The best way to improve your OET writing score is to study examples — both strong and weak ones. This article presents five referral letter openings and excerpts based on common OET nursing scenarios, with commentary explaining what works, what does not, and how examiners apply the six grading criteria.
Each example is based on the type of case notes you will encounter in the real exam. The commentary highlights the specific elements that separate a Grade B response from a Grade C.
How OET Writing Is Graded: Quick Recap
Before reviewing the samples, remember that examiners assess six criteria: purpose (is the reason for writing clear?), content (is the right information selected?), conciseness and clarity (is the letter focused?), genre and style (does it read like a professional clinical letter?), organisation and layout (is information logically grouped?), and language (is grammar, vocabulary, and spelling accurate?).
Sample 1: Diabetic Management Referral
Scenario
A 58-year-old male patient, Mr. Kumar, was recently diagnosed with Type 2 diabetes during a routine health check. He has a BMI of 31, a family history of diabetes, and has been started on metformin 500mg twice daily. You are referring him to a community diabetic educator for ongoing management and lifestyle counselling.
Strong Opening
Dear Ms. Roberts, Re: Mr. Anil Kumar, DOB 14/03/1968 — Referral for Diabetic Education and Lifestyle Management. I am writing to refer Mr. Kumar for diabetic education and ongoing lifestyle support following his recent diagnosis of Type 2 diabetes. He was diagnosed on 22 May 2026 after a routine health screening revealed an HbA1c of 8.2%.
Commentary
This opening scores well on purpose — the reason for referral is stated in the first sentence. The reference line provides immediate patient context. The inclusion of the HbA1c value gives the reader the clinical rationale without requiring them to read further. Content selection is appropriate — the writer has chosen the most relevant detail rather than listing the entire medical history.
Sample 2: Post-Surgical Discharge Letter
Scenario
A 72-year-old female patient, Mrs. Chen, is being discharged after a right total hip replacement. She lives alone and requires community nursing visits for wound care and mobility monitoring. You are writing to the community health team.
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Weak Opening
Dear Community Health Team, I am writing this letter regarding Mrs. Chen who is a 72-year-old female patient who was admitted to our ward on 15 May 2026 and she underwent a right total hip replacement on 16 May 2026. She has a medical history of hypertension and osteoarthritis and she was also diagnosed with iron deficiency anaemia two years ago.
Commentary
This opening loses marks on several criteria. Purpose is buried — the reader does not learn why the letter is being written until potentially the second or third paragraph. Conciseness is poor — the sentence structure is long and repetitive (multiple uses of 'who' and 'she'). Content selection is questionable — the iron deficiency anaemia diagnosed two years ago may not be relevant to the current discharge and community nursing needs. A stronger version would lead with: 'I am writing to request community nursing visits for Mrs. Chen following her discharge after a right total hip replacement on 16 May 2026.'
Sample 3: Mental Health Referral
Scenario
A 34-year-old male patient, Mr. Ahmed, presented to the emergency department with panic attacks and severe anxiety. He reports difficulty sleeping, loss of appetite, and social withdrawal over the past three months. He has no history of mental health treatment. You are referring him to the community mental health team for assessment.
Strong Opening
Dear Mental Health Team, Re: Mr. Faisal Ahmed, DOB 09/11/1991 — Urgent Referral for Anxiety and Panic Disorder Assessment. I am writing to urgently refer Mr. Ahmed for a comprehensive mental health assessment following his presentation to the emergency department on 28 May 2026 with recurrent panic attacks and escalating anxiety symptoms over the past three months.
Commentary
This scores highly on genre and purpose. The word 'urgently' signals the priority level. The reference line includes the clinical reason. The opening sentence efficiently covers who, why, and the timeframe. Notice how the writer avoids listing every symptom in the first sentence — background details like sleep difficulties and appetite loss belong in the body paragraphs, not the introduction.
Sample 4: Paediatric Referral
Scenario
A 6-year-old child, Mia Thompson, has been brought to the clinic by her mother with recurrent ear infections (four episodes in the past eight months). Conservative treatment with antibiotics has provided temporary relief. You are referring the child to a paediatric ENT specialist for further assessment.
Strong Body Paragraph
Mia has experienced four episodes of acute otitis media since October 2025, each treated with a course of amoxicillin. While each course resolved the acute infection, symptoms have recurred within four to six weeks. Her mother reports that Mia has been experiencing intermittent hearing difficulties, particularly in noisy environments such as her school classroom, which has begun to affect her learning. On examination today, mild bilateral tympanic membrane erythema was noted.
Commentary
This body paragraph demonstrates strong content selection — the pattern of recurrence, the treatment history, and the functional impact on the child's daily life are all relevant to the ENT referral. The mention of hearing difficulties in the classroom gives the specialist context about urgency. The writing is clinical but clear, avoiding unnecessary detail about Mia's general health while including everything the specialist needs to prioritise the referral.
Sample 5: Elderly Patient Transfer
Scenario
An 85-year-old male patient, Mr. Singh, is being transferred from an acute medical ward to a rehabilitation facility after a stroke. He has left-sided weakness, requires assistance with mobility and feeding, and has a PEG tube for supplementary nutrition. You are writing to the receiving facility.
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Strong Closing
Mr. Singh currently requires two-person assistance for all transfers and is using a wheelchair for mobility. He is receiving supplementary nutrition via PEG tube alongside oral intake of soft diet as tolerated. His medication chart and latest blood results are enclosed with this letter. I would appreciate your ongoing management of his rehabilitation, with a focus on restoring mobility and transitioning to full oral nutrition. Please do not hesitate to contact me if you require any further information.
Commentary
This closing works well because it gives the receiving facility a clear snapshot of the patient's current functional status — what he can and cannot do right now. The specific request (rehabilitation focus areas) tells the reader what outcome is expected. The mention of enclosed documents shows organisation. The final line is a standard professional courtesy that examiners expect in the genre.
Key Takeaways from These Samples
- State the purpose in your first sentence — every time.
- Select content that is relevant to the reader and the reason for the letter. Leave out historical details that do not affect the current referral.
- Keep sentences focused. One idea per sentence. Avoid long chains connected with 'and' or 'who.'
- Close with a specific request, not a vague 'thank you for your kind attention.'
- Write as a professional, not as a student. The letter should sound like something a senior nurse would send to a colleague.
Practice writing your own letters using these patterns, then compare your work against these samples. The gap between your draft and a Grade B response will show you exactly where to focus your preparation.