The task
Assume that today's date is 23 October 2026. Mrs Paredes is being discharged home this afternoon.
You are an occupational therapist on the orthopaedic ward of the local hospital. Using the information in the case notes, write a letter of referral to Ms Fang Bitar, a community occupational therapist, requesting a home assessment, the installation of rails and a review of Mrs Paredes's daily living skills. Address the letter to Ms Fang Bitar, Community Occupational Therapist, Community Occupational Therapy Service, Community Health Centre, 42 High Street. 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.
Case notes
Patient details
- Name: Mrs Lucia Paredes
- DOB: 14/03/1945 (81 yrs)
- Address: 15 Church Lane
- Admitted: 19/10/26; discharge: 23/10/26
Social background
- Widow (husband died 2019); lives alone; R-handed
- Single-storey house; 3 steps at front door, no rail; shower over bath
- Daughter lives interstate, phones daily; unable to visit until Dec
- Neighbour helps with shopping 1×/wk
- Sings in church choir; enjoys knitting
- Daughter told staff she and her brother are 'not speaking' after argument over late father's estate
Medical history
- Hypertension: amlodipine daily
- Osteoarthritis both knees; uses walking stick outdoors
- Nocturia: gets up 2–3×/night to toilet
- Bilateral cataract surgery 2016
- Appendicectomy 1972
- Allergies: penicillin (rash)
Admission
- Fall 19/10 approx 02:00: tripped on loose bath mat in dark on way to toilet; on floor ~2 hrs before able to phone neighbour
- X-ray: undisplaced R distal radius fracture; no other injuries; no head strike
- Managed non-operatively: below-elbow plaster cast for 6/52
- Analgesia: regular paracetamol; pain well controlled
- Bone density scan requested; GP to follow up
OT assessment
- Mobility (physio): independent with walking stick indoors, previously outdoors only
- Unable to do buttons, cut food or open jars one-handed (L hand only)
- Showering: unable to step over bath edge safely → no showering in bath until bath board/rails fitted; seated wash at basin agreed, carer to supervise; cast must be kept dry, cast protector supplied
- Toilet: low seat, nothing to hold; difficulty standing up using one hand → toilet frame with raised seat supplied; trialled on ward, transfers safe + independent; delivered home 23/10
- Kitchen: managing simple meals with adapted cutlery; kettle tipper trial successful
- Alert and orientated; keen to remain at home
- Previously declined personal alarm ('don't want to be a nuisance'); now agreeable
- Complained hospital food 'tasteless' and night nurse 'rude'
Plan
- Community OT referral: home visit within 1/52; assess bathroom/toilet; grab rails (shower/bath, toilet) + front step rail; consider bath board, night lighting; review toilet frame; review ADLs
- Personal alarm application started; until installed, agreed to keep mobile phone with her day and night
- Fracture clinic 30/10: check X-ray
- Cast care: seek urgent medical review if ↑ pain, numbness, swelling or colour change in fingers
- Interim home support confirmed (short-term community care): carer visits every a.m. from 24/10 for supervised wash + help with dressing; domestic help 1×/wk. Aged care assessment requested for ongoing support
- Discharge summary sent to GP; GP review in 1/52
- Neighbour checked home before discharge: loose bath mat removed; plug-in night light fitted in hallway
Who is reading, and what do they need?
Ms Bitar is a community occupational therapist who will do the home visit within a week. She understands equipment and rails, so she needs the specific home hazards, the patient's current abilities and what is already arranged, not general explanations of fracture care.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Fall 19/10 about 02:00: tripped on loose bath mat in dark going to toilet; about 2 hrs on floor | The circumstances of the fall show why the bathroom, toilet route and lighting are the focus of the visit. |
| Undisplaced R distal radius fracture; below-elbow cast 6/52; right-handed; fracture clinic 30/10 | The dominant hand being in plaster explains the functional limits and tells the OT how long the problem lasts. |
| Unable to do buttons, cut food or open jars one-handed | Gives the specific ADL difficulties the OT is asked to review. |
| No showering in bath until board/rails fitted; seated wash; cast kept dry | Explains the bathroom risk (shower over bath, cannot step over the edge safely) and the interim arrangement pending rails. |
| Toilet low, nothing to hold; frame with raised seat trialled, safe; delivered 23/10 | The OT is asked to review the toilet frame and install rails, so the trial result and delivery date matter. |
| 3 front steps, no rail; step rail requested | One of the three requested installations and a hazard for a patient who uses a stick outdoors. |
| Nocturia 2–3×/night; night light fitted; alarm application started; keeps phone with her | Night toileting links directly to the fall. Lighting and alarm arrangements show what is in place and what remains. |
| Lives alone; carer every a.m. from 24/10; domestic help 1×/wk; aged care assessment requested | Shows what support exists now, so the OT can fit the assessment around it and see the gaps. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Daughter and brother 'not speaking' over late father's estate | Family conflict with no relevance to the home assessment. Only the daughter's absence until December matters, and only briefly. |
| Complained hospital food 'tasteless' and night nurse 'rude' | Complaints about the stay do not help the community OT. |
| Sings in church choir; enjoys knitting | Leisure detail that could matter later for ADL goals, but is not needed in this referral's limited words. |
| Cataract surgery 2016; appendicectomy 1972 | Old surgical history with no bearing on the requested assessment. |
| Hypertension on amlodipine; penicillin allergy | Looks like relevant medical history, but the notes do not link either to the fall, so keep to a minimum or omit. |
| Cast care: urgent review if pain, numbness, swelling or colour change | Patient-directed advice already given. If mentioned, all four listed signs must be included, so it is safer to compress. |
A paragraph plan for this case
Open with the request for a home visit within a week and the three specific tasks, then briefly state the fracture and the fall. Use a middle paragraph for the bathroom, toilet, steps and kitchen findings and the equipment already supplied. End with night-time risks, interim supports and what the OT should review.
Where candidates slip on this task
- Do not say who removed the loose bath mat or fitted the night light. The notes say only that the neighbour checked the home and that the mat was removed and the light fitted.
- The request is threefold: home assessment, rail installation and ADL review. Make each part clear and tie rails to specific places: shower or bath, toilet and front step.
- Distinguish what is already in place (toilet frame delivered, cast protector, carer from 24/10) from what the community OT is still asked to do, such as bath board and lighting.
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 Occupational Therapy letter tasks
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- Rheumatoid arthritis flare limiting work tasks update letter
- Falls risk and carer strain in Parkinson's disease update letter
Your profession's guide: OET Occupational Therapy. Layout and structure: OET letter format.
Questions about this task
Do I mention the fall in detail?
Only enough to explain the hazards: tripped on a loose bath mat in the dark on the way to the toilet, and was on the floor for about two hours. It justifies the focus on bathroom, toilet and night lighting.
Should the personal alarm be included?
Yes. She lives alone and was on the floor for about two hours, and she previously declined an alarm but now agrees. The application is started and she will keep her phone with her until installed.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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