The task
Assume that today's date is 5 November 2026. Ms Cakobau has attended the outpatient support clinic today. This is original independent practice material.
You are a registered nurse in an outpatient support clinic. Using the case notes, write a referral letter to Ms Tara Boylan, Rheumatology Specialist Nurse, requesting practical medicine-use support and assessment of Ms Akanisi Cakobau's hand difficulties. Address the letter to Ms Tara Boylan, Rheumatology Specialist Nurse, Rheumatology Clinic, 24 Station Road, NSW 2000, Australia. 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?
Rheumatoid arthritis and hand-function problems: referral
You are a registered nurse in an outpatient support clinic. Using the case notes, write a referral letter to Ms Tara Boylan, Rheumatology Specialist Nurse, requesting practical medicine-use support and assessment of Ms Akanisi Cakobau's hand difficulties. Address the letter to Ms Tara Boylan, Rheumatology Specialist Nurse, Rheumatology Clinic, 24 Station Road, NSW 2000, Australia. 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 Akanisi Cakobau
- DOB: 18/03/1968 (58 yrs)
- Review: outpatient support clinic, 05/11/26
- Referral discussed; pt consents
Social background
- Lives alone; daughter visits most evenings; keen to remain independent with medicines
- Independent with washing and walking; buttons increasingly difficult; prepares simple meals without help
- Retired accounts clerk; enjoys radio quizzes
- Daughter privately mentioned an unrelated dispute over inheritance
Medical history
- RA diagnosed 2022; rheumatology follow-up ongoing
- Hydroxychloroquine prescribed by rheumatologist; no recent medicine changes
- No known drug allergies
- Appendicectomy 1998; uncomplicated
Assessment
- Bilateral hand stiffness ↑ over 3/52; mornings worst
- Difficulty gripping cups and turning keys; no recent injury
- Today: alert, afebrile; no acutely hot, red joint
- Observed: unable to open medicine bottle or push tablets from blister
- Reports two missed hydroxychloroquine doses last week because packaging inaccessible
- Can read labels and explain prescribed regimen correctly; no reported confusion about instructions
- Denies nausea, rash or other new medicine symptoms
- Daughter currently assists with packaging but cannot attend every day
Treatment/Progress
- Last rheumatology review 14/09/26; no treatment changes advised
- Pt worried: stiffness means tablets have stopped working
- Current disease activity not established; no conclusion about treatment failure
- Requested stronger tablets; no changes made at this clinic
- Complained receptionist sounded bored during booking
- Temporary pharmacy assistance arranged today; pt can obtain today's prescribed medicine
Plan
- Refer for practical medicine-use support: assess opening aids and pharmacist-approved accessible packaging
- Request hand-function/disease-activity assessment; discuss findings with rheumatologist, who retains prescribing
- Consider occupational therapy for joint protection and daily-task adaptations
- Pt advised to contact treating team if symptoms worsen or medicine access fails
Who is reading, and what do they need?
Ms Tara Boylan, the Rheumatology Specialist Nurse, needs actionable information about hand function, medicine access and the requested assessment. The notes establish rheumatoid arthritis diagnosed in 2022 with ongoing rheumatology follow-up, but do not establish her previous involvement. Prioritise observed barriers and their consequences, with enough context to coordinate practical support and rheumatologist review.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Hydroxychloroquine prescribed by rheumatologist; no recent medicine changes | Identifies the affected treatment and establishes the prescribing context for specialist coordination. |
| Bilateral hand stiffness increased over three weeks; mornings worst | Defines the symptom pattern prompting assessment without assuming its cause. |
| Observed inability to open medicine bottle or push tablets from blister | Provides direct evidence of the practical barrier that medicine-use support must address. |
| Two hydroxychloroquine doses missed last week because packaging was inaccessible | Shows the treatment consequence of the access barrier and explains why practical intervention matters. |
| Current disease activity not established; no conclusion about treatment failure | Optional context that makes uncertainty explicit; neutral reporting of symptoms and missed doses with a request for assessment also avoids asserting treatment failure. |
| Assess opening aids and pharmacist-approved accessible packaging | Makes the practical medicine-use request specific and actionable. |
| Assess hand function/disease activity; discuss findings with rheumatologist, who retains prescribing | Defines the assessment request and the respective responsibilities for review and prescribing. |
| Can read labels and correctly explain regimen; no reported instruction confusion | Helps direct support towards physical access rather than assuming an education or comprehension problem. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retired accounts clerk; enjoys radio quizzes | Occupation and leisure interests do not help the specialist assess hand function or arrange medicine access. |
| Daughter privately mentioned an unrelated inheritance dispute | This confidential, unrelated disclosure adds no useful information for the requested care. |
| Uncomplicated appendicectomy in 1998 | Remote surgery has no stated connection to the current hand or packaging difficulties. |
| Receptionist sounded bored during booking | The service complaint does not guide rheumatology assessment or practical medicine support. |
| Last rheumatology review 14 September 2026; no treatment changes advised | Although apparently useful specialist history, this can be compressed because unchanged treatment is already established. |
| No known allergies; afebrile; no acutely hot, red joint; no new medicine symptoms | These supporting negatives may be compressed or omitted when the access problem and assessment request remain clear; they do not establish treatment effectiveness. |
A paragraph plan for this case
Open with the referral purpose and essential identification, then establish the current hydroxychloroquine treatment and increasing hand stiffness. Explain the observed packaging barrier, missed doses and retained regimen understanding; selectively add cup/key difficulties without recent injury, button difficulties and preserved washing, walking and simple meal preparation. Close with requests for opening aids, pharmacist-approved packaging and hand-function/disease-activity assessment, preserving rheumatologist prescribing responsibility; occupational therapy for joint protection and daily-task adaptations is useful optional context.
Where candidates slip on this task
- Use Ms Akanisi Cakobau and DOB 18 March 1968 for identification; age 58 matches the review date, 5 November 2026. Keep documented referral consent brief.
- Present her worry that tablets have stopped working and request for stronger tablets as concerns, without endorsing treatment failure; no changes were made at this clinic.
- Use living alone, most-evening daughter visits and medicine independence selectively; distinguish packaging help unavailable every day from today's temporary pharmacy assistance, which secures today's medicine but leaves ongoing support necessary.
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
Should the referral suggest that hydroxychloroquine has stopped working?
No. Report the worsening stiffness and packaging-related missed doses neutrally and request disease-activity assessment. You may explicitly state that disease activity has not been established, but this is optional if the referral avoids asserting treatment failure. The rheumatologist retains prescribing responsibility; the outpatient clinic made no medicine changes.
Does today's pharmacy assistance make specialist medicine-use support unnecessary?
No. Today's arrangement enables access to today's prescribed medicine, while the observed bottle and blister difficulties remain relevant. Her daughter cannot help every day. Opening aids and pharmacist-approved accessible packaging therefore remain appropriate requests, with occupational therapy an optional addition for daily-task adaptations.
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.