The task
Assume that today's date is 6 November 2026. You have completed a home review of Mr Iancu Dragojevic. This is original independent practice material.
You are a registered nurse working in the home review service. Using the case notes, write a referral letter to Ms Yolanda Remulla, Community Parkinson's Nurse, Home Review Service, 24 High Street, SW1P 2AA, United Kingdom. Request an individual assessment of Mr Dragojevic's mobility, freezing triggers and the relationship between episodes and medication times. Distinguish his reported falls and concerns about medication from established findings. 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.
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Which case notes belong in this letter?
Parkinson's disease with freezing episodes: referral
You are a registered nurse working in the home review service. Using the case notes, write a referral letter to Ms Yolanda Remulla, Community Parkinson's Nurse, Home Review Service, 24 High Street, SW1P 2AA, United Kingdom. Request an individual assessment of Mr Dragojevic's mobility, freezing triggers and the relationship between episodes and medication times. Distinguish his reported falls and concerns about medication from established findings. 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 Iancu Dragojevic
- DOB: 14/03/1954 (72 yrs)
- Address: 8 Orchard Road, SW1P 2AB, United Kingdom
- Home review: 06/11/26; consented to specialist referral
Social background
- Lives with wife; she attended review and agrees to support assessment
- Independent dressing/feeding; wife prepares main meals
- Retired bookbinder; enjoys collecting stamps
- Asked staff to keep son's debts confidential
Medical history
- Parkinson's disease diagnosed 2018; neurology follow-up
- Co-careldopa: long-standing regimen; unchanged for 6/12
- Manages own medication; reports taking doses as prescribed; none missed
- Appendicectomy 1983; uncomplicated recovery
- Seasonal rhinitis; no current symptoms
Recent progress
- Past 3/52: gradually ↑ freezing; feet feel stuck, especially doorways/turning
- Pt reports 2 falls in 10 days, both turning in kitchen; unwitnessed
- No reported injury, head strike, LOC or dizziness
- GP assessment yesterday: no acute illness/injury identified
- Pt blames tablets; recalls episodes before/after doses; relationship unrecorded; causation unconfirmed
Today's assessment
- Today: short steps; brief freeze turning; no fall
- Alert, orientated; no new confusion reported
- Wife anxious about leaving him alone
- Previously walked to shops alone; now avoids going out
- Narrow kitchen entrance; often carries tea while walking
- Wants to remain independent making tea despite wife's concerns
- Complained that visiting staff never arrive punctually
Plan
- GP plan: prescribed Parkinson's regimen unchanged pending specialist review
- Refer community Parkinson's nurse: home assessment within 1/52
- Assess mobility, freezing triggers and relationship to medication times; consider Parkinson's-specific physiotherapy
- Request individual strategies for safer kitchen mobility
- Start diary today: medication times, freezing, falls, circumstances and what helped restart walking
- Wife agreed to accompany kitchen walking pending assessment
- GP review 19/11; contact GP sooner for further falls/deterioration
Who is reading, and what do they need?
Ms Remulla is the community Parkinson's nurse asked to assess Mr Dragojevic at home. She needs his full name and home address to identify him and arrange the visit, along with the requested assessment, timeframe and evidence limits, with concise medication context. Optional functional detail includes independent dressing and feeding, his wife's meal preparation and support for assessment, her anxiety about leaving him alone, his avoidance of outings, and his wish to keep making tea independently.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Three weeks of gradually increased freezing, especially at doorways and when turning | Establishes the recent mobility problem and specific situations the specialist needs to investigate. |
| Reports two unwitnessed falls in ten days, both while turning in the kitchen | Explains the need for timely assessment while preserving the distinction between reported events and witnessed findings. |
| Blames tablets; recalls episodes before/after doses; timing unrecorded and causation unconfirmed | Identifies the patient's concern and the unanswered assessment question without attributing freezing or falls to medication. |
| GP plan: prescribed Parkinson's regimen unchanged pending specialist review | Clarifies current management and prevents the referral from implying an authorised medication change. |
| Community Parkinson's nurse home assessment within one week | Gives the receiving service an explicit action and timeframe for arranging care. |
| Assess mobility, freezing triggers and medication timing; consider Parkinson's-specific physiotherapy | Defines the assessment scope and preserves physiotherapy as an option for consideration. |
| Today's short steps and brief freeze on turning; no fall | Provides directly observed mobility evidence that can be distinguished from the patient's account of previous falls. |
| Narrow kitchen entrance; carries tea while walking; individual kitchen mobility strategies requested | Connects the home environment and everyday activity to the practical advice requested from the specialist. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retired bookbinder; collects stamps | These biographical details do not explain freezing triggers or help arrange the requested assessment. |
| Requested confidentiality about son's debts | This confidential family matter has no documented connection to the mobility referral. |
| Appendicectomy in 1983; uncomplicated recovery | The remote resolved operation does not inform the current Parkinson's assessment. |
| Seasonal rhinitis; no current symptoms | The inactive condition does not contribute to the documented mobility problem or specialist request. |
| Complaint about visiting staff arriving late | Although it concerns the same service, this complaint does not help assess mobility or medication timing. |
| Alert and orientated; no new confusion reported | This can be omitted or compressed unless needed to contextualise today's observations; it does not establish the cause of freezing. |
A paragraph plan for this case
Retain Mr Dragojevic's full name and home address in the patient information heading or subject line; his date of birth can also support identification. Open with the referral purpose, one-week timeframe and consent from the 6 November review. Group the 2018 Parkinson's diagnosis and neurology follow-up with concise medication context, recent freezing, reported falls and today's observed mobility, adding optional functional context where useful. Close with the specialist requests and, if space permits, the diary, his wife's agreed kitchen accompaniment and scheduled 19 November GP review.
Where candidates slip on this task
- Keep unwitnessed falls distinct from today's observed freeze without falling. Optional negatives are no reported injury, head strike, loss of consciousness or dizziness; yesterday's GP assessment found no acute illness/injury.
- Do not present his tablet concerns as causation or confirm adherence independently: he reports no missed doses. The six-month unchanged co-careldopa regimen remains unchanged under the GP's current plan.
- The full diary plan starts on 6 November and records medication times, freezing, falls, circumstances and what helped restart walking. If included in the letter, its main contents may be summarised without listing every category. Preserve the requested individual assessment within one week and consideration of Parkinson's-specific physiotherapy.
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
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Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
How should the patient's belief that his tablets cause the episodes be handled?
Treat his attribution as a reported concern. The notes record recalled episodes before and after doses, but no recorded timing relationship or confirmed causation. Request assessment of that relationship and retain the GP's decision to leave the prescribed regimen unchanged pending specialist review.
Must every relevant background detail appear in this short referral?
No. Retain his full name and home address in the patient information heading or subject line so the service can arrange the visit. Prioritise the recent freezing, reported falls, uncertain medication relationship, unchanged treatment and requested assessment within one week. Select additional context for its practical value: observed turning difficulty, kitchen conditions or the diary may help. Family support and routine follow-up can be compressed when space is limited.
Sources
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