The task
This is original independent practice. All patient-specific observations, events and individual care arrangements are fictional. Assume that today's date is 4 November 2026. Kaitlin is attending the adolescent outpatient service for review. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
You are a registered nurse in the adolescent outpatient service. Using the case notes, write a referral letter to Ms Felicidad Abella, Specialist Eating-Disorder Nurse, Adolescent Outpatient Service, 24 Station Road, NSW 2000, Australia. Request specialist assessment, support and coordination of weekly monitoring, communicating Kaitlin's current condition, the referring team's medical responsibilities and her information-sharing consent. A copy of the written safety plan will accompany your letter. Ask Ms Abella to reinforce this plan; its detailed instructions do not need to be repeated. 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?
Restrictive eating disorder: referral
You are a registered nurse in the adolescent outpatient service. Using the case notes, write a referral letter to Ms Felicidad Abella, Specialist Eating-Disorder Nurse, Adolescent Outpatient Service, 24 Station Road, NSW 2000, Australia. Request specialist assessment, support and coordination of weekly monitoring, communicating Kaitlin's current condition, the referring team's medical responsibilities and her information-sharing consent. A copy of the written safety plan will accompany your letter. Ask Ms Abella to reinforce this plan; its detailed instructions do not need to be repeated. 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: Ms Kaitlin Carley; DOB 19/03/2009 (17 yrs)
- Referral date: 04/11/26; adolescent outpatient service
Social background
- Lives with mother; attends school; mother available for meal support
- School attendance ↓ over 3/52; struggling with morning lessons
- Previously attended lunch club; stopped when eating with peers became difficult
- Mother complained about reception staff's telephone manner
Medical history
- No significant previous illness; no regular medication
- Denies vomiting, laxatives, diuretics or excessive exercise
- No fainting, chest pain or palpitations reported
- Denies self-harm or suicidal thoughts at today's review
Assessment and progress
- 14/10: assessment → restrictive eating disorder; breakfast/lunch usually missed
- Measured weights: 14/10 54.6 kg → 04/11 52.5 kg
- Dietitian agreed meal support; mother began supporting breakfast
- 04/11: breakfast now eaten with support; evening meal with mother
- Fluids: water and milk regularly; no vomiting
- 04/11: most lunch uneaten; persistent tiredness and poor concentration
- 04/11: pulse 64 beats/min; seated BP 104/68 mmHg; temperature 36.4°C
- Anxious about eating at school; accepts specialist help and agrees to referral
- Weight gain feared; asks staff to avoid commenting on appearance
- Enjoys photography; recently bought a camera
Consent and plan
- Understands referral and information-sharing choices; consent documented
- Prefers part of each consultation alone
- 04/11: blood tests pending; referring team to review results
- Specialist: assess/support; coordinate weekly intake/mood/symptoms/weight/observations; referring team retains medical decisions; next medical review 06/11
- Mother: consent for appointments/meal-support advice only; exclude weights/therapy discussions
- School: consent for attendance adjustments only; exclude diagnosis/weights
- Safety-related confidentiality limits explained; review consent before wider sharing
- Written safety plan provided to Kaitlin; copy accompanies referral; specialist to reinforce. Plan: non-emergency deterioration → contact team promptly; new thoughts of self-harm/suicide → immediate ED assessment; fainting/chest pain/breathing difficulty/unresponsiveness or immediate danger of self-harm → call 000 immediately; do not delay emergency care to contact team
Who is reading, and what do they need?
Ms Abella is the specialist eating-disorder nurse in Kaitlin's adolescent service, receiving a referral for assessment and coordinated support. She needs current intake, measured weight change, observations and exact sharing permissions, with medical responsibility clearly allocated. The written safety plan accompanies the letter. Kaitlin is 17 and understands the documented referral choices; her preference for some consultation time alone can help the nurse arrange her assessment.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Measured weights: 14/10 54.6 kg → 04/11 52.5 kg | The two dated measurements establish the weight loss prompting specialist assessment. |
| Most lunch uneaten; persistent tiredness and poor concentration. | These current difficulties identify unresolved intake and functional problems for specialist support. |
| 04/11: pulse 64 beats/min; seated BP 104/68 mmHg; temperature 36.4°C. | Current observations provide a baseline for coordinated monitoring without establishing overall medical stability. |
| Specialist assessment/support and weekly intake/mood/symptoms/weight/observations; referring team retains medical decisions; next medical review 06/11. | The nurse needs a clear remit and the next medical review date so specialist support complements ongoing medical care. |
| Mother: appointments and meal-support advice only; exclude weights and therapy discussions. | The specialist must involve the mother within Kaitlin's specific permission rather than assume unrestricted parental access. |
| School: attendance adjustments only; exclude diagnosis and weights. | School coordination must address attendance without disclosing clinical information outside the documented consent. |
| Written safety plan provided to Kaitlin; copy accompanies referral; specialist to reinforce. | Ask the nurse to reinforce the enclosed plan. Its detailed emergency instructions are already available to the recipient. |
| Breakfast supported by mother; evening meal together; school-eating anxiety; specialist help accepted. | Selected details can show what support is working and where further help is needed. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Mother complained about reception staff's telephone manner. | This service complaint does not help the specialist assess eating difficulties or coordinate the agreed care. |
| Enjoys photography; recently bought a camera. | These interests do not explain the immediate referral or alter monitoring and information-sharing arrangements. |
| No significant previous illness; no regular medication. | This general background can be omitted when space is needed for current findings, responsibilities and consent. |
| Denies vomiting, laxatives, diuretics or excessive exercise. | These denials may be compressed or omitted; they do not replace the current nutritional assessment or monitoring request. |
| Regular water/milk; no vomiting; no fainting, chest pain or palpitations reported. | These supporting observations can be compressed or omitted without treating their absence as proof of medical safety. |
A paragraph plan for this case
Open with the specialist referral request. Present the two dated weights, current lunch intake, symptoms and observations. Add selected context, such as supported meals or school-eating anxiety, if useful. Explain weekly specialist monitoring, retained referring-team medical responsibility and the next medical review on 6 November. Pending blood results can briefly clarify investigation follow-up. Ask the nurse to reinforce the enclosed safety plan without reproducing its detailed instructions. Set out the separate mother and school disclosure permissions clearly. Private consultation time and consent review can support this closing paragraph.
Where candidates slip on this task
- Treat fear of weight gain and the request to avoid appearance comments as engagement information; do not invent reasons for school anxiety or imply supported breakfast resolves restriction.
- Today's denial of self-harm or suicidal thoughts is optional context, not proof of future safety. Safety-related confidentiality limits have been explained; this does not permit unrestricted disclosure.
- Keep both measured weights dated and distinguish weekly specialist monitoring from the next medical review on 6 November. Current observations and pending tests do not justify declaring Kaitlin medically stable.
- Refer to the enclosed safety plan and request reinforcement. If you choose to describe its instructions, preserve the urgent routes and never suggest delaying emergency care for team contact. Do not claim Kaitlin understood the plan when only its provision is documented.
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
How much school and family background is useful?
Select background that explains the practical eating difficulty or available support. Her mother's meal support and difficulty eating at school are useful; reduced attendance or stopping lunch club can briefly illustrate impact. These details remain optional when the current intake problem and coordination needs are already clear.
Does the referral allow unrestricted sharing with her mother or school?
No. Keep each recipient's permission separate: appointments and meal-support advice for her mother, attendance adjustments for school, with the stated exclusions preserved. Kaitlin understands the documented choices. The safety-related confidentiality limits have been explained, and consent should be reviewed before wider sharing.
Sources
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