The task
Assume that today's date is 22 October 2026. You have just seen Ms Pappas for her final appointment before she moves interstate.
You are a dietitian at a hospital antenatal clinic in Melbourne. Using the information in the case notes, write a letter of referral to Ms Thandiwe Nikolaidis, a dietitian at the antenatal clinic in Brisbane where Ms Pappas will continue her care. Ask her to continue Ms Pappas's dietary management and review her blood glucose levels. Address the letter to Ms Thandiwe Nikolaidis, Dietitian, Antenatal Clinic, Maternity Outpatients Department, 40 Riverside Road, Brisbane QLD 4000. 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.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Referral letter.
Case notes
Patient details
- Name: Ms Hana Pappas
- DOB: 03/05/1997 (29 yrs)
- Current address: 14 Elm St, Melbourne; from 31/10/26: 8 Banksia Ave, Brisbane
- G1P0; 28/40 today; EDD 14/01/27
- Referred to dietitian 08/10/26 after GDM dx; seen 09/10, 16/10, 22/10
Social background
- Lives with partner; relocating interstate 31/10/26 (partner's work transfer)
- Partner is civil engineer, new project in Brisbane for 2 yrs
- Works PT as graphic designer from home; will continue remotely
- Lacto-ovo vegetarian since teens
- Enjoys pottery classes; plans to find new studio
- Mother-in-law tells pt she 'brought this on herself by eating too much fruit'
Medical history
- Pre-pregnancy BMI 31 (wt 84 kg); wt today 91 kg (↑ 7 kg)
- FHx: mother T2DM
- Appendicectomy age 12
- Iron deficiency at 20/40: oral iron supplement daily; pregnancy multivitamin (incl. folic acid, iodine)
- Allergies: nil known
Diagnosis
- 75 g OGTT at 26/40: fasting 5.4, 1 hr 10.4, 2 hr 8.1 mmol/L → GDM; diet-controlled
- Obstetric review 20/10: growth scan normal; BP normal
Dietetic management
- Initial diet hx: large serves breakfast cereal, fruit juice, white bread; irregular meals
- Plan: 3 small meals + 3 snacks; consistent carb spread through day; low GI wholegrain choices; protein each meal (legumes, eggs, dairy, tofu)
- Breakfast changed: cereal + juice → wholegrain toast with eggs or yoghurt; post-breakfast BGLs now within target
- Supper snack added 16/10 (e.g. wholegrain crackers + cheese) to help fasting BGLs
- Walking 20–30 min after dinner most days
- Good understanding; keeps food & BGL diary in phone app; happy to share records
Progress
- SMBG 4x/day (fasting + 1 hr after each main meal); targets agreed with Melbourne team: fasting ≤5.0 mmol/L, 1 hr post-meal ≤7.4 mmol/L
- Post-meal BGLs 6.1–7.2 mmol/L, all within target over last 7 days
- Fasting BGLs 5.2–5.6 mmol/L on 4 of last 7 days (above target of ≤5.0) despite supper snack
- Pt anxious about possibly needing insulin
- Complained clinic waits too long and receptionist 'rude'
Plan
- Discussed with obstetric/diabetes team today → review booked 24/10 (before move) to consider metformin or insulin; Melbourne team to continue BGL review until Brisbane care confirmed
- Copy of BGL/food diary given to pt; obstetric summary sent separately by obstetric team
- Request dietitian appt within 1/52 of arrival (by 07/11)
- Postnatal: OGTT 6–12/52 postpartum; education re long-term T2DM risk
Who is reading, and what do they need?
Ms Nikolaidis is a Brisbane antenatal dietitian who has not met the patient and takes over dietary care after 31/10. She needs current glucose status, the diet plan in place, the pending treatment review and the requested timeframe. Obstetric details are sent separately, so keep the content dietetic and focused.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Fasting BGLs 5.2–5.6 on 4 of last 7 days, target ≤5.0 | The one unresolved glucose problem despite the supper snack. It is the main reason the Brisbane dietitian needs to review readings. |
| Post-meal BGLs 6.1–7.2, all within ≤7.4 target over 7 days | Shows the breakfast change is working and should be maintained. It also gives the reader the agreed targets to continue using. |
| 3 small meals + 3 snacks, low GI, protein each meal | This is the current plan the reader is asked to continue. Summarise it briefly instead of listing the earlier diet history in detail. |
| Review 24/10 to consider metformin or insulin | A possible treatment change before the move, whose outcome is unknown when writing. The reader needs to know Melbourne continues BGL review until Brisbane care is confirmed. |
| Lacto-ovo vegetarian; iron deficiency at 20/40, daily oral iron | Affects protein sources and food advice, so a dietitian taking over needs it. Keep it to one brief mention. |
| Weight 84 kg pre-pregnancy (BMI 31), 91 kg today | Weight gain is part of the dietetic picture for the new dietitian. It is also baseline data for her own monitoring. |
| Food and BGL diary in phone app; happy to share records | Gives the reader a practical way to see the readings and diet. It also shows the patient is engaged. |
| Request appointment within 1/52 of arrival (by 07/11) | This is the action requested, and the date follows from the move on 31/10. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Mother-in-law says she 'brought this on herself' with fruit | Family opinion rather than clinical information. Repeating it adds nothing for dietary management and could mislead about her diet. |
| Pottery classes; graphic designer working remotely; partner's project | Lifestyle and work detail that does not change dietary management. The reason for the move needs at most a few words. |
| Complained clinic waits too long; receptionist 'rude' | A service complaint, irrelevant to the Brisbane dietitian's task. |
| Growth scan normal, BP normal at 20/10 review | Trap: it looks clinically relevant, but the obstetric team sends the obstetric summary separately, so the reader does not need it here. |
| Appendicectomy age 12; allergies nil | Remote surgical history with no bearing on nutrition or glucose management. |
A paragraph plan for this case
Open with the referral purpose, the patient's move date and her GDM diagnosis. Give the dietetic management and glucose progress next, separating the fasting problem from the readings within target. Close with the 24/10 review, who covers until Brisbane care is confirmed, the appointment date requested and the postnatal follow-up.
Where candidates slip on this task
- Keep fasting and post-meal readings distinct. Only fasting values are above target, on 4 of the last 7 days, so avoid describing her control as poor overall.
- The 24/10 review outcome is unknown today. Say that metformin or insulin will be considered, not that either will start, and make clear Melbourne continues review until Brisbane care is confirmed.
- Give the actual date for the appointment request (by 07/11), worked out from arrival on 31/10, rather than only 'within a week'. Do not calculate gestation at arrival.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Dietetics letter tasks
- Home jejunostomy feeding after oesophagectomy referral letter
- Malnutrition in COPD - progress update update letter
- Update to the treating paediatrician: infant with cow's milk protein allergy and faltering growth update letter
Your profession's guide: OET Dietetics. Layout and structure: OET letter format.
Questions about this task
Should the patient's anxiety about insulin be included?
It is optional. The reader may benefit from knowing, but it is not needed for the requested actions. The review on 24/10 is only considering metformin or insulin, so avoid implying insulin is planned.
How much of the earlier diet history is needed?
Only enough to show what changed and why it matters. The reader needs the current plan and the glucose response, not the full initial diet history or each appointment date.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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