The task
Assume that today's date is 22 October 2026. Ms Farahani's last session at the hospital voice clinic was on 15 October 2026.
You are a speech pathologist at a hospital voice clinic. Using the information in the case notes, write a letter to Ms Deepika Bahrami, a speech pathologist at a community voice clinic near the patient's home, referring Ms Farahani to continue her voice therapy. Address the letter to Ms Deepika Bahrami, Speech Pathologist, Community Voice Clinic, 42 Market 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: Ms Rhiannon Farahani
- DOB: 14/03/1988 (38 yrs)
- Address: 7 Kingfisher Lane
- Referred by ENT surgeon Dr Murali Sahin; attending hospital voice clinic since 03/09/26
Social background
- Primary school teacher (Year 2, class of 26), full-time; also teaches music 2 sessions/wk
- Married, 2 children (6 and 9 yrs)
- Hospital approx 1.5 hrs each way by train; no further leave available from school → missed 2 appts
- Sings alto in community choir weekly
- Enjoys gardening and yoga
- Pt says school principal 'doesn't take staff health seriously'
Medical history
- Mild asthma — salbutamol inhaler PRN (uses approx 1x/month)
- Appendicectomy 2009
- Occasional heartburn — ENT advised reflux lifestyle measures; GP managing
- Non-smoker; alcohol 2–3 standard drinks/wk; coffee approx 4 cups/day
- Allergies: nil known
ENT assessment (Dr Sahin, 28/08/26)
- 6/12 hx progressive hoarseness, worse at end of school day/week; vocal fatigue; voice 'cracks' when singing
- Videostroboscopy: small bilateral mid-membranous vocal fold nodules; no other lesion; mucosal wave mildly ↓ at nodule sites
- Plan: conservative mgt with voice therapy; surgery not indicated at present; ENT review with repeat stroboscopy in 3/12 (late Nov)
Speech pathology
- Initial assessment 03/09: GRBAS G2 R2 B1 A0 S1; VHI-10 26/40
- Sessions attended: 4 of 6 booked (2 missed due to travel/work)
- Vocal hygiene education: hydration (water bottle in class); ↓ throat clearing (replace with swallow/sip); ↓ caffeine; avoid shouting and whispering
- Therapy: semi-occluded vocal tract exercises (straw phonation) + resonant voice; home program 2x daily, 10 min — adherence approx 4 days/wk
- Classroom: now using hand signals/clapping for attention; personal voice amplifier recommended — not yet obtained
- Progress 15/10: VHI-10 18/40; GRBAS G1 R1 B1; ↓ end-of-day fatigue; still hoarse by Friday
- Pt anxious about losing voice for job; motivated
- Pt complained about cost of hospital parking
- Pt prefers late-afternoon appts (after 4 pm, after school)
Plan
- Transfer to community voice clinic: continue therapy weekly–fortnightly; progress resonant voice → carryover into connected speech and classroom voice
- Reinforce vocal hygiene; support pt to obtain voice amplifier; discuss reducing choir load until ENT review
- Red flags: stridor or acute breathing difficulty → immediate emergency assessment (call ambulance if indicated); worsening hoarseness despite therapy, throat pain, dysphagia or haemoptysis → urgent medical/ENT review
- Please send progress report to Dr Sahin before ENT review (late Nov)
- Copies of assessment and session notes enclosed
Who is reading, and what do they need?
Ms Bahrami is a speech pathologist who will continue the therapy and has not seen Ms Farahani. She needs the diagnosis, baseline and current ratings, the exercises and home program, occupational voice demands, the plan, and the report due to the ENT. Clinical, specific information is expected.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| ENT 28/08: bilateral mid-membranous nodules; conservative management; review with stroboscopy late Nov | Gives the diagnosis, the treatment path, and the date the receiver's progress report must meet. |
| Baseline 03/09: GRBAS G2 R2 B1 A0 S1; VHI-10 26/40 | The receiving therapist needs the starting measures to compare progress. |
| 15/10: VHI-10 18/40; GRBAS G1 R1 B1; less fatigue; still hoarse by Friday | Shows partial improvement and the remaining problem, and should not be described as resolved. |
| Straw phonation and resonant voice; home program 2x daily, adherence about 4 days/week | Defines the current therapy stage and adherence for the next clinician. |
| Class of 26, plus music sessions; clapping and hand signals; amplifier recommended, not obtained | The occupational voice load explains the goals and the amplifier support still needed. |
| Hospital 1.5 hrs each way, no leave, 2 of 6 sessions missed; prefers after 4 pm | This is the reason for transfer and an appointment preference that helps attendance. |
| Red flags: stridor or acute breathing difficulty; worsening hoarseness, throat pain, dysphagia, haemoptysis | The full set is needed together: emergency assessment for the airway signs, urgent review for the others. |
| Weekly–fortnightly therapy; reduce choir load; progress report to Dr Sahin; notes enclosed | Sets out the actions requested of the receiver. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Principal 'doesn't take staff health seriously' | A personal complaint about an employer; it adds nothing to the clinical request. |
| Complaint about hospital parking costs | Not clinically relevant to the referral. |
| Appendicectomy 2009, gardening, yoga, two children | No bearing on voice therapy planning. |
| Asthma with salbutamol about once a month | Trap: it looks relevant to the voice, but the notes draw no link to the voice problem, so it can be compressed or omitted. |
| Alcohol 2–3 drinks/week; heartburn details | Only reflux lifestyle measures managed by the GP are needed in brief; no further detail is required. |
A paragraph plan for this case
Begin with the referral request and reason for transfer, then give diagnosis, ENT plan and scores. Cover therapy, home program and workplace, then the requested plan, the full red-flag list, the report to Dr Sahin and enclosures.
Where candidates slip on this task
- Give both scores accurately: baseline G2 R2 B1 A0 S1 and VHI-10 26/40; latest G1 R1 B1 and 18/40. Do not say her voice has recovered, since she is still hoarse by Friday.
- Do not shorten the red flags. Airway signs need emergency assessment (ambulance if indicated), and the other four signs, hoarseness worsening despite therapy, throat pain, dysphagia and haemoptysis, need urgent review.
- Distinguish the dates: last session 15 October, today 22 October, ENT review late November, with the progress report required before that review. Do not invent a specific ENT date.
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 Speech Pathology letter tasks
- Transfer of care: developmental language disorder, family relocating referral letter
- Silent aspiration on swallow study: update on fluid and medication changes update letter
- Motor neurone disease: progressive dysarthria and dysphagia update letter
Your profession's guide: OET Speech Pathology. Layout and structure: OET letter format.
Questions about this task
How do I explain why she is being transferred?
Link it to the practical barrier in the notes: a long train journey each way, no further leave, and two missed sessions. Add that she prefers appointments after 4 pm, and leave out comments about her employer.
Why include the choir?
The plan asks the receiver to discuss reducing choir load until the ENT review, and her voice cracks when singing. It is a relevant clinical recommendation, not social detail, though other hobbies are not.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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