OET Writing format: referral letter structure

OET Writing is the sub-test where strong native-context candidates often outperform native English speakers. The reason is the format: you're writing a clinical document in a structure you do at work, not an essay about an abstract topic.

This guide is the paragraph-by-paragraph template that consistently scores Band B+ across all 12 professions, plus the criteria you're being graded on.

The task

You get:

• 3 minutes of reading time (use it well — the case notes are dense)
• 40 minutes of writing time
• One letter to write, 180–200 words, addressed to a named recipient
• Profession-specific case notes — a nurse gets a nursing scenario, a vet gets a veterinary one

Most common letter types:

• Referral letter (most common): one clinician asking another to take over the case
• Discharge letter: handing the patient back to their GP/community team
• Transfer letter: between facilities (hospital → care home, etc.)
• Specialist consult request: requesting an opinion

The four scoring criteria

| Criterion | What it measures | |---|---| | Purpose | Is the reason for writing clear from the opening? | | Content | Is the clinically necessary information included, with irrelevant detail excluded? | | Conciseness and clarity | Is the structure logical and the prose efficient? | | Genre and style | Is the tone, register, and formatting appropriate for a clinical letter? |

Each scored independently, 0–7. Aggregate determines the 0–500 band.

The structure that scores Band B

A high-scoring letter has five paragraphs, in this exact order:

Paragraph 1 — opening + purpose

State who you are, who the patient is, and why you're writing, all in 1–2 sentences.

Dear Dr Smith,

I am writing to refer Ms Maria Patel, a 67-year-old retired teacher, for further assessment and management of her ongoing dizziness, which has worsened over the past two weeks and is now affecting her ability to live independently.

Why it scores: purpose is clear immediately, audience is named, patient is named.

Paragraph 2 — relevant history

What the recipient needs to know about the patient's background — only what's directly relevant to this referral.

Ms Patel has a history of well-controlled hypertension on amlodipine 5mg daily and type 2 diabetes managed with metformin. She lives alone and has been independent in activities of daily living until this episode.

Common mistake: dumping the entire medical history. The case notes give you 6 conditions — include only the ones relevant to the current presentation.

Paragraph 3 — current presentation

The details of why this referral, now.

She first noticed dizziness three weeks ago when standing from a seated position. It has progressively worsened, and she has now had two falls — most recently last Thursday, resulting in a bruised hip. There is no associated loss of consciousness or chest pain.

Why it scores: chronology is clear, the relevant negatives are stated (no LOC, no chest pain), and the impact is specified (falls + hip injury).

Paragraph 4 — what's been done + handover ask

What you've already managed, what your assessment is, and what you specifically want the recipient to do.

On examination, her postural blood pressure showed a significant drop. I have stopped her amlodipine and started fluid replacement, and her dizziness has marginally improved. I would appreciate your urgent assessment for further investigation into possible autonomic dysfunction and to optimise her cardiovascular medications.

Common mistake: vague handover ("please review") instead of specific ("please assess for X and adjust Y").

Paragraph 5 — closing

Brief and professional. Always include a willingness to provide further information.

Please do not hesitate to contact me if you require further information.

Yours sincerely,

Sarah Chen, Community Nurse

What to leave OUT

OET case notes deliberately include irrelevant information to test your filtering. Examples:

• A 20-year-old grommets surgery isn't relevant to current dizziness
• Family history (unless directly relevant)
• Patient's hobbies, occupation in unrelated detail
• Procedural details the recipient doesn't need to take over the case

If a sentence doesn't help the recipient make a decision, cut it.

Word count

180–200 words is the target. Outside that range you lose marks. To hit it:

• Paragraph 1: 25–35 words
• Paragraph 2: 30–40 words
• Paragraph 3: 50–70 words
• Paragraph 4: 50–70 words
• Paragraph 5: 10–20 words

Register and tone

A clinical letter is formal but not pompous.

• Use full forms: "do not" not "don't"
• Avoid emotion: "the patient is unwell" not "the patient is suffering terribly"
• Use professional courtesy: "I would appreciate your assessment" rather than "please assess"

Common mistakes that cost the most marks

1. Burying the purpose in paragraph 2 instead of paragraph 1
2. Including everything from the case notes — the rubric specifically rewards filtering
3. Vague handover request — be specific about what action you want
4. Wrong tense — chronology should be in past for events that have occurred; present for current state
5. Going over 200 words — long letters score lower on conciseness

Practice plan

• Weeks 1–2: one letter every other day. Self-mark against the four criteria.
• Weeks 3–4: one letter every day. Compare against published Band B exemplars in your profession.
• Weeks 5+: one timed letter twice a week.

Next steps

• See exemplar letters in OET writing samples
• Foundation: What is OET?
• Plan: How to prepare for OET

When Writing is at Band B and Speaking is the bottleneck, join the waitlist.