Dr Jeremy Barnett

Emergency Registrar
Maroubra Hospital
Lakes Rd,(Maroubra = put this on a separate line)
1/06/2011
Dear Dr Barnett,
RE: John Elvin, aged 48
I am writing to urgently refer the above mentioned patient who is presenting signs and
symptoms of an acute myocardial infarction and mild pulmonary oedema.
Mr Elvin has been complaining of occasional mild chest pain which was related to stress due
to his profession (business owner). The patient was diagnosed with mild asthma and he is
under treatment with Seretide and Salbutamol. ( = new paragraph) On 12/05/2011, the patient
was diagnosed with pharyngitis and presented a mild bilateral wheeze. A stress test was
conductead and revealed some slight ischaemic changes and Mr Elvin was started on Lipitor,
nitrates, aspirin and anginine. ( = new paragraph) On 26/05/2011, the patient was
complaining of chest pain for the last week and had a low compliance with his asthma
medication. Examination revealed a mild bilateral wheeze still present.
Today, 1/06/2011, Mr Elvin complained of a crushing chest pain that was not relieved by
anginine and had a very audible wheeze. The ECG showed a mild ST elevation (ST 120) in
anterior leads with a slight S3 sound. ( = A) Moderate wheeze and bilateral crackles with a
SP O2 86% on R/A were also noticed. He was prescribed O2 15 L, GTN patch, 5 mg of
morphine IV, Ipratropium Bromide 500 ug via nebuliser and Frusemide 40 mg.
Please note that Mr Elvin smokes one pack ( = of cigarettes) per day and drinks 10 standard
drinks 5/7.
In the view of the above, your further management in the definitive diagnosis will be
appreciated.
If there should be any queries, ( = please) do not hesitate to contact me.
Yours Sincerely,
Doctor

NB. The body of your letter has word count of 249 which is a little too high, try and be more
concise. 10% more or less than the limits given is something to aim for.
This is quite an effective response to the task, communicating fairly clearly and appropriately
with the reader. The information has been selected quite successfully and the organisation
and language are reasonably well-controlled. However, there are several errors to address
(see text).
As with all writing when you introduce a new subject or introduce new information, start a
new paragraph. It makes reading and comprehension easier, especially with the blank lines
between each paragraph.
Assessment 4
Dr Peter Carr
Respiratory Physician
Bayview Private Clinic
89 Canyon Road
Bayview

13/07/2018

Dear Dr Carr,

RE: Mrs Doreen Watson, DOB: 1/04/1962

I am writing to refer the above(^-)mentioned patient for pulmonary rehabilitation.

Mrs Watson was admitted (in-->to) our hospital severely injured with a hairline fracture of
the femur, a massive blood loss from a deep cut on her right tight and renal tubular acidosis.
Please note that she (is--> has been) diagnosed with COPD since 2015 that is managed with
Fluticasone and Budesonide inhalers.

On 2/07/2018, Mrs Watson was transferred from the ICU to our ward and had one pint of
blood transferred due to her low haemoglobin value (6.8 mg/dL).

On 7/07/2018, the patient complained of a headache, fever and had a productive cough with
greenish sputum accompanied by chest pain, nausea and vomiting. (^Her) Examination
revealed that she was tachycardic with a pulse value of 90, tachypneic, (a --> had an) O2
saturation of 94 and (^was) hypotensive with a BP value of 100/60. She was given pain
killers, supportive O2 therapy and blood, sputum cultures and a chest X-ray were ordered.

(^ The lab results revealed that) Mrs Watson (was--> is) suspected of (^having) pneumonia
and Vancomycin IV was started. She (^has) responded well to the treatment with no fever
reported (, --> and she was/is) eating and drinking well. The patient (was--> has been)
recommended an oral iron supplement and regular pulmonary rehabilitation sessions for
COPD.

In (the-/) view of the above, your further management of (the patient--> Mr...) would be
appreciated.

If there should be any queries, please do not hesitate to contact me.

Yours sincerely,

Doctor

--------------------------------------------------
A fairly good letter overall, organisation is fine and you've done well to connect sentences
together to make paragraphs cohesive.
However a couple of points:
-RTA refers to Road Traffic Accident. This is why she was so badly injured.
- Mention of a GP review in a week would need to be mentioned
- Present perfect would be more appropriate for the final paragraph
Assessment: 4-

Dr M McLaren,
Neurologist
Suite 3, 67 The Crescent
Newtown
9/08/2014
Dear Dr McLaren,
Re: Mr Michael Weir, DOB: 20/09/1970
I am writing to refer the above mentioned patient, who has been exhibiting signs and
symptoms of multiple sclerosis, for further assessment and management.
The patient has been under treatment with sertraline hydrochloride for depression since 2012.
On 7/07/2014, Mr Weir reported ( = a) weakness in his left leg. His examination revealed ( =
his) BP was 90/80, BMI was 28.5 and lifestyle changes were recommended.
Today, 9/08/2014, Mr Weir reported two recent episodes of loss of consciousness, dizziness,
tingling in his hands and (persisting = persistent) weakness in his left leg. On examination the
patient was hypotensive with ( = a) BP value of 88/70, BMI was 28 and he is having ( = a)
loss of sensation on both hands with a diminished left pattelar reflex. A head and lumber
spinal CT (was = were) ordered.
Please note that Mr Weir is a smoker, has a stressful job, reporting no time for exercise or
relaxation(,) and is married with three children.
In view of the above, your further management regarding his definitive diagnosis would be
greatly appreciated.
If there should be any queries, please do not hesitate to contact me.
Yours faithfully,
Doctor

This is quite an effective response to the task, communicating fairly clearly and appropriately
with the reader. The information has been selected quite successfully and the organisation
and language are reasonably well-controlled. However, there are several errors to address
(see text). Assessment 4
Dr Tanya Williams
Respiratory Specialist
Bayview Private Hospital
81 Canyon Road
Bayview
18/10/2014
Dear Dr Williams,
Re: Mr Zach Foster, DOB: 25/10/1991
I am writing to refer the above-mentioned patient for lung function and asthma management.
Mr Foster has been diagnosed with asthma since the age of 3 and ( = has) had two hospital
admissions; the most recent one was 3 years ago. He is currently under treatment with
Ventolin and Pulmicort 200mcg.
For the last three weeks, the patient has been complaining of shortness of breath, when
playing sport, wheezing and coughing.
On 11/10/2014, Mr Foster presented with a burning sensation in (his = the) lower part of his
chest which appeared after eating and an unclear compliance (to = with) Pulmicort. His
examination revealed a clear chest, peak flow 500 L/min and CXR and FBE were ordered.
He was prescribed Pantoprazole and ensured the compliance (to = with) Pulmicort.
On 18/10/2014, the patient was still non-compliant (to = with) Pulmicort, the Pantoprazole
was effective and CXR and FBE were normal. Mr Foster has been prescribed another 7
weeks of Pantoprazole and was advised to take the Pulmicort. He was scheduled for a review
in 7 weeks.
Please note that Mr Foster is a smoker (4 years, 10-20 cigarettes/day), is allergic to cats and
has hayfever. Also, his 18-year-old sister (is = has been) diagnosed with asthma.
In the view of the above, your further management of the patient Mr Foster would be
appreciated.
If there should be any queries, please do not hesitate to contact me.
Yours sincerely,
Doctor

This is quite an effective response to the task, communicating fairly clearly and appropriately
with the reader. The information has been selected quite successfully and the organisation
and language are reasonably well-controlled. However, there are several errors to address
(see text). Assessment 4

following on with the present perfect - he has had asthma since he was 3 and in the period up
to the present, he has been in hospital twice
Dr Tanya Williams
Respiratory Specialist
Bayview Private Hospital
81 Canyon Road
Bayview
18/10/2014
Dear Dr Williams,
Re: Mr Zach Foster, DOB: 25/10/1991
I am writing to refer the above-mentioned patient for lung function and asthma management.
Mr Foster has been diagnosed with asthma since the age of 3 and ( = has) had two hospital
admissions; the most recent one was 3 years ago. He is currently under treatment with
Ventolin and Pulmicort 200mcg.
For the last three weeks, the patient has been complaining of shortness of breath, when
playing sport, wheezing and coughing.
On 11/10/2014, Mr Foster presented with a burning sensation in (his = the) lower part of his
chest which appeared after eating and an unclear compliance (to = with) Pulmicort. His
examination revealed a clear chest, peak flow 500 L/min and CXR and FBE were ordered.
He was prescribed Pantoprazole and ensured the compliance (to = with) Pulmicort.
On 18/10/2014, the patient was still non-compliant (to = with) Pulmicort, the Pantoprazole
was effective and CXR and FBE were normal. Mr Foster has been prescribed another 7
weeks of Pantoprazole and was advised to take the Pulmicort. He was scheduled for a review
in 7 weeks.
Please note that Mr Foster is a smoker (4 years, 10-20 cigarettes/day), is allergic to cats and
has hayfever. Also, his 18-year-old sister (is = has been) diagnosed with asthma.
In the view of the above, your further management of the patient Mr Foster would be
appreciated.
If there should be any queries, please do not hesitate to contact me.
Yours sincerely,
Doctor
Mr Kenneth Smith
Surgeon
Newtown General Hospital
Banbury
8/12/2018
Dear Mr Smith,
Re: Mr Aaron Shaw, DOB: 2/06/(2976 = 1976)
I am writing to urgently refer the above-mentioned patient who is presenting with signs and
symptoms of Fournier’s gangrene.
Mr Shaw (has been complaining for the last = presented complaining of) four days of
progressive pain and swelling in his groin and a low grade fever. His examination revealed a
temperature of 38.2 oC , a BP value of 150/100 mmHg, a heart rate value of 110 BPM,
HbA1c 12.8% and elevated WCC. Also, ( = a / his) genital examination revealed a diffuse
erythema and oedema of his scrotum and perineal area and a large part of his scrotum is
presenting with multiple areas of haemorrhagic necrosis, (spearing = sparing) the penis.
The patient has been diagnosed with Fournier’s gangrene, uncontrolled DM-2 and
hypertension and has been prescribed fluids, ciprofloxacin 400 mg IV, clindamycin 300 mg
IV, ampicillin 1g IV.
Mr Shaw (is = been) diagnosed with DM-2 since 2012 and hypertension since 2010. He has a
2-week history of increased thirst, excessive urination and has lost over 20kg in the past 10
months. The patient does not smoke or drink alcohol and is currently ( = being) treated with
Atenolol 50 mg, Metformin 250 mg, 70/30 insulin 4 units BD and Lipitor 20 mg.
In the view of the above, your further management of the patient (Mr Shaw = delete) would
be appreciated ( = possible debridement?).
If there should be any queries, please do not hesitate to contact me.
Yours sincerely,
Doctor
Dr Michael Brown
Hepatologist
Newbridge Hospital
56 Clayton Road
(Bassenthall = Bassethall)
19/08/2018
Dear Dr Brown,
Re: Mr Leo Berry, DOB: 6/07/1974
I am writing to refer the above-mentioned patient(,) who is presenting signs and symptoms of
cirrhosis of the liver(,) for further assessment and treatment.
Mr Berry has worked as a phlebotomist in the Middle East and was diagnosed and treated for
Hepatitis C in 2015(,) and he was fully cured. Please note that the patient (is having = has) 15
drinks/week and smokes 15-20 cigarettes/day.
The patient presented to the GP practice on 12/08/2018 with a 2-month history of generalised
weakness and tiredness, a gradual loss in appetite and being easily bruised on exposed parts
of the skin. His abdominal examination revealed mild tenderness and ascites(,) but no
hepatomegaly or splenomegaly were present. Liver function tests and an ultrasound scan of
the abdomen were ordered and the patient was scheduled for review in 1 week.
On 19/08/2019, Mr Berry had no improvement in his condition and his tests results revealed
LFTs increased bilirubin, AST/ALT/ALP, PT/INR(,) and decreased WCC and PLT. Also, his
ultrasound showed mild ascites, enlargement of the liver and the spleen with the presence of a
right posterior hepatic notch.
In the view of the above, your further management and assessment of the patient would be
appreciated for possible liver biopsy and MRI scan.
If there should be any queries, please do not hesitate to contact me.
Yours sincerely,
Doctor

This is quite an effective response to the task, communicating fairly clearly and appropriately
with the reader. The information has been selected quite successfully and the organisation
and language are reasonably well-controlled. However, there are several errors to address
(see text). Assessment 4

Also= In addition, additionally

Had brusing= multiple bruises

Diseases do not need articles: asthma,diabetes

Singular events need an article

https://www.occupationalenglishtest.org/writing-prep-purpose/

https://www.occupationalenglishtest.org/use-connectors-to-add-clarity-to-your-writing/
https://www.bristol.ac.uk/arts/exercises/grammar/grammar_tutorial/page_41.htm

(,) before= which, what ,where, but, connector

Dr (McClauley-Browne = McCauley-Browne)
Gyn(a)ecologist
Women’s Health Clinic
11 Scarborough St
Westport
NSW
2344
13/06/2018
Dear Dr (McClauley, = McCauley-Browne
Re: Ms (Jermina = Jemima) Langley, DOB: 16/11/1958
I am writing to refer the above-mentioned patient, who is presenting signs and symptoms of (
= a) second degree uterine prolapse, for further management.
Ms Langley, mother of 3 children, was first diagnosed with ( = a) uterine prolapse, (past =
post) onset of menopause, in 2017. She was treated with ( = a) vaginal pessary, Climara 25
mcg and referred to a physiotherapist for ( = instruction on) pelvic floor exercises.
In June 2018, the patient presented with urinary incontinence and ( = a) worsening of the
uterine prolapse. She admitted that she (is = was) not following the pelvic floor exercises and
not tolerating the vaginal pessary.
On 13/06/2018, her examination revealed that the cervix can be visualised in the vaginal
opening and she was diagnosed with ( = a) second degree uterine prolapse and stress
incontinence. Also, the patient currently weights 85 kg with a 10 kg weight gain in the past 6
months. She was prescribed Climara 25 mcg transdermal patch(es) and daily multivitamins.
In the view of the above, I am referring Ms Langley for ( = a) laparoscopic or vaginal
hysterectomy, ( = re-education about) daily pelvic floor exercises and weight loss
management.
If there should be any queries, please do not hesitate to contact me.
Yours sincerely,
Doctor

This is a reasonable response to the task. The purpose of the letter has been fairly well
communicated in an appropriate way. On the whole, there is a reasonable attempt to organise,
select and write the information; however, there are a number of errors that need to be
addressed (see text). Assessment 3+
Dr Leigh Waters
Surgeon
Stillwater Hospital
54 Main Street
Stillwater
24/08/2018
Dear Dr Waters,
Re: Mrs Carol Potter, DOB: 30.12.1947
I am writing to refer the above-mentioned patient(,) whose symptoms are suggestive of
worsening osteoarthritis, for your further assessment and management.
Mrs Potter has been diagnosed with osteoarthritis since 2008 and hypertension in 2015,
which is well controlled.
On 23/02/2018, she presented with an increasing pain in her left knee for the last 12 months
which can occur at rest after a long walk. Additionally, the pain is not relieved anymore with
her regular medication- Panadol Osteo 2 tablets t.d.s. and Temazepam 10 mg nocte.
Her examination revealed a decreased ROM of the left knee due to the pain, but no injury,
redness or swelling was observed. Mr Potter was prescribed naproxen 250 mg t.d.s. (and –
remove) blood tests and (an) X-ray were ordered.
On today’s examination, the X-ray showed signs of severe osteoarthritis characterized by the
presence of osteophytes and loss of joint space. Her blood tests were normal. As a result of
this, physiotherapy was arranged and doses of analgesics were increased.
In the view of the above, your further management of the patient would be appreciated.
(Should there) be any queries, please do not hesitate to contact me.
Yours sincerely,
Doctor
Associate Professor Simon Anderson
Surgeon
Suite 65
City Hospital
25-29 Main Road
Centreville
22/02/2014
Dear Prof. Anderson,
Re: Mr Daniel McCrae, DOB: 17/10/1962
I am writing to urgently refer the above-mentioned patient, who has been diagnosed with
adenocarcinoma of the ascending colon, for your further assessment and management.
On 19/09/2013, Mr McCrae presented with signs and symptoms of a viral infection, which
was treated with Paracetamol and 1-3 days of rest.
On 8/02/2014, the patient presented as if he never fully recovered from the infection, ( = and
was) tired and pale. He (has been complaining = complained) of abdominal discomfort, gas
and diarrhoea or constipation for the (last = previous) several weeks. His examination was
normal and a CBC, faecal occult blood test and colonoscopy were ordered.
Mr (McCrane = McCrae) returned to our practice on 22/02/2014 ( = today?), mentioning that
he (is =was) still feeling unwell. His examination and CBC were normal, but he had a
decreased level of the Hb (91) and an increased value of the Hct (34%). The patient’s faecal
blood test came out positive and a malignancy was detected in the colonoscopy. The biopsy
confirmed that Mr (McCrane = McCrae) has adenocarcinoma of the ascending colon.
Please note that Mr (McCrane = McCrae) has a very stressful job as a barrister, smokes and
has a BMI value of 28.4.
In view of the above, your further assessment and management of the patient would be
appreciated.
Should there be any queries, please do not hesitate to contact me.
Yours sincerely,
Doctor

This is quite an effective response to the task, communicating fairly clearly and appropriately
with the reader. The information has been selected quite successfully and the organisation
and language are reasonably well-controlled. However, there are several errors to address
(see text). Assessment 4
General Practitioner
6/10/2019
Dear Doctor,
Re: San Vaman, DOB: 12/01/2016
I am writing to refer the above-mentioned patient, who has been diagnosed and treated for
(several = severe) bacterial pneumonia, for your further assessment and management.
The patient was brought, by his mother, in(to) our paediatric ward, on 1/10/2019 having
difficulty in breathing, coughing and with a fever of 2 out of 7. His examination showed that
he had dyspnoea, shaking chills, (a = delete) nasal congestion and ( = a) temperature value of
37.4oC. Additionally, the respiratory rate was 75 breaths/minute and had a PR of 176/min(,)
with the presence of hypoxemia (82% without O2).
The auscultation revealed that (Son = San) (was having = had) crepitation in both lungs (right
upper zone and left lower zone) and rhonchi in the left upper and middle lung fields. The
test(s) ordered showed that he had a white cell count of 20.0*10 9/L, the CRP value was 150
and on the chest X-ray (there were observed homogeneous patchy areas = homogeneous
patchy areas were observed) with the consolidation of several lobes. The blood culture came
back positive for Streptococcus pneumonia.
(Son = San) was started on treatment with oxygen inhalation (2L/min), injectable Ceftriaxone
(1gm IM once daily for 5 days), Levosalbutamol syrup and Paracetamol syrup.
Today, (6/10/2019 = not necessary, date is written above), San has no fever, hypoxemia or
tachycardia and he is ready for discharge.
In view of the above, I would appreciate if you could advise the mother to observe the child
for dyspnoea and hypoxemia and review the patient in one week.
Should there be any queries, please do not hesitate to contact me.
Yours faithfully,
Doctor
 General Practitioner
6/10/2019
Dear Doctor,
Re: San Vaman, DOB: 12/01/2016
I am writing to refer the above-mentioned patient, who has been diagnosed and treated for
(several = severe) bacterial pneumonia, for your further assessment and management.
The patient was brought, by his mother, in(to) our paediatric ward, on 1/10/2019 having
difficulty in breathing, coughing and with a fever of 2 out of 7. His examination showed that
he had dyspnoea, shaking chills, (a = delete) nasal congestion and ( = a) temperature value of
37.4oC. Additionally, the respiratory rate was 75 breaths/minute and had a PR of 176/min(,)
with the presence of hypoxemia (82% without O2).
The auscultation revealed that (Son = San) (was having = had) crepitation in both lungs (right
upper zone and left lower zone) and rhonchi in the left upper and middle lung fields. The
test(s) ordered showed that he had a white cell count of 20.0*10 9/L, the CRP value was 150
and on the chest X-ray (there were observed homogeneous patchy areas = homogeneous
patchy areas were observed) with the consolidation of several lobes. The blood culture came
back positive for Streptococcus pneumonia.
(Son = San) was started on treatment with oxygen inhalation (2L/min), injectable Ceftriaxone
(1gm IM once daily for 5 days), Levosalbutamol syrup and Paracetamol syrup.
Today, (6/10/2019 = not necessary, date is written above), San has no fever, hypoxemia or
tachycardia and he is ready for discharge.
In view of the above, I would appreciate if you could advise the mother to observe the child
for dyspnoea and hypoxemia and review the patient in one week.
Should there be any queries, please do not hesitate to contact me.
Yours faithfully,
Doctor