *Pronounced A-poss-troh-feez
4.1 The patients behaviour was very strange.
4.2 Its OK to miss one tablet, but not two.
4.3 Mrs Stromess headaches were getting worse.
4.4 The doctors performing the surgery were all specialists.
4.5 The patients in the Waiting Room were becoming impatient and noisy
5. Joining words ( yet, and, but; consequently, therefore; furthermore, in
addition, moreover; )
than one person (plural possessive).
The definitions of these words can overlap, so you want to be careful about
how and when you use them.
consequently, therefore: Something happened or something is true because of
something preceding it.
Example: Jonathan read the company website and articles about the company
before his interview. He was able to ask very good questions during his
interview. Revision: Jonathan read the company website and articles about the
company before
his interview; therefore, he was able to ask very good questions . . . a
his interview; consequently he was able to ask very good questions . . . a
furthermore, in addition, moreover: Similar to the word “and,” but with more of
a relationship to the first part of the sentence.
Example: Soo-yeon checked the grammar in her college application essay
twice. She asked her neighbor to check the grammar one more time.
Revision: Soo-yeon checked the grammar in her college application essay
twice; in addition, she asked her neighbor to check the grammar one more time.
however: Just like the word “but,” only for longer sentences.
Example: Miguel’s car didn’t start this morning. He got a jump start from his
neighbor and was able to make it to his appointment on time.
Revision: Miguel’s car didn’t start this morning; however, he got a jump start
from his neighbor and was able to make it to his appointment on time.
indeed, in fact: Similar to the word “and,” but there is a closer relationship to
the first part of the sentence, and it extends the information in the first part of
the sentence. Example: Priya seems to be a workaholic. She spent the holiday in
her Clinic finishing the report.
86
Revision: Priya seems to be a workaholic; in fact, she spent the holiday in her
Clinic finishing the report.
nevertheless: Very similar to the word “but,” but the truth of what comes before
“nevertheless” is emphasized.
Example: All his friends have been praising the high quality of service in the
new Pathology Department for months. When he went there, the Receptionist
was quite
rude.
Revision: All his friends have been praising the high quality of service in the
new Pathology Department for months; nevertheless, when he went there, the
Receptionist was quite rude.
then: Something happening in sequence, after a previous event.
Example: Wenyu carefully reviewed the credit card offers she had received this
month. She chose the one with the best terms and completed the application.
Revision: Wenyu carefully reviewed the credit card offers she had received this
month;
then, she chose the one with the best terms and completed the application.
‘And’ is a simple joining word – be careful you use it only once in a sentence -
and try to think up a different joining word the next time you join two
connected ideas together!
Consider this sentence:
Tom never attended lectures and somehow passed his exams and then he went
on to be a doctor in Guatemala and he has been living there for six years now
and has married and has two children and I think he likes his life. [AND it is
boring, repetitive, uninspiring, poor English].
So how do you make this long sentence better? By making it into two
sentences!
Tom never attended lectures. Somehow he passed his exams, went on to be a
doctor in Guatemala where he has lived for six years, married, and had two
children: I think he likes his life.
6. Making up complex sentences – joining 2 sentences together
If you are writing something like:
The patient presented with a severe headache. One hour later the patient
suffered an episode of vomiting and diarrhoea.
87
The above 2 sentences are all about the same thing: the patient and his (or her)
problems. The two sentences are also both independent clauses - both of them
are sentences in their own right. If you join them together – two independent
clauses - into one long sentence – it will become better English, more concise.
They will become a compound sentence.
The patient first presented with a severe headache which was followed one
hour later with vomiting and diarrhoea. Another example:
The globalization of commerce is underpinned by smart technology. One
problem is, however, ever increasing cyber attacks by computer hackers who
penetrate databases and password protected files.
These 2 sentences are both “stand alone” sentences in their own right – but the
second one is dependent on the first one - there is no need for the second clause
unless you wrote the first one. Joining these two together (an independent and a
dependent clause) will make this a complex sentence.
Better: Globalized commerce, underpinned by smart technology, has the rising
problem of computer hacking – unauthorised access to our private data.
Handy words to use when joining two sentences together:
and so / consequently / however / therefore / but / and / as well as / which was
followed by / which first arose / in addition to / but, unfortunately /
Exercises: Joining words* Join the following sentences - make each pair into
one sentence, using an appropriate joining word. Choose from however, but, so,
subsequently, when. (Answers are at the end of the book.) * Also known as
conjunctions.
1st half of sentence
6.1 Spring is coming: a wonderful time of year.
6.2 The patient received a blood transfusion.
6.3 Some mothers get post partum depression.
2nd half of sentence

The nights are cold and the days, sunny.
After the transfusion, he turned pink. Most of them get over it and move on. Not
all mothers are afflicted.
The fathers need to exercise patience.
88
More exercises on joining words: choose from and, whereas, despite, unless,
moreover
6.6 The patient was very anxious about the dentist’s drill. She was trembling all
over.
6.7 The patient was scared about getting his teeth checked. He kept his mouth
shut tight.
6.8 The nurse explained everything. The surgeon just kept his distance, waiting
for the nurse to stop talking.
6.9 The nurse explained everything. The patient being only semi conscious after
the surgery.
6.10 All trauma accident victims require fluids of one kind or another. Of
course, this is not the case if the accident victim has only sustained light
injuries.
7. Prepositions
Prepositions help describe position: at school, in the room, on the table, under
the bed.
Prepositions help describe direction: handed the paper to him, I received a
present from him. I am travelling to the city. I will come to see you tomorrow. I
poured water into the jug. I
am standing under the shower.
Prepositions pinpoint an actual time: on that day, on the 12th May, in June of
that year,
in 2004, on the first day of every month.
Below is a list of prepositions in the English language:
Aboard,
by,
about, around,
above, along,
before, between,
except,
across, amid, behind, below, beyond, for,
past,
under,
within,
89
of, since,
until, without
over,
underneath, unto,
like,
down,
near,
after, among, beneath,
against,
off,
onto, through,
up,
out,
throughout, toward,
upon, with,
beside, during,
To make these prepositions highly relevant to your letter writing, consider the
following examples:
The scars will reduce over time. 2001 2002 2003 2004 2005
The patient reached over the bench, lost his balance, fell down and twisted his
knee. His slippers were under the bed and he could not find them.
The consultant sat down on the chair beside the bed.
The name on the chart behind the bed was incorrectly spelt.
The interns are beside one another.
Two nurses, one behind the other, were listening intently to the surgeon.
Exercises: Prepositions - Choose an appropriate preposition to complete the
following.
You will need the following prepositions: up / over / on / at / in / into / to /
under / towards / out
Exercise 7.1 – 7.13

(Answers are given in the back of this book.)
90
The nurse had good reason to complain. While checking (1) __ __ old Joe
Brown this afternoon, she could not help notice that he had taken out his
dentures and placed them (2)____ the glass beside his bed. It was one of his bad
habits. He had also used his bedpan and pushed it (3) ____ the bed. She could
smell the stale urine. What a job she had! And now her shift was almost (4)
____. “Nurse! Nurse!” someone cried (5) ____ . She turned and saw Joe
standing (6) ____ the doorway, holding himself (7) ____ with a walking stick.
“What now?” she thought. She smiled and turning (8) ____ him, she queried:
“Yes?” “You forgot this”, said Joe. She looked (9) ____ what he held in his
hand. It was an envelope. “But . . .” she started to say. “No buts,” said Joe, “just
take it.” “What is it?” she asked. “Oh, just some
scribblings of mine. Here.” Joe thrust the envelope (10) ______ her.
He turned and walked slowly (11) _____ his bed. “Goodnight, see you
tomorrow” she said. “Maybe” said Joe. It was about an hour later when she had
arrived home, taken off her shoes, made a coffee, and sat down. She could hear
the clock ticking. It was only then that she remembered the envelope and
opened it. You light (12) ____ my days, love Joe. “Dear Joe”
she said quietly to herself. She decided to take a perfumed candle (13) ____ Joe
in the morning.
8. Punctuation
The ones discussed here are the colon : the semi colon ; the ellipsis . . . [3 dots] ;
and the dash -
First, the colon : the semi-colon ; and the comma ,
and the comma ,
- Colons indicate the start of a horizontal list.
- Semi-colons separate the items in a list with each item itself having several
bits of information and all bits are equally important (the first mentioned is as
important as the last mentioned)
- Commas divide the sentence into digestible / easily understood parts.
Examples:
The patient was taking much medication: Amoxycillin, Lipitor, Aspirin and
Ramipril.
[Note the use of a colon : and commas after each drug tradename].
The patient was taking much medication: Amoxycillin (120mg b.d.); Lipitor (20
mg 1/mane); Aspirin (100 mg 1/mane) and Ramipril (1.25mg 1/mane).
91
[Note the use of a semi-colon ; after each drug tradename, strength and dosage
information].
More examples:
The patient has had a long history of drug abuse: alcohol, amphetamines,
smoking and caffeine.
Same sentence, but with more detail – and separating each “item” on the list
with a semi-colon: Using semi colons means that every item is as important as
each other – there is no hierarchy of importance. The patient has had a long
history of drug abuse: alcohol (4 x 750 ml. bottles of beer every night);
amphetamines (cocaine and crack since the age of 18); smoking (20 to 30
cigarettes a day since the age of 15); and caffeine (up to 10 strong coffees a day
since the age of 16).
Exercise on using colons, semi-colons – or just commas
Should the following sentences have a colon, semi-colons, commas or a mixture
of all
three?
8.1. The patient has been attending this Clinic for the past two years
complaining of
dyspepsia GORD hypertension and insomnia.
8.2. The patient has been suffering for the past week from a number of
complaints a runny nose bilateral headaches dizzy spells and nausea.
8.3. The patient has been suffering for the past week from a runny nose bilateral
headaches dizzy spells and nausea.
8.4. Mr Jones has been coming to this Clinic for the past five years during
which time he has had a number of problems addressed chronic rhinitis (2004),
GORD (2005), hypertension (2007) insomnia (2008) and most recently (June
2009) irregular blood pressure.
9 The comma “ ,”
Commas divide up sentences into different (but related) parts. If you regard the
comma as a way of indicating to the reader that this is the place where you
would pause briefly – and take a breath – that is probably spot on. Strictly
speaking, a comma joins two independent (stand alone) clauses followed by
and, but, or, for, nor, so.
92
Say the following out loud (no pauses) : Good morning my name is Dr Singh
and I am on the Ward today I have just called by to see how you are going Did
you have a good sleep last night? I would just like to check your temperature
and look at the surgical wound Would that be OK? [Then you pause, to take a
breath – before you turn blue].
No .. you would probably say: Good morning, my name is Dr Singh and I am
on the Ward today. I have just called by to see how you are going. Did you have
a good sleep last night? I would just like to check your temperature, and look at
the surgical wound. Would that be OK? [Ah! Much better!]
Exercise on using commas - please add them where you think they should be.
(Answers are given in the back of this book).
9.1 I am referring the above patient who presented today with a severe migraine
for an EEG test.
9.2 This patient has been suffering from chonic pain for the past five days and
now requires I believe surgical intervention.
9.3 Dental procedures done on this patient in the past have been protracted and
somewhat painful and consequently the patient has now become highly anxious.
9.4 The woman is suffering from post partum depression due largely to the
Caesarean section (performed without any problems) and her inability to
understand fully because of language difficulties why she had to have the
procedure rather than a normal delivery.
9.5 In the past triage nurses have had overall responsibility for the patient’s care
however new legislation will change this.
9.6 As a discharge plan Mrs Jones and her family need your help in her four
hourly pressure area care her daily sponge bath assistance with all care and
application of Duoderm dressings to a small pressure sore on the right buttock.
9.7 I am pleased to refer the above patient with multiple myeloma for
monitoring of her diet plan and medication.
9.8 I am pleased to refer Mrs. Brown a 70 year old lady non smoker non
alcoholic widowed with 3 children who lives alone with symptoms and signs of
myocardial infarction for further assessment and management.
And now, the ellipsis and dash: The ellipsis (3 little dots) “ . . . ”
The ellipsis is very useful for all those academics out there writing long
dissertations. It is used when you are quoting something – but omitting some of
the quotable text.
93
Example: According to Jones (2004) “ ... without which it would not have been
possible.”
The main thrust of what you are quoting is that Jones, back in 2004, did some
kind of research and concluded that the result would not have been possible
unless abc or xyz
had been used / consulted. The “bit” left out could be several hundred words – a
couple of sentences or just the first clause of the sentence. It is up to you. But if
you are quoting, word for word, then put in a citation – and three little dots for
the section you are omitting.
The Dash “- ”
If used with care, a dash can be a very useful bit of punctuation. Dashes are
particularly useful in an appositive phrase - setting off the main pieces of
information.
For example:
(A) I am referring the above patient - forty three, divorced, has suffered a
cardiac arrest thirty minutes ago - for admission and urgent attention.
Be warned: dashes are best left to the academics writing narratively. If you are
an OET candidate, then it is safer to write this example as per (B) below:
(B) I am referring the above patient, a forty three year old, divorced male, who
has suffered a cardiac arrest thirty minutes ago, for admission and urgent
attention. Note the differences.
rm – the doing word.

Advice is the noun form – the thing you are giving – you are not giving a card –
you are
giving advice. [Think of ice - advice - like icecream - which is a noun – so
advice is the noun form.]
Loose is the opposite to tight - His shirt was loose because he was so thin.
Lose is when you have lost something. Have you seen my shirt? I don’t want to
lose it.
Since a particular time or event – something has happened.
Ago refers to things that happened before now – before this time.
More examples:
• I advise you to brush more regularly.
94
• If you want my advice, your problem is really bad oral hygiene.
• The splint is too loose.
• If you lose the splint, it will cost another $350 to replace – so look after it.
• Since attending this Clinic, the patient has had a lot of respiratory problems.
• The patient has had a lot of respiratory problems since 2001.
• Nine years ago, when the patient first started attending this Clinic, he had
breathing
problems.
Sometimes we use “it” to refer back to a particular subject - be careful – make
sure you are using “it” clearly - that there is no doubt what or whom you are
referring to.
The cat being chased by the dog jumped over a high fence. It was an amazing
sight.
What was amazing? The dog chasing the cat? The cat jumping up and over a
very high fence? Perhaps it was the amazingly high fence? “It” is not clear.
Exercise: Choose the right word (noun or verb?) in each sentence. (Answers are
given in the back of this book.)
10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12
If you want my advise / advice you will stay in bed.
I advised / adviced the patient to drink more fluids but he was non compliant.
The patient was advised / adviced to eat more fresh fruit.
I need you to losen / loosen your tie.
Did you lose / loose something?
Hospital gowns are very How long since / ago It has been a long time
loose / lose and revealing! you saw her last?
since / ago I spoke to him – at least two years. Since / Ago that time many
things have changed.
Since / Ago then the exam format has changed.
What have you been doing since / ago then ?
Since 2004 / Ago 2004 the patient has had many epileptic episodes.
10.13 The patient has had many epileptic episodes ever since he starting seeing
me three years ago / since.
10.14 When this patient came to see me three weeks since / ago, she was very
anxious and confused.
11. Verb tenses
95
The basic rule is to stick to the same tense if the action took place during the
same time (the same morning, same day, everything happened before the
operation, everything
happened after the operation, everything is planned to take place after the
patient is discharged).
Example: Yesterday * the patient was suffering from diarrhoea and was advised
to maintain his fluid intake to avoid dehydration. Today ** he is much better
and is recovering. [Incidentally, these two sentences are fine – no problems at
all.]
* = straight away, you are using past tense [Past tense must be used] ** = now
you are using present tense [Present tense must be used]
Both these sentences are in the same paragraph – as they should be, as they are
both referring to the patient’s physical condition.
Here is someone who clearly does not use the correct object:
A man walked into the Medical Clinic saying: “I’ve hurt my arm in several
places.”
The doctor said, “Well don't go there anymore.”
Q: What should he have said – to make it perfectly clear to the doctor what has
happened ? A: I’ve sustained several injuries to my arm. [Don’t use the word
‘places’]
Try some of these exercises - make sure you use the past tense of the doing
word (the ‘verb’ ) in sentences relating to things in the past - and present tense
of the verb word for things relating to the present time.
Exercise: Getting the verb tense right
11.1 The patient sat / sits over there on that seat yesterday.
11.2 Last week, when I see / saw this patient, everything seemed fine.
11.3 I have explain / explained everything to him.
11.4 I explain / explained how to use the insulin syringe but he does not listen.
11.5 Whenever this patient try / tries / tried to walk without the walking frame,
she becomes nervous and slides her feet along the floor.
11.6 It’s amazing how improve / improved Mrs Jones was after just the first
injection.
11. Appositives
96
‘Appositives’ are modifying phrases or nouns, between two commas, adding
more information or detail. Here is an example of an appositive (the noun is in
this colour, the appositive is in red).
The chief surgeon, an expert in organ-transplant procedures, took her nephew
on a hospital tour.
Note: If you eliminated [took out] the appositive – you would end up with the
nuts- and-bolts of the sentence:
The chief surgeon took her nephew on a hospital tour.
[The appositive just gives us more information about the surgeon].
You can put appositives to good use – in the opening paragraph of your Letter
of Referral.
I am referring the above patient, a 45 year old divorced male, who is suffering
from suspected colon cancer, for further investigation and ongoing
management.
Eliminate the appositive – and what have you got?
I am referring the above patient for further investigation and ongoing
management.
AND THAT IS WHY YOU MUST PUT A COMMA before and after the
appositive – to set it out clearly – because if you don’t put a comma before and
after the appositive,
it will not be a grammatically correct sentence!
Let’s see if you can put a comma in before and after the appositive phrase in the
following sentences (in other words – can you identify the appositive phrase) :
Exercise:
12.1
12.2 order
Writing appositives
Mrs Williams a forty five year old with lupus came to see me this morning. This
patient requires urgent surgery if possible before noon tomorrow in
to prevent his inguinal hernia from increasing in size.
12.3 The nurse having instructed the patient on the correct dosage and need to
12.4 12.5
comply with the doctor’s instructions left the Outpatients Department to go
home.
97
I am referring the above patient a sixty-three year old widowed woman who is
suffering from severe varicose veins for vascular surgery as soon as possible.
The dental surgeon having completed the operation removed his mask and
gloves as he walked out the room.
13. More tricky stuff: Had / Has had / Had had
Ah! The past tense! In English there are many kinds of past tense - past perfect,
past imperfect, and past continuous. Let’s try and simplify things.
If you look at the past as having different degrees of past - recent past - and
long- time-ago past - then it makes it easier to use these ‘past participles’, little
helping words “has” as in has had and “had” as in had had.
‘Had’ is used for recent past tense: I had a coffee with my breakfast this
morning.
‘Had had’ is used for long time ago past events - which will not recur: The
patient had had an appendectomy in 1995.
‘Has had’ is used for long time ago past events – which MAY recur: The patient
has had asthma in 2001 and 2004.
When you use has had in a sentence – it infers the patient has had asthma in the
past and may get it again in the future: the problem is still occurring – or might
occur – in the future.
But! When you use had had in a sentence - it infers the patient had asthma in the
past and has made lifestyle changes - bringing about a “cure” – and the patient
is not
expected to ever get asthma again.
Exercise: Using past participles
sentences):
13.1 The patient had / has morning.
He/She is now completely cured of asthma.
(Choose the correct option in the following
All past tense
been very anxious when she arrived this
13.2 The patient had / has
13.3 Three years ago, the patient
13.4 Last week, the patient had / has had / had had a laminectomy.
a prolapsed disk.
has had / had had a laminectomy.
98
13.5 Mrs Jones has / has had / had had much chronic pain over the last two
years.
13.6 Mrs Jones has / has had / had had chronic pain over the last two years but
with the new analgesics she found relief.
13.7 Bert Smithers has / had / has had / had had a vasectomy last week.
13.8 Bert Smithers has / had / has had / had had an appendectomy when he was
only eighteen and now, in his seventies, he has / had / has had / had had
a proctectomy just last week.
13.9 We had / have had a great time last Saturday at the party.
13.10 We had / have had many memorable office parties over the years.
Answers start on next page
ANSWERS TO THE EXERCISES Exercises on Is it a sentence or not?

1.1 Yes
1.2 No ‘Surgery’ is not a subject. The surgery – this would make it a sentence.
1.3 No
1.4 Yes
1.5 No.
1.6 No.
1.7 No.
1.8 No.
1.9 No.
1.10 No.
The blood pressure ... would make it a sentence.
Would need: Before a Barium Meal, you need to fast. See 1.2 and 1.3
See 1.2 and 1.3
Would need: On examination, the vital signs ... Would need: Accordingly, the
Paracetamol/Codine ... Would need: During the hospital stay, the surgical ...
Exercises on Adjectives and Adverbs
2.1 3 adjectives: uncontrolled / persistent / lower right No adverbs.

4 nouns: patient / numbness / pain / leg
2.2 2 nouns: feet / podiatrist
1 verb: examined
“regularly” is the adverb (an adverb of frequency)
99
Placement of adverb/adjectives in a sentence:
2.3 The patient . . . chronic diahhorrea.
2.4 . . . the Indian Doctor yesterday.
2.5 . . . has a high temperature.
2.6 The patient looked amazed at the xray result: no cancer!
2.7 The new nervous triage nurse . . .
2.8 I am referring the above widowed male, a 54 year old Engineer. Or:
I am referring the above male, a 54 year old widowed Engineer.
Exercises on Articles
3.1 The
3.2 Expert opinion seems to be that Western medication is the best thing for you
at
this time.
3.3 ... but there is no need to be. The medical team here ...
3.4 ... having measles and mumps as a child ...
3.5 She has cancer and only found out yesterday.
3.6 She has liver cancer and only found out yesterday.
3.7 These days, having cancer is not necessarily ...
3.8 ... as they are exacerbating the pimples on your face.
3.9 Harry has terrible acne and is using the soap which his Doctor
recommended.
The soap seems to be helping.
3.10 She lives with her parents and two brothers and studies at Melbourne
University.
Exercises on Apostrophes
4.1 The patient’s behaviour was very strange
4.2 It’s OK to miss one tablet ...
4.3 Mrs Stromess’ headaches were ...
4.4 The doctors performing ...
4.5 The patients in the ...
Exercises on Complex sentences using joining words (conjunctions)
6.1 Spring is coming: a wonderful time of year when the nights are cold and the
days are sunny.
6.2 The patient received a blood transfusion and afterwards, turned pink.
100
6.3 Some mothers get post partum depression but most of them get over it and
move on.
6.4 Some mothers get post partum depression however not all mothers are
afflicted.
6.5 Some mothers get post partum depression so the fathers need to exercise
patience.
6.6 The patient was very anxious about the dentist’s drill and was trembling all
over.
6.7 The patient was scared about getting his teeth checked: moreover he kept his
mouth shut tight.
6.8 The nurse explained everything, whereas the surgeon just kept his distance,
waiting for the nurse to stop talking.
6.9 The nurse explained everything, despite the patient being only semi-
conscious after the surgery.
6.10 All trauma accident victims require fluids of one kind or another unless, of
course, the victim has only sustained light injuries.
Exercises on Prepositions
7.1 up on
7.2 in
7.3 under
7.4 over
7.5 out
7.6 in
7.7 up
7.8 towards
7.9 at
7.10 towards
7.11 towards / to
7.12 up
7.13 to
Exercises on Punctuation: colons, semi colons, commas
8.1 The patient has been attending this Clinic for the past two years,
complaining
of dyspepsia, GORD, hypertension and insomnia.
8.2 The patient has been suffering for the past week from a number of
complaints: a runny nose, bilateral headaches, dizzy spells and nausea.
101
8.3 The patient has been suffering, for the past week, from a runny nose,
bilateral headaches, dizzy spells and nausea.
8.4 Mr Jones has been coming to this Clinic for the past five years, during
which time he has had a number of problems addressed: chronic rhinitis (2004);
GORD (2005); hypertension (2007); insomnia (2008); and most recently (June
2009), irregular blood pressure.
Exercises on Punctuation: using commas
9.1 I am referring the above patient, who presented today with a severe
migraine, for an EEG test.
9.2 This patient has been suffering from chonic pain for the past five days, and
now requires, I believe, surgical intervention.
9.3 Dental procedures done on this patient in the past have been protracted and
somewhat painful and, consequently, the patient has now become highly
anxious.
9.4 The woman is suffering from post partum depression due largely to the
Caesarean section (performed without any problems), and her inability to
understand fully, because of language difficulties, why she had to have the
procedure rather than a normal delivery.
9.5 In the past, triage nurses have had overall responsibility for the patient’s
care, however, new legislation will change this.
9.6 As a discharge plan, Mrs Jones and her family need your help in her four
hourly pressure area care, her daily sponge bath, assistance with all care, and
application of Duoderm dressings, to a small pressure sore on the right buttock.
9.7 I am pleased to refer the above patient with multiple myeloma, for
monitoring of her diet plan and medication.
9.8 I am pleased to refer Mrs. Brown, a 70 year old lady, non smoker, non
alcoholic , widowed, with 3 adult children, who lives alone, with symptoms and
signs of myocardial infarction, for further assessment and management.
Exercises on: tricky words
10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10
10.11 10.12 10.13
If you want my advice you will stay in bed.
I advised the patient to drink more fluids but he was non compliant.
The patient was advised to eat more fresh fruit. I need you to loosen your tie.
Did you lose something?
102
Hospital gowns are very loose and revealing!
How long since you saw her last?
It has been a long time since I spoke to him – at least two years. Since that time
many things have changed.
Since then the exam format has changed.
What have you been doing since then ?
Since 2004 the patient has had many epileptic episodes.
The patient has had many epileptic episodes ever since he starting seeing me
three years ago.
10.14 When this patient came to see me three weeks ago, she was very
anxious and confused.
Exercises on: Getting the verb tense right
11.1 The patient sat over there on that seat yesterday.
11.2 Last week, when I saw this patient, everything seemed fine.
11.3 I have explained everything to him.
11.4 I explain how to use the insulin syringe but he does not listen.
11.5 Whenever this patient tries to walk without the walking frame, she
becomes nervous and slides her feet along the floor.
11.6 It’s amazing how improved Mrs Jones was after just the first injection.
Exercises on: using appositives
12.1 12.2
Mrs Williams, a forty five year old with lupus, came to see me this morning.
This patient requires urgent surgery, if possible before noon tomorrow, in
order to prevent his inguinal hernia from increasing in size.
The nurse, having instructed the patient on the correct dosage and need to
12.3
comply with the doctor’s instructions, left the Outpatients Department to go
home.
12.4 I am referring the above patient, a sixty-three year old widowed woman,
who
is suffering from severe varicose veins, for vascular surgery as soon as possible.
12.5 The dental surgeon, having completed the operation, removed his mask
and
gloves as he walked out the room.
Exercise: Using past participles
103
13.1 The patient had been very anxious when she arrived this morning.
13.2 The patient had a prolapsed disk.
13.3 Three years ago, the patient had had a laminectomy.
13.4 Last week, the patient had a laminectomy.
13.5 Mrs Jones has had much chronic pain over the last two years.
13.6 Mrs Jones had had chronic pain over the last two years, but with the new
analgesics she found relief.
13.7 Bert Smithers had a vasectomy last week.
13.8 Bert Smithers had had an appendectomy when he was only eighteen and
now, in his seventies, he had a prostectomy just last week.
13.9 We had a great time last Saturday at the party.
13.10 We have had many memorable office parties over the years.
Good luck with your OET Test –
104

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All you need to know for your

Success in Writing sub-test

Overall task fulfilment

Control of Presentation Features

Test take’s guide to Writing sub-test

Format of Referral Letter

Starting and Ending the Writing Task

Format of Letter providing Information

How to writing Paragraph 1 ( introducing the PT- expressions to describe symptoms)

How to writing Paragraph 2 (explain treatments)

How to writing Paragraph 3 ( explain complications and adverse incidents)

How to writing Paragraph 4 (requesting ongoing care- polite requests)

Sample referral letter

Sample Letter which informs the public

10 case notes + 10 sample letter related

Writing and Speaking

Overall Task Fulfilment

• Make your conclusion specific to the situation

Think about this:

• Is the letter of the required length?

• Has your letter responded to the task question?

• Is the language in your letter original?

• Avoid informal and casual expression and maintain a formal tone.

• Do not overuse medical terminology including abbreviations and

Think about this:

• Is the letter organised into paragraphs?

• Is the information logically presented?

• Is the expression of suitable formality?

• Is the vocabulary and expression of a suitable standard?

• Have the abbreviations and acronyms been written in full?

• Show clearly the connections between information in the case notes if

Think about this:

• Have you selected relevant information and omitted non-relevant

• Make sure you demonstrate a range of language structures – use

• Is your grammar of sufficient standard? Key areas are:

Control of Presentation Features

• Use correct punctuation including commas and capital letters

Think about this:

• Is the letter formatted appropriately?

• Is the punctuation correct?

• Have you used capitals correctly?

• Are there a lot of spelling errors?

Checking at the end

Marking the test

Initially you may write:

I am writing to refer Mr X to you for care and support.

I am writing to transfer Mr X back to your care. (Mr X

Remember that you explain the reason for the letter at

2. Are you writing the correct type of letter?

Who are you writing to?

What is the reason for writing? Explain the main

Be clear about the level of urgency of your letter e.g.

What treatment did the patient receive?

The patient has a medical history

Is the letter the correct word length?

*Informal SMS texting is never used in formal letters.

Organisation of your material

1. Who are you writing to?

How do you address a child in a letter?

Using a hyphen with numbers

Use a hyphen when you write out a fraction.

Rule 2: When a number is used to make an adjective,

1. 'We’ll have a one-hour meeting about his case'. but