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OET Writing sub-test

This is a 45 minutes professional specific task that assess the candidate’s ability to

In the Occupational English Test writing sub-test, there are three types of letters which shows up in exams.

  1. Referral
  2. Transfer
  3. Discharge

Depending upon the scenario, it would be candidate’s assessment to judge the type and write the appropriate response. Although there are three types of letters that are asked all has a similar approach.

The response of the candidate is assessed on the following criteria as described by the OET Official website.

  • Purpose (Band score from 0 to 3)
  • Content (Band score from 0 to 7)
  • Conciseness & Clarity (Band score from 0 to 7)
  • Genre & Style(Band score from 0 to 7)
  • Organisation & Layout (Band score from 0 to 7)
  • Language (Band score from 0 to 7)



The fundamental part of the OET Writing subtest is to identify the reason for the letter that will decide the letter’s goal that will also be reflected through the Writing task and case notes and why the reader should be reading it.

The Writing task is located at the end of the case notes and will often include the type of letter you need to write as well as the letter’s main topic. 

If the Writing task hasn’t given you all the information you need to understand the type of letter or the main topic, you can usually find it in the final section of the case notes (just above the Writing task).

This will be the beginning of our Writing task, which requires selection of correct grammar and indicators to the kind of language to signal the purpose of letter.

This portion of letter should be crisp and clear explaining the purpose of the letter so that a reader doesn’t have to search the important information delivered in this particular part. This is the purpose of the letter that would later be expanded in upcoming paragraphs with relevant details.

Examples of some introduction are:

Example 1:

Thank you for seeing Mrs Priya Sharma, a type 2 diabetic, for further management of her blood sugar levels. 

Example 2: 

Mr Spencer has been a patient at this hospital for the past five weeks and will be discharged tomorrow. He requires your ongoing support and treatment during his rehabilitation. 

Example 3: 

Thank you for accepting Mr Dunbar into your care for the regular monitoring of his diabetes and encouragement to comply with his medication and dietary regimens. 

Some other examples of introductions: Thank you for seeing/reviewing/providing…

I am writing to (urgently) refer/transfer/discharge/update/request…
Mr X, your (my) patient,/ Your (My) patient, Mr X…

Don’t make this mistake with ‘refer’

One common mistake test-takers make is with ‘refer’. In the context of OET Writing, refer means:

  • To introduce a patient to another healthcare professional for the first time.

When writing a reply to the professional who made the referral, candidates think the expression ‘refer back’ is correct, but it isn’t. It doesn’t make sense in English.

You cannot introduce someone for a second time. You cannot ‘refer back’. In this situation, updating the reader might be the reason for writing or discharging the patient back into their care.

Some verbs that are useful and specific to the type of letter asked are

  • Transfer  
  • Discharge  
  • Update  
  • See  
  • Accept  
  • Request  
  • Provide  
  • Recommend 

The expansion of the purpose with relevant details is as important as the purpose itself.

Some examples are:

Example 1:

Further management of her blood sugar levels, ongoing support and treatment, regular monitoring of his diabetes.  

Example 2:

Her non-fasting blood sugars are 7-8mmol/L, but her fasting blood sugar levels are usually in the 16+ range, which is high. Therefore, I am referring her to you for your specialist advice. 

Example 3:

Prior to this injury, he received home help for all house cleaning tasks and was independent in all personal care and community tasks. He is keen to return home where he lives alone and maintain his independence. 

Example 4:

He was diagnosed with atrial fibrillation on the same admission and was subsequently prescribed warfarin and sotalol. His hypertension is controlled by Ramipril. As with his other medication, Mr Dunbar is intermittent in his compliance. 


To accurately deliver the information is crucial to continue caring for the patient which will be represented by the transformation/ summarisation or paraphrasing of relevant case notes into complete and meaningful sentences keeping the meaning same.

The content of the letter would describe the relationship between the patient and the reader and what aspect of patient’s care would be involved with the reader.

Example 1:

  • A hospital Occupational Therapist writes a letter discharging patient Jack Spencer to the Occupational Therapist at the Care Centre where he will receive rehabilitation.

In this situation, the reader and the patient do not have an existing professional relationship so the letter will need to include information about the patient’s current abilities and inabilities for the reader to get a clear understanding. Although the case notes provide details of the patient’s children, grandchildren, job (before he retired) and financial status, these details will not be needed for the reader because they will not impact the care they provide.


Example 2:

  • The hospital Occupational Therapist was writing a letter to the patient’s regular GP to update them on their progress.

In this example, the information provided would change. While the patient’s social history is still not necessary, the details provided about the patient’s current abilities and inabilities would also be altered. The letter would need to provide an update about how these have changed since the GP last saw the patient rather than presented as new information.


The specific and relevant content ensures that reader has a clear understanding of the situation.

Conciseness and Clarity

This mates with the content part of the OET Writing sub test as many of the skills and strategies applied or needed to achieve high scores are similar.

The case notes have extensive information about the patient that is not required all time to be described. This assesses the candidate’s ability to identify irrelevant information that should be left out. The skipped notes could be repeated information or information not relevant to the desired care of the patient to the reader.

Some common mistakes made by the test-takers are:

  • Including irrelevant beyond scope of care or already known information to the reader.
  • Providing too much background or historical detail to the current situation.
  • Not grouping similar information together.

Example 1:

Information not needed for care

Mrs Asma’s case notes cover 6 visits to her GP over a two-month period. The first visit mentions this detail:


Discussion: Concerned that her glucose levels are not well enough controlled – checks levels often (worried?) Attends health centre – feels not taking her concerns seriously

The Writing task is to write a letter referring the patient to the endocrinologist. We can break this case note into what is and what is not relevant to the endocrinologist.

  • Relevant: Mrs Asma is concerned that her glucose levels were not well controlled causing her to present on the 13 May.
  • Not relevant: Mrs Asma felt the health centre was not taking her concerns seriously.

Mrs Asma’s feelings on the health centre are outside of the endocrinologist’s role. It does not have any impact on the assessment or treatment they will provide her.

A good summary of this case note would be:

  • She initially presented on 13/05/21 concerned that her blood sugar levels were no longer well controlled.

Example 2:

Too much historical detail

Avoiding unnecessary or repeated information is also an important part of this criterion. In many sets of case notes, multiple visits to or by the patient will be reported.

Some of the information in the earlier visits will have been superseded by how the patient’s condition progressed. Summarising the information to only include the details which remain relevant is therefore important.

Mr Akram’s case notes cover his medical presentation:

Admitted to hospital with R fractured humerus & olecranon process following fall at home. Surgery completed on olecranon process, screw inserted 3 wks ago.

This task is to discharge the patient into the care of an Occupational Therapist (OT). Once again we can break the information into what is and what is not relevant:

  • Relevant: Mr Akram’s injuries were a right fractured humerus & olecranon process
  • Not relevant: The type of surgery.

The OT needs to know what injuries the patient sustained because it will help them correctly care for Mr Akram. However, details of the surgery are not relevant as they will not impact the type of care provided post-discharge.

An example of a clear summary is:

  • Mr Akram had a fall at his home and sustained a fracture to the right humerus and olecranon process. Surgery was completed three weeks ago.


Example 3:

Grouping similar information in your letter

The last element of this criterion is to group similar information together for the reader.

Grouping information will help your summary be quick and easy to read, ensuring your reader doesn’t have to re-read the letter to understand it.

For example, patient Mr Charlie’s case notes record he is non-compliant with his diet and medication and that this is discussed with him on 3 separate visits including:

March 2020

non-compliant with diet. Non-compliant with medication. Blames poor memory

October 2020

Resumed medications but still only taking intermittently. Again provided education re importance of

 adherence to drug regimen

The task is to transfer the patient into the care of the Community Nurse in the area where he will be moving to. The Community Nurse is requested to provide ongoing monitoring.

  • Relevant: Mr Charlie’s medication and diet compliance need monitoring
  • Not relevant: The frequency or specific dates when the patient has been recorded as non-compliant

A good summary of these case notes would be:

  • He has not been compliant with his diet or medication regimen, reporting poor memory as the primary cause of his neglect.


Genre & Style

The OET Writing sub-test/ letter should be formal. This assesses candidate’s capability to use proper grammar and punctuation that will display if the letter is in a formal manner and professional tone.

Test takers are expected to use formal language when writing from professional to professional or even from professional to patient.

  • Avoid using note form and be sure to expand the relevant notes into complete sentences.



  • Thanks for having a look at Jia
  • I’ve sent her to you because she needs to lose some weight.

These phrases use the patient’s first name and are not respectful toward her condition.


  • Thank you for seeing Ms Jia Houssain
  • I am referring her to you for your specialist advice.
  • Avoid making judgements, instead use facts.


  • She writes with her left hand and drove a manual car before the fall.
  • He works on his I-mac every day and carries a heavy laptop home.

When describing a patient’s lifestyle choices, use facts instead of words which sound judgemental.:


  • Mrs X is a heavy smoker
  • Mr Y is a binge drinker OR Mr Y is an alcoholic
  • Mrs Z does not exercise enough


  • Mrs X smokes 30 cigarettes a day
  • Mr Y avoids drinking in the week but drinks 17 units of alcohol on an average weekend
  • Mrs Z admits she is only physically active once every 4-months.

Use formal tone from the very beginning of the letter which will leave the right impression at the end, while remaining formal at the end too.

For example:

  • If you require further information, please do not hesitate to contact me.
  • Thank you for your continued management of this patient.

This shows your appreciation for their involvement.



  • Sincerely
  • Thank you
  • Regards


  • Yours sincerely (If we start the letter with ‘Dear Dr Jeff’ or ‘Dear Ms Natalia)
  • Yours faithfully (If you do not know the name of the person, we are writing to but instead have their job title. For example, if we start the letter ‘Dear Dentist’ or ‘Dear Nursing Manager’, then we end the letter with ‘Yours faithfully’)

Kindly note: It is preferred to use reader’s job title for healthcare letters rather more generic Sir/Madam.

Avoid contractions, as they are being considered as informal.



  • They’re keen to return home.
  • She’s looking forward to holding her baby.
  • I didn’t follow the care plan correctly.


  • They are keen to return home.
  • She is looking forward to holding her baby.
  • I did not follow the care plan correctly.

Use of Abbreviations should only be accounted at relevant reader.

For Example:

Reader: Endocrinologist

  • Mrs Sharma was diagnosed with NIDDM in 1999.

As you are writing to an endocrinologist, this abbreviation would be very familiar and the condition is central to the patient’s reason for seeing them, so it’s appropriate to abbreviate. For an orthopaedic surgeon perhaps, the abbreviation is less appropriate. Any mention of the condition, because it may have some impact on the treatment the patient receives, should therefore be in full form.

Reader: Community Nurse

  • He was diagnosed with atrial fibrillation

There is more than one abbreviation used globally for Atrial Fibrillation: AF or AFib. As a result, it’s best to use the full form of this condition rather than abbreviating it.

If you think your reader might not know what the abbreviation is, it’s best to not abbreviate, otherwise, it will interrupt their reading.


Organisation & Layout

Any writing that is organized and properly laid out would always have a positive impact to the reader as In OET Writing task too.

Another important point to consider is that since every writing task is different so every letter will be organized differently.

It helps assessors decide whether your structure makes it easier or harder for the reader to understand.


After selection of all information from case notes to include and not include, decide in what order you will expand and present the information. This organization can be thematic or chronologically arranged.


The clearest way to organise the letter is around time. You start at the beginning and continue up to the present day. In this the writer uses dates at the start of each paragraph to separate the details. By doing this, the information is formed into a timeline that is clear to the reader and easy to follow.


In this method most important information is putted first.

Please note: You can add as many paragraphs as you consider necessary to clearly communicate the information to the reader. The structuring of the paragraphs should be in the clearest order for the reader so that the important details don’t get hidden within the paragraph.

Same goes with the sentences. The sentence containing the most important information for that paragraph comes first, the next most important sentence comes in second and so on.


This is the application of Grammar, Vocabulary, Punctuation and Spelling to OET Writing task.


Use appropriate connectors

  • Simple connectors (called conjunctions): and, but, or.
  • Complex connectors: however, therefore, although, unless, subsequently.

Some connectors are not suitable for letter writing. These include:

  • Academic connectors: furthermore, moreover
  • Informal connectors: besides, meanwhile, so.

Avoid when a sentence still makes sense without connector:

For Example:

  • Furthermore, Mrs Jones will need to attend a follow-up appointment in 3 days’ time.

Instead, you could simply write:

  • Mrs Jones will need to attend a follow-up appointment in 3 days’ time.

When to use the passive voice?

The passive cannot be used with all verbs.


In healthcare, verbs relating to natural processes such as healing cannot be used as part in passive form:

Wrong – His wound was healed by regular dressing changes.

Correct – His wound has healed OR His wound is healing well as a result of regular dressing changes.


Other healthcare verbs which cannot be used in passive form include: improve, deteriorate and rise.

Can you correct the sentence below using the passive form incorrectly to a correct sentence?

Wrong – Her condition was deteriorated on admission

what’s an example of a relative clause?

Take a look at the two examples of a relative clause below:

Example one

Mrs Singh, who was admitted yesterday via ambulance, will be discharged home today.

Example two

The wound on Miss Delarue’s leg, that has been treated with sulfasalazine dressings, is healing well.

These two examples are called ‘non-defining relative clauses’ because they add some interesting but non-essential information to the rest of the sentence. To show the information is non-essential, commas are at either end of the clause.

To know if you have put the commas and the information into the sentence correctly, you should be able to read the rest of the sentence with the commas and information removed and it will still make sense. In our examples, it would leave these as the remaining sentences:

Example one

Mrs Singh will be discharged home today.

Example two

The wound on Miss Delarue’s leg is healing well.

There’s another type of relative clause to learn about

There is also a defining relative clause. This type of clause adds essential extra information to a sentence. For this reason, there are no commas to separate the extra information from the rest of the sentence.

Some examples include:

Example one

The Occupational Therapist who visited Mr Mahmoud’s home will provide you with their report.

Example two

The medication which the patient’s GP had previously prescribed has been changed following surgery.

In both of these examples, the defining clause is underlined and is providing more information about the noun in front of it. The information helps the reader understand this noun more clearly.

In the first example, the defining clause clarifies which OT the writer means. In the second example, the defining clause clarifies which of the patient’s medication is being described.

Relative pronouns

In all these examples you will notice certain important words called relative pronouns: who, which and that.

  • Who can describe people (Mrs Singh, the OT)
  • Whichcan describe things (the wound, the medication)
  • Thatcan describe both things and people.

So when should you use relative pronouns?

The most effective use of relative clauses are to combine 2 pieces of information into 1 sentence.

The first example I showed you came from 2 sentences:

First sentence

Mrs Singh was admitted via ambulance yesterday

Second sentence

Mrs Singh will be discharged home today.

By using a relative clause, you can avoid the repetition of Mrs Singh and provide the information more clearly to the reader. Look out for information in case notes which would be repetitive if you wrote it in 2 sentences and combine into 1 with a relative clause.

Finally, a good understanding of relative clauses will make you a better reader as you will be able to pick out when the writer is adding non-essential information to the sentence, separated by commas and when the details need to be read together.


 it shapes how to communicate with the audience of your Writing and Speaking sub-test.

Demonstrating a range of appropriate vocabulary in your writing and speaking will make you stand out from other candidates and impress your assessors. 

Should medication names have a capital letter?

  1. Generic drug names do not need a capital letter
  • aspirin
  • metformin
  • metoprolol
  • diazepam
  • fluconazole
  1. Brand names for drugs do need a capital letter
  • Panadol
  • Zyrtec
  • Tylenol
  • Claritin
  • Eurax


Punctuation adds clarity to OET writing. It can help you better communicate your message to the reader.

Some examples of candidates concerns regarding vocabulary about when and how to use it properly.

Simple and clear

For example: “he takes metformin, lisinopril and atorvastatin”.

Complex and not clear

For example: “he takes metformin, 1000mg with his evening meal, lisinopril, 10 mg and atorvastatin, 20 mg both once a day”.

Complex and clear

He takes metformin, 1000mg with his evening meal; lisinopril, 10 mg and atorvastatin, 20mg both once a day.


Spelling is important in Writing but you won’t need to be perfect to achieve a B. However, some misspelled works will stand out more than others.

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