The task
Original independent practice material. Patient details, observations and individual GP instructions are fictional case facts; general safety advice is labelled separately. Assume that today is 4 November 2026. You have assessed Mr Bernard Farell at home. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
You are a registered nurse in the community nursing service. Using the case notes, write a referral letter to Ms Keely Dasey, Heart Failure Specialist Nurse, Community Rapid-Review Service, 42 Station Road, SW1V 2AB, United Kingdom. Request assessment today of Mr Bernard Farell's worsening symptoms, explaining his transport barrier and the GP's instructions concerning his existing prescriptions. 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.
Free · no sign-up · nursing
Which case notes belong in this letter?
Heart failure with increasing oedema: referral
You are a registered nurse in the community nursing service. Using the case notes, write a referral letter to Ms Keely Dasey, Heart Failure Specialist Nurse, Community Rapid-Review Service, 42 Station Road, SW1V 2AB, United Kingdom. Request assessment today of Mr Bernard Farell's worsening symptoms, explaining his transport barrier and the GP's instructions concerning his existing prescriptions. 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.
Mark every line: Include keeps the specific detail; Compress keeps the relevant gist in fewer words; Omit leaves it out. Then compare your choices with our reviewed analysis. Some choices are optional.
Download practice checklist (PDF)
One-page worksheet. Answers and reasons are on the linked webpage, so you can practise before checking.
Case notes
Patient details
- Name: Mr Bernard Farell
- DOB: 18/03/1950 (76 yrs)
- Address: 18 Orchard Road, SW1V 2AD, United Kingdom
- Community nursing assessment: 04/11/26; referral written today
Social background
- Lives alone; independently manages medicines and personal care
- Daughter usually drives him to appointments; unavailable this week
- No alternative transport; cannot attend clinic today; agrees to home assessment
- Retired accountant; enjoys collecting old postcards
- Complained that reception staff sounded bored during his telephone call
Medical history
- Chronic heart failure diagnosed 2023; usually stable
- Hypertension; under regular GP care
- Appendicectomy 1968; uncomplicated recovery
- Medicines reconciled today; complete current prescription list enclosed
- Reports taking prescribed furosemide consistently; no missed doses
Assessment and symptom trend
- Weight: 01/11 78.2 kg → 04/11 80.6 kg
- Ankle oedema now reaches both shins; increasingly breathless walking indoors
- Usual shoes now tight; previously comfortable
- Comfortable at rest; no chest pain, orthopnoea or syncope
- Alert; speaking full sentences; no visible respiratory distress
- BP 118/72 mmHg; pulse 78 regular; RR 18; SpO2 96% room air
- Food and fluid intake unchanged; no vomiting
- No recent fever or cough
- No new medicines; denies taking non-prescription anti-inflammatory medicines
- Weights recorded each morning using same scales
- No prescribed flexible diuretic self-adjustment plan
- Consents to referral and sharing assessment with GP
Plan: individual GP instructions unless labelled otherwise
- GP reviewed symptoms by telephone: requests home assessment today; if unavailable, contact GP today for alternative assessment
- GP: continue current prescriptions pending review; diuretic changes require prescriber assessment
- Report assessment to GP today; explore transport support for future appointments
- General safety advice given: call 999 for severe breathing difficulty or collapse with abnormal responsiveness
Who is reading, and what do they need?
Ms Dasey needs the patient's name and home address to arrange today's review; previous contact cannot be assumed. Both may appear in a patient-information heading rather than the body. Date of birth provides useful auxiliary identification information but may be omitted when the name and home address are retained. Her specialist role favours concise clinical detail. Living alone, independent medicine and personal care, hypertension, adherence, consent and the daughter's temporary unavailability provide supporting context. Lead with the assessment request, deterioration and transport barrier rather than expanding each background detail.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Home assessment today; if unavailable, contact GP today for alternative assessment. | Establishes the requested response and preserves the same-day alternative if the service cannot attend. |
| No alternative transport; cannot attend clinic today; agrees to home assessment. | Explains why clinic attendance cannot meet the immediate assessment need and confirms agreement to a home visit. |
| Weight: 1 November 78.2 kg; 4 November 80.6 kg. | Provides dated, objective evidence supporting the urgency of specialist review. |
| Oedema now reaches both shins; increasingly breathless walking indoors. | Shows the extent of swelling and the functional effect of the documented deterioration. |
| Comfortable at rest; no chest pain, orthopnoea or syncope. | Balances the deterioration with the recorded resting condition and relevant symptom negatives without implying reassurance beyond assessment. |
| Continue current prescriptions pending review; diuretic changes require prescriber assessment. | Communicates the GP's explicit interim medication instructions and prevents an unsupported implication that doses should change immediately. |
| Recorded advice: call 999 for severe breathing difficulty or collapse with abnormal responsiveness. | Preserves the documented emergency advice, including both triggers and the emergency number applicable to this UK case. |
| Usually stable chronic heart failure; medicines reconciled today; complete current prescription list enclosed. | Offers useful diagnostic and medication context; these details can remain brief because the urgent findings already establish the purpose. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retired accountant; enjoys collecting old postcards. | Neither occupation nor hobby affects arranging today's assessment or understanding the clinical change. |
| Reception staff sounded bored during his telephone call. | This service complaint does not help the specialist assess symptoms or organise access. |
| Appendicectomy in 1968; uncomplicated recovery. | The remote, resolved surgical history has no stated connection to the present referral. |
| Usual shoes now tight; previously comfortable. | Although relevant to swelling, this duplicates the more informative finding that oedema reaches both shins. |
| Weights recorded each morning using the same scales. | Measurement consistency supports the weight comparison but need not occupy space once the dated measurements are clear. |
| Unchanged intake; no vomiting, fever, cough, new medicines or non-prescription anti-inflammatory use. | These supporting checks may be compressed or omitted when the main deterioration, resting condition and assessment arrangements remain clear. |
A paragraph plan for this case
Open with the request for today's home assessment, using the identifiers and 4 November assessment date, and explain the transport barrier alongside that request. Next group the dated weights, shin oedema and indoor breathlessness with resting comfort and all listed symptom negatives; alertness, full sentences, absence of visible respiratory distress and measured observations are optional supporting detail. Finish with the GP's prescription instructions, the same-day alternative if home review is unavailable and the recorded emergency advice; the enclosed medicine list, reporting back today and future transport support can receive brief mention.
Where candidates slip on this task
- Use 4 November 2026 as the referral date and compare the two recorded weights across three days; avoid suggesting a longer trend or adding an explanation for the gain.
- Consistent furosemide use does not justify dose adjustment: retain the instruction to continue prescriptions, require prescriber assessment for changes, and treat the absent flexible plan as useful context.
- Retain both recorded emergency triggers and the UK number 999; changing the number to 000 would contradict this patient's location and the advice documented in the notes.
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 Nursing letter tasks
- Referral to pulmonary rehabilitation after a COPD admission referral letter
- Referral to a falls prevention program after a fall at home referral letter
- Referral to hospital-in-the-home for intravenous antibiotics referral letter
Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Must every normal finding and background detail appear?
No. Prioritise the deterioration, resting comfort and listed symptom negatives, home assessment requirement, transport barrier and GP instructions. Numerical observations and other supporting checks can strengthen the referral, but omission is reasonable when the specialist can still understand the situation and continue care.
How should the medicine instructions be handled?
Distinguish the GP's interim instruction from any future prescribing decision. Select continuation of existing prescriptions pending review and the requirement for prescriber assessment before diuretic changes. The enclosed reconciled list can supply medication detail; do not invent a furosemide dose or adjustment.
Sources
Last checked . Rules and prices change: confirm on the official page before you book or apply.
OETAce is an independent practice site. OET is a registered trademark of Cambridge Boxhill Language Assessment (CBLA); we are not affiliated with or endorsed by CBLA. All practice material here is original.