What Organisation and layout checks
Organisation and layout is scored from 0 to 7. It asks whether your letter is set out clearly, whether the paragraphs follow a logical plan, and whether the most important information is easy to find. One of the clearest signs of a weak letter is copying the structure of the case notes into the letter.
There is no single required letter format. Any clear, consistent layout that suits the task is acceptable. The skeleton below is one safe, common choice.
A layout skeleton
Ms Hannah Clarke Clinical Nurse Consultant Westgate Community Health Centre 14 Park Road Milltown 22 October 2026 Dear Ms Clarke Re: Mr Samuel Adeyemi, DOB 14/02/1951 [Paragraph 1 Purpose: who, why, what you need] [Paragraph 2 Relevant background: only what affects the request] [Paragraph 3 Current situation: what happened and how he is now] [Paragraph 4 Requests: specific actions, timing, what to watch for] Yours sincerely Registered Nurse
- Recipient: use the name, title and address exactly as the task gives them. Do not invent extra details.
- Date: use the date the case notes give as today's date, or the date the task tells you to use.
- Re: line: the patient's full name and, if given, date of birth. This tells the reader at a glance who the letter is about.
- Sign-off: your role is enough if the task does not give you a name.
Salutation and close
Match the greeting to the close. The common British convention is shown below. Choose one pattern and keep it consistent.
| Greeting | Close |
|---|---|
| Dear Dr Okafor (you know the name) | Yours sincerely |
| Dear Ms Clarke | Yours sincerely |
| Dear Sir/Madam (no name given) | Yours faithfully |
Plan paragraphs by purpose
Each paragraph should have one job. A simple plan for most letters is: purpose, then relevant background, then the current situation, then requests. When the background is short or the current problem is the main point, the current situation can come before the background. Choose the order that helps this reader, then stick to it.
| Paragraph | Job | Example first words |
|---|---|---|
| 1 Purpose | Who, why, what you need | I am writing to refer Ms Yuki Tanaka, 52, for assessment of ... |
| 2 Background | Only history and social details that affect care | Ms Tanaka has a history of asthma, which is relevant because ... |
| 3 Current situation | The main problem, the treatment and the current state | She presented on 2 October with ... |
| 4 Requests | Specific actions, timing, safety points | I would be grateful if you could ... |
Do not copy the order of the case notes
Case notes are usually organised by category: personal details, social history, medical history, progress notes, plan. If your letter follows the same order, the reader meets old history before the reason for the letter, and the key point appears last.
Nursing transfer letter
Paragraph 1: marital status, home, family. Paragraph 2: past medical history from 2010. Paragraph 3: admission. Paragraph 4: purpose and requests.
Paragraph 1: purpose and transfer date. Paragraph 2: background that affects care. Paragraph 3: current condition and care needs. Paragraph 4: requests.
Why: The better plan puts the reader's task first and keeps history in a supporting role.
Also avoid one paragraph per heading of the notes, such as 'Social history' then 'Medications'. Group information by what it means for the reader, for example everything about mobility and falls risk together.
Make the key information hard to miss
Some information is critical: a new allergy, a high-risk medication change, an urgent result, a safety risk at home. Do not bury it in the middle of a long paragraph of history.
A new medication change in a discharge letter
She enjoys knitting and lives with her sister, and her warfarin was stopped and apixaban started, and she has two cats.
Please note that her warfarin has been stopped and she has been started on apixaban, so INR monitoring is no longer needed.
Why: A separate, clear sentence near the start of the relevant paragraph makes the change impossible to miss.
- Put critical points at the start of a paragraph, not the end.
- Give important changes their own sentence.
- Use 'Please note that' sparingly, only for something the reader must not miss.
One idea per paragraph
A paragraph is easier to read when every sentence in it serves the same job. Mixing history, current care and requests in one paragraph forces the reader to sort the information for you.
Discharge letter from a ward nurse to a practice nurse
Mr Silva had a skin graft on his left shin on 10 October. Please check the graft on Monday. He has had type 2 diabetes for 12 years and lives with his wife. The donor site on his thigh is healing well. Please also review his blood sugar.
Mr Silva had a skin graft on his left shin on 10 October, and the donor site on his thigh is healing well. He has had type 2 diabetes for 12 years, which may slow healing. [New paragraph] I would be grateful if you could check the graft on Monday and review his blood sugar control at the same visit.
Why: In the better version, the facts sit together and both requests sit together in the final paragraph, so the reader finds the tasks in one place.
End the letter with a short closing line after your requests, such as 'Please do not hesitate to contact me if you require further information.' Keep it to one sentence. It is a courtesy, not a place for new information.
Check yourself
4 quick questions. Tap an answer to see why.
1 What should the Re: line contain?
2 The task gives no name for the reader, only 'The Manager, Hillview Aged Care'. Which pair is consistent?
3 Which paragraph plan is most likely to score well?
4 A patient was found to have a new allergy to a common antibiotic during admission. Where should this go?