1. Name the reader and the request
Read the task box before the notes. Write one sentence in your head: "I want this specialist to assess X because Y." That sentence becomes your opening paragraph and your filter for every note.
OET Writing
OET Writing: referral letter structure and note selection
A referral letter asks a colleague to take action. This guide shows you how to decide which case notes the reader needs, which to leave out, and how to order the paragraphs so the request is clear from the first line to the last.
What a referral letter has to do
The question many candidates ask is not "how do I start?" but "how much of the case notes should go in?" The answer depends on the reader and the request, not on the notes.
What OET actually asks for
OET describes the Writing sub-test as a profession-specific task, such as a document of referral, advice, or a letter of transfer or discharge, written from case notes. You get 5 minutes of reading time, during which you cannot write or mark anything, and then 40 minutes to write. You can look at the case notes at any point during the 40 minutes.
Length is a guide, not the goal
OET gives a guide of 180–200 words for the body of the letter and says assessors do not count your words. They check whether you have included what the reader needs and left out what they do not. A long referral is almost always a selection problem.
The six criteria behind every decision
Your letter is scored on Purpose, Content, Conciseness & Clarity, Genre & Style, Organisation & Layout, and Language. Note selection feeds Content and Conciseness & Clarity directly, and paragraph order is what Organisation & Layout rewards.
What makes a referral different
In a discharge or transfer letter you hand over ongoing care. In a referral you ask someone, often a specialist, to assess or treat a problem you cannot resolve yourself. The reader must understand within the first paragraph why the patient is coming to them, and everything after that should justify the request.
A five-step method: from case notes to paragraph plan
Use the reading time for steps 1 to 3 in your head, then spend the first few minutes of writing time on steps 4 and 5. OET itself suggests using the first 2–3 minutes of writing time to plan.
2. Sort every note into three groups
Essential: the reader cannot act without it. Supporting: it helps the reader understand the problem or plan safely. Omit: it is irrelevant to this request, already known to the reader, or resolved.
3. Merge what repeats
Case notes often record the same problem at several visits. The reader needs the trend, not each entry. Turn three peak-flow readings or three blood pressures into one sentence that shows the direction of change.
4. Choose chronological or thematic order
If the story is a routine timeline, dated paragraphs work well. If the current problem matters most, group by theme: the problem now, what has been tried, relevant background. OET notes there is no fixed number of paragraphs.
5. Put the key sentence first
Inside each paragraph, lead with the most important sentence. Then close the letter by repeating the request clearly, so the reader finishes knowing exactly what you want them to do.
Practice example: selecting notes for a respiratory referral
This is an invented practice case written by OET with Dr Hesham to demonstrate the method. It is not an official OET task and does not describe a real patient.
Practice example: the task
You are a GP at Riverside Surgery. Write a letter of referral to Dr Helen Marsh, Consultant Respiratory Physician, City Hospital, requesting specialist assessment of Mr Brennan’s asthma.
Practice example: case notes (summary)
- Mr Tom Brennan, 47, warehouse supervisor; lives with wife and two teenage children
- Asthma since childhood; hay fever (cetirizine 10 mg PRN); appendicectomy 1998; NKDA
- Ex-smoker: 10/day for 20 years, quit 2019; pet cat for 8 years
- Meds: beclometasone/formoterol 100/6, 2 puffs BD; salbutamol 100 mcg PRN
- 12/08: night cough 3–4 nights/week, salbutamol daily; inhaler technique corrected; peak flow 380 L/min (predicted 560)
- 28/08: A&E attendance with exacerbation; prednisolone 40 mg for 5 days
- 09/09: symptoms unchanged; repeat prescriptions confirm good adherence; peak flow 360 L/min
- 14/10: still waking at night; 4 days off work in September; stopped five-a-side football; BP 128/82; flu vaccine given
Keep, because the specialist needs it
- Night symptoms and daily reliever use: the evidence of poor control
- Peak flow falling from 380 to 360 L/min against a predicted 560: one sentence, not two
- The A&E exacerbation and oral steroid course
- Current inhalers, corrected technique and confirmed adherence: shows the problem is not simply technique or compliance
- Ex-smoker, pet cat and hay fever: possible contributing factors the specialist will consider
- Time off work and stopping football: the impact on daily life
Omit, because it does not change the request
- Appendicectomy in 1998: unrelated and resolved
- Normal blood pressure and the flu vaccine: routine, no action needed
- Wife and children: not relevant to the respiratory assessment
- Each visit’s date and reading listed separately: summarise the trend instead
Paragraph plan (thematic order)
- P1, purpose: referral for specialist assessment of poorly controlled asthma
- P2, the problem now: night symptoms, daily reliever use, falling peak flow, recent exacerbation and steroid course
- P3, what has been tried: current inhalers, technique corrected, adherence confirmed
- P4, relevant background and impact: ex-smoker, cat, hay fever; time off work and reduced exercise
- P5, closing request: assessment and advice on further management
Model opening sentence
I am writing to refer Mr Tom Brennan, a 47-year-old warehouse supervisor, for specialist assessment of his asthma, which remains poorly controlled despite good adherence to treatment and corrected inhaler technique.
Model closing sentences
I would be grateful if you could assess Mr Brennan and advise on further management of his asthma. Please do not hesitate to contact me if you require any further information.
Key takeaway
Notice that the opening already tells the reader why the patient cannot be managed in primary care: treatment has failed despite adherence and good technique. Every kept note in paragraphs 2 to 4 proves that point. If a note does not support the request or help the specialist plan safely, it does not earn a place in the letter.
Common mistakes in OET referral letters
These patterns are common in practice referral letters. Each one is easy to fix once you can name it.
Hiding the purpose
Opening with the patient’s history and only stating the reason for referral in paragraph three. The reader should know what you want after the first sentence.
Copying the notes in date order
Visit-by-visit paragraphs make the reader rebuild the story. Use chronology only when the timeline itself matters; otherwise group by theme.
Including normal or resolved findings
Normal blood pressure, old unrelated surgery and routine vaccinations rarely help a specialist answer your question.
Leaving out what has already been tried
Without previous treatment, adherence and technique, the specialist cannot tell whether the referral is justified or what to try next.
A vague or missing closing request
Ending with "Thank you" alone. Restate the request: assess, investigate, advise, or take over management.
Note-form shorthand
Abbreviations such as "BD", "PRN" or "SOB" belong in the notes, not in the letter. Expand them into full, professional sentences.
Official sources
The test facts on this page were checked against these official OET pages on 27 October 2026.
Referral letter FAQ
Short answers to the questions candidates ask about structuring OET referral letters.
How many paragraphs should an OET referral letter have?
There is no fixed number. OET says to use as many paragraphs as you need to communicate clearly. Many referral letters work well with an opening purpose paragraph, two or three body paragraphs and a short closing request.
How do I decide which case notes to leave out?
Ask whether the reader needs the note to act on your request or to care for the patient safely. If the answer is no, because it is unrelated, normal, resolved or already known to the reader, leave it out.
Should a referral letter be in chronological order?
Only when the timeline itself is what the reader needs. If the current problem matters most, group information by theme, starting with the problem now, then what has been tried, then relevant background.
Will I lose marks if my letter is over 200 words?
OET says the 180 to 200 word guide is not strictly enforced and assessors do not count words. However, a much longer letter usually contains irrelevant notes, which affects Content and Conciseness and Clarity.
OET Writing next step
Find out whether your note selection is working
Write a referral letter under timed conditions and send it for a Writing Assessment. You will see which notes cost you marks, how your paragraph order reads to an assessor, and what to change next.