The task
Original independent practice. Assume that today's date is 3 November 2026. Mr Althani has attended an outreach review. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
You are a registered nurse in a community outreach service. Using the case notes, write a referral to Ms Maryanne Crist, Public Health Nurse, Community Outreach Service, 24 High Street, SW1A 2AA, United Kingdom. Request consented adherence support for Mr Hamad Althani and coordination of household-contact screening. 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?
Pulmonary tuberculosis: referral
You are a registered nurse in a community outreach service. Using the case notes, write a referral to Ms Maryanne Crist, Public Health Nurse, Community Outreach Service, 24 High Street, SW1A 2AA, United Kingdom. Request consented adherence support for Mr Hamad Althani and coordination of household-contact screening. 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 Hamad Althani
- DOB: 18/06/1988 (38 yrs)
- Address: 8 Park Road, SW8 2AB, United Kingdom
- Outreach review: 03/11/26; attends independently
Social background
- Lives with wife and daughter (6); shared household facilities
- Telephone contact preferred after midday; depends on wife for transport
- Reads English medicine labels; prefers verbal explanations before written information
- Recounted delayed luggage when immigrating in 2019
- Discussed relative's visa dispute; requested privacy
Medical history
- No previous TB treatment or known household history of tuberculosis
- No regular medicines before this illness; no over-the-counter remedies reported
- Allergies: nil known
Assessment and initial care
- 06/10: cough 6/52, night sweats, appetite ↓
- 12/10: sputum testing confirmed pulmonary TB
- 12/10: TB team notified; household contact-screening referral initiated
- Household screening appointment offered for 23/10; letter received but attendance not confirmed
- 13/10: isoniazid + rifampicin + pyrazinamide + ethambutol started, with pyridoxine; all once daily; TB specialist retains prescribing responsibility
Treatment and progress
- 24/10: cough ↓, appetite improving; reported taking treatment without practical difficulty
- Medicines available at home
- 01–02/11: missed medicines despite supply at home; thought improvement meant treatment could stop
- 03/11: no breathlessness or haemoptysis reported
- Today: eating better; cough now occasional; denies medication-related nausea or rash
- TB team informed of omissions today; specialist review 05/11
- Wife + daughter (6): screening missed (transport); rebook through contact-screening service
- Both contacts asymptomatic; wife aware of diagnosis and willing to attend screening
Agreed plan
- Consents to referral and necessary information sharing for adherence support/contact screening
- 04/11: contact patient; agree reminders, reinforce treatment completion, explore barriers
- Report further missed doses promptly to TB team
- Worried neighbours may discover diagnosis; agree discreet visit arrangements
- Please help household resolve transport difficulties for screening
Who is reading, and what do they need?
Ms Crist needs enough information to organise adherence support and household screening without assuming responsibility for prescribing. Patient identifiers support matching and contact. The named daily treatment can provide a concise medication summary. Communication preferences, transport difficulties and privacy concerns can make the arrangements workable. Earlier symptoms, routine negative findings and background history need only brief treatment when they help explain the current request.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 12 October: sputum testing confirmed pulmonary TB. | Establishes the confirmed condition underlying both adherence support and household-contact screening. |
| 1–2 November: medicines missed despite supply; believed improvement meant treatment could stop. | Identifies the actual adherence problem and the misunderstanding that support needs to address. |
| Consent to referral and necessary information sharing for adherence support and contact screening. | Establishes permission for the requested support and the relevant information sharing. |
| 4 November: contact patient; agree reminders, reinforce completion and explore barriers. | Gives the recipient a dated, practical starting point for the requested intervention. |
| Further missed doses: report promptly to TB team. | Defines how subsequent omissions should reach the team managing treatment. |
| Wife and daughter, six: screening missed through transport difficulties; rebook through contact-screening service. | Identifies both contacts, the unresolved screening need and the practical obstacle requiring coordination. |
| Daily isoniazid, rifampicin, pyrazinamide and ethambutol, with pyridoxine, started 13 October; TB specialist retains prescribing responsibility; team informed of omissions; review 5 November. | Provides optional treatment context and clarifies existing clinical oversight alongside the requested adherence support. |
| Discreet visits; telephone after midday; verbal explanations preferred before written information. | Makes support easier to arrange while respecting his stated communication and privacy preferences. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Delayed luggage when immigrating in 2019. | The travel anecdote does not help organise current treatment support or household screening. |
| Relative's visa dispute; privacy requested. | This confidential third-party matter has no stated connection with the referral. |
| No regular medicines before illness; no over-the-counter remedies reported. | The recipient is organising support rather than reconciling or prescribing medicines. |
| 23 October screening letter received; attendance initially unconfirmed. | The later confirmed missed screening and rebooking requirement supersede this earlier uncertainty. |
| 6 October: six-week cough, night sweats and reduced appetite. | Compress if diagnostic context is useful; the confirmed diagnosis and current omissions carry the referral. |
| 24 October: cough reduced, appetite improving; treatment reportedly manageable. | Earlier reported success can be compressed because the subsequent omissions determine the present support need. |
A paragraph plan for this case
Open with the consented referral purpose and patient identification, then establish confirmed TB and the recent omissions. Next organise the requested adherence actions, TB-team reporting and specialist oversight, adding only useful current context such as a concise treatment summary or improved symptoms. Finish with both household contacts, screening rebooking and transport help, incorporating discreet contact arrangements. Optional context includes that both contacts are asymptomatic and his wife is willing to attend screening.
Where candidates slip on this task
- Distinguish the missed medicines on 1–2 November from the planned contact on 4 November and specialist review on 5 November; these dates describe different responsibilities.
- Do not portray the omissions as caused by unavailable medicines or adverse effects: supply was present, and the recorded explanation concerned improvement and stopping treatment.
- Keep the earlier screening invitation separate from the confirmed missed appointment; prioritise rebooking for both contacts.
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
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Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Does every symptom and negative finding need to appear?
No. Confirmed pulmonary TB and the recent omissions explain the referral. Current improvement, absent breathlessness or haemoptysis, and denied nausea or rash may provide brief context, but none needs a separate account if the recipient can organise support without it.
Which privacy information belongs in this referral?
Include consent for the referral and necessary information sharing. His concern about neighbours can support discreet visit arrangements. The relative's visa dispute should be omitted because it concerns confidential third-party information with no stated bearing on adherence or screening.
Sources
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