The OET Writing sub-test is one letter in 45 minutes. You get a set of case notes and a task: usually to refer, transfer or discharge a patient to another health professional. You have five minutes to read the notes, then 40 minutes to write. This page shows a structure that works, a full set of case notes with a sample letter, and 12 questions to check your skills.

The case notes and sample letter are original practice written in the OET format. The patient is fictional, the letter is not an official OET model answer, and it has no official grade.

How the letter is marked

Two assessors mark your letter on six criteria:

OET recommends a letter body of about 180 to 200 words. There’s no automatic penalty for going over or under, but a much longer letter usually means you’ve copied in notes the reader doesn’t need.

A structure that works

1. Opening paragraph: purpose. Who the patient is and why you’re writing. “I am writing to refer Mrs X, who is being discharged today following…”
2. Background. The admission or presenting problem, and the relevant treatment so far.
3. Current condition. The patient’s status now: wound, mobility, pain, medication changes.
4. Social situation (if relevant). Who is at home, support available, risks.
5. Request. Exactly what you want the reader to do, and by when. Then a polite closing line.

Your job is to choose and order. The case notes always contain information that isn’t relevant to the reader: childhood illnesses, hobbies, test results that are normal and change nothing. Leave them out.

Sample task

Case notes

Patient: Mrs Joan Mitchell, 78 years old

Admitted: 10 October 2026, after a fall at home

Diagnosis: Fractured left neck of femur

Treatment: Left hip hemiarthroplasty, 11 October 2026. Wound clean and dry, closed with staples.

Medical history: Type 2 diabetes (metformin 500 mg twice daily), hypertension (ramipril 5 mg daily). Appendicectomy 1970.

Discharge medication: As above, plus enoxaparin 40 mg subcutaneous injection once daily for 4 weeks (VTE prophylaxis); paracetamol 1 g four times daily as required.

Mobility: Walks short distances with a walking frame. Physiotherapy exercises taught; independent with stairs using rail.

Social: Widowed, lives alone in a two-storey house. Daughter staying with her for 2 weeks after discharge. Enjoys gardening; has a cat.

Concerns: Patient anxious about giving her own injections; daughter willing to learn but not yet confident. Blood glucose slightly raised during admission (7.8 to 11.2 mmol/L).

Plan: Discharge home 18 October 2026. Staples to be removed on day 12 to 14 after surgery. Community nurse to support enoxaparin injections and monitor wound and blood glucose. Orthopaedic outpatient review in 6 weeks.

Task: You are the charge nurse on the orthopaedic ward. Write a letter to Ms Sarah Collins, Community Nurse, Riverside Health Centre, 14 Mill Lane, Westbury, referring Mrs Mitchell for continued care after discharge.

Sample letter

18 October 2026

Ms Sarah Collins Community Nurse Riverside Health Centre 14 Mill Lane Westbury

Dear Ms Collins,

Re: Mrs Joan Mitchell, aged 78

I am writing to refer Mrs Mitchell, who is being discharged home today following surgery for a fractured left neck of femur, for wound care, support with her injections and blood glucose monitoring.

Mrs Mitchell was admitted on 10 October after a fall at home and underwent a left hip hemiarthroplasty the following day. Her wound is clean and dry and has been closed with staples, which should be removed between 23 and 25 October (day 12 to 14 after surgery).

She has been prescribed enoxaparin 40 mg subcutaneously once daily for four weeks. She is anxious about self-injecting, and her daughter, who will be staying with her for the next two weeks, is willing to learn but not yet confident. In addition, her blood glucose was slightly raised during admission. She has type 2 diabetes, managed with metformin, and hypertension.

Mrs Mitchell walks short distances with a frame and can manage stairs using a rail. However, she normally lives alone.

I would be grateful if you could remove her staples, teach and support her and her daughter with the injections, and monitor her wound and blood glucose. She will be reviewed in the orthopaedic clinic in six weeks.

Yours sincerely,

Charge Nurse Orthopaedic Ward

The body of this letter is just under 200 words.

Why it works:

• The purpose is in the first sentence: a referral, with the three things the community nurse needs to do.
• The dates are worked out for the reader. Day 12 to 14 after surgery on 11 October is 23 to 25 October. Giving the dates, with “day 12 to 14 after surgery” alongside, saves the community nurse from counting.
• Irrelevant details are left out: the appendicectomy in 1970, the gardening and the cat don’t change the community nurse’s care.
• The request is specific. The closing paragraph lists exactly what the reader should do.
• The tone is professional and written for a colleague, without abbreviations the reader might not share.

The questions

Common mistakes

• Copying the notes. Turn notes into full sentences and group related information. Don’t list every fact in the order it appears.
• Burying the purpose. If the reader has to reach the third paragraph to learn why you’re writing, you lose marks for Purpose.
• Including everything. More information is not better. Ask: would the reader do anything differently because of this fact?
• Informal language. Avoid contractions, “Hi” and “Thanks a lot” in an OET letter.
• Not checking. Leave time to check spelling, drug names, doses and dates. Wrong information is a Content error, not just a language error.

More OET practice

Read the OET test guide for the full format, and practise speaking with the OET Speaking role-play guide. For pacing your 45 minutes, see OET tips and time management.