The task
This is an original independent practice task. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing. Assume that today is 5 November 2026. It is 09:40, and Mr Castelli is awaiting ambulance transfer.
You are a registered nurse at a residential care facility. Using the case notes, write a transfer letter to Ms Melissa Tozzi, Emergency Department Triage Nurse, Urgent Receiving Unit, 18 Hospital Road, NSW 2000. Request urgent assessment of Mr Piergiorgio Castelli's new confusion, explaining the acute change from his usual functioning and the transfer already arranged. 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: Transfer letter.
Free · no sign-up · nursing
Which case notes belong in this letter?
New confusion in an older adult: transfer
You are a registered nurse at a residential care facility. Using the case notes, write a transfer letter to Ms Melissa Tozzi, Emergency Department Triage Nurse, Urgent Receiving Unit, 18 Hospital Road, NSW 2000. Request urgent assessment of Mr Piergiorgio Castelli's new confusion, explaining the acute change from his usual functioning and the transfer already arranged. 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 Piergiorgio Castelli
- DOB: 12/03/1945 (81 yrs)
- Residential care resident since 2024
Social background
- Daughter visits twice weekly; regular telephone contact
- Retired tailor; enjoys gardening
- Daughter privately complained about brother's inheritance demands
- Pt previously complained that breakfast toast was cold
Usual function and medical history
- Baseline: fully orientated; coherent conversation; independent personal care and unaided walking
- No known dementia/previous confusion; daughter confirms usual cognition yesterday
- Hypertension; routine review stable 3/12 ago
- No new medicines/recent dose changes; current medication list accompanies transfer
- No known drug allergies
- Bilateral hearing aids: worn and functioning today
- Appendicectomy 1968; uncomplicated
- Routine foot-care appointment next week
Assessment: 5 November 2026
- 07:30: usual coherent conversation at breakfast; dressed independently
- 09:15: sudden confusion; disorientated to place/date; fluctuating attention
- Repeatedly attempts to leave to collect children from school
- Awake; responds to own name; needs repeated redirection
- 09:20: T 37.1°C; pulse 88/min; RR 18/min
- BP 146/82 mmHg; SpO2 97% room air
- Capillary BGL 6.1 mmol/L
- Speech clear; face symmetrical; equal arm movement
- No reported fall/head injury
- No pain reported; unable to give reliable detailed history
Immediate actions and transfer plan
- 09:25: on-call clinician advised immediate ED assessment; cause undetermined
- 09:30: ambulance requested for immediate ED transfer; receiving triage nurse notified
- Request urgent assessment of acute change/cause; continue close supervision for wandering
- Nursing plan: stay with pt; reassure; short explanations; avoid repeated questioning
- Daughter informed; will meet pt at ED
- Observation sheet and transfer letter accompany medication list
- 09:40: awaiting ambulance; staff member remains with pt
Who is reading, and what do they need?
Ms Tozzi is the receiving emergency triage nurse and has already been notified of the ambulance request. She needs Mr Castelli’s name, DOB and residential-care context for identification, followed by the acute change, timing and supervision needs. Keep background selective: his daughter’s visiting pattern adds less than her planned ED attendance, and routine history must not obscure the urgent request.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Urgent assessment of acute change/cause; continue close supervision for wandering; cause undetermined. | Establishes the requested response and immediate supervision need without assigning an unsupported diagnosis. |
| Baseline: fully orientated, coherent conversation, independent personal care and unaided walking. | Shows the receiving nurse how substantially the current presentation differs from his usual functioning. |
| 07:30: usual coherent conversation at breakfast; dressed independently. | Provides a same-day reference point for the acute change and supports its urgency. |
| 09:15: sudden confusion; disorientated to place/date; fluctuating attention. | Identifies the onset and observed features requiring urgent assessment. |
| 09:30: ambulance requested for immediate ED transfer; receiving triage nurse notified. | Clarifies that emergency transport has already been arranged and communication initiated. |
| Attempts to leave to collect children; awake, responds to name, needs repeated redirection. | Explains the practical wandering risk and the level of support currently needed. |
| Observations: 37.1°C; pulse 88/min; RR 18/min; BP 146/82; SpO2 97% room air; BGL 6.1 mmol/L. | Provides useful objective assessment data for triage; select detail without letting measurements displace the acute change. |
| No medicine changes; medication list, observation sheet and transfer letter accompany transfer. | Supports medication review and continuity of assessment without reproducing documents already accompanying him. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retired tailor; enjoys gardening. | Occupational and leisure details do not help triage this acute change. |
| Daughter privately complained about brother’s inheritance demands. | Confidential family conflict has no documented connection to the presentation or immediate care. |
| Previously complained that breakfast toast was cold. | The historical complaint does not describe today’s cognitive change or explain its cause. |
| Appendicectomy in 1968; uncomplicated. | Remote uncomplicated surgery adds no useful context for this urgent assessment. |
| Routine foot-care appointment next week. | Although healthcare-related, the appointment does not affect the immediate transfer or requested assessment. |
A paragraph plan for this case
Open with the urgent assessment request and ambulance status, then contrast his usual cognition, personal care and walking with the 07:30 and 09:15 findings. Follow with current behaviour and selected assessment findings; hypertension, no known dementia or previous confusion, functioning hearing aids, no reported fall/head injury, and the limited history can be compressed if used. Close with supervision, reassurance, short explanations and avoiding repeated questioning; add accompanying records, unchanged medicines, allergy status, the daughter’s ED attendance and staff presence while awaiting the ambulance as space permits.
Where candidates slip on this task
- Keep 07:30 usual functioning distinct from 09:15 sudden confusion; at 09:40 he is still awaiting the ambulance requested at 09:30, rather than already transferred.
- Preserve clear speech, facial symmetry and equal arm movement as observations only; neither these findings nor the recorded vital signs establish the cause of confusion.
- Treat collecting children from school as the content of his confused behaviour, not a verified obligation; connect the attempted departures to the documented need for close supervision.
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
- Transfer to residential aged care after a stroke: dysphagia and pressure injury transfer letter
- Transfer to a rehabilitation unit after knee replacement complicated by delirium transfer letter
- Below-knee amputation: transfer transfer letter
Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Should the letter identify a diagnosis for the new confusion?
The notes record sudden confusion, disorientation and fluctuating attention, with the cause undetermined. Describe those findings and request urgent assessment. No known dementia and the daughter’s confirmation of usual cognition yesterday can support the baseline comparison, but neither establishes a diagnosis.
Must every observation and background detail appear?
Prioritise the urgent request, usual function, the 07:30 and 09:15 findings, and the ambulance arrangements. Observations and selected background can help triage, but each is not compulsory. Use available space for details that support assessment or continuity of care, while keeping the acute change prominent.
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.