The OET Referral Letter: Complete Structure for Referral, Discharge and Transfer (2026)

Quick answer: the OET Writing task gives you 45 minutes, 5 for reading the case notes and 40 for writing one letter of around 180 to 200 words. You will write a referral letter or a discharge letter, and rarely a transfer letter. All three follow one structure: recipient address, date, salutation, a three line introduction, body paragraphs arranged by urgency, and the plan. The exam is not testing new information. It is testing whether you can rearrange the same information correctly.

Here is the secret that removes half the fear of OET Writing. There are three letter types, referral, discharge and transfer, and they are one letter wearing three coats. The information stays the same. The pattern stays the same. What changes is the arrangement, and the arrangement follows pure clinical logic. Once you hold the structure on this page, you stop asking what do I write and start asking only where does each piece go. This guide is my complete letter system from three years of classes: the Task First Rule, the Three Things Introduction, the Urgent Flag, the Rearrangement Logic, the Story Method, and the word count truth from my own exam.

The letter at a glance

The Task First Rule

Do not start with the case notes. Start with the writing task line at the bottom: using this information, write a discharge letter to the patient's GP. That one line decides everything, because the recipient decides what dies. Writing to the patient's own GP? The GP already knows the social history, the past medical history, the family history. Remove them all. Writing to a specialist who has never met the patient? Now the history matters. Reading the case notes before knowing your reader is how students copy everything and fail the selection test. Task first. Reader first. Then the notes.

The 5 plus 40 rule

In the 5 minutes of reading time, your job is a silent survey: what will I pick, what will I omit. In the 40 minutes of writing time, you can mark anything, so this is when you highlight, select your case notes, and build your pattern on the paper. Use the reading time for judgment and the writing time for construction.

The Urgent Flag

Read your case notes very, very carefully, hunting one family of words: immediate, immediately. Immediately refer. Immediate bronchoscopy. Immediate transfer. Any of these means your referral letter is an urgent referral, and your introduction must say so. I have watched students write a calm, polite introduction for a patient the notes marked as immediate, and lose heavy marks for it. The urgency is not decoration. It is the first fact of the letter.

The Three Things Introduction

Your introduction is complete when it carries exactly three things, and incomplete without any one of them: the name of the patient, the chief complaint or the diagnosis, and the purpose of the letter. Urgent assessment and management. Urgent surgical intervention. Further management and care. An update on the patient. One purpose, stated, not explained.

The Three Things Introduction

Three things, or it is incomplete.

“I am writing to update you regarding Mrs. Jagosh¹, who has been treated for anterior wall myocardial infarction², for further follow up care³.”

Three lines. Anyone reading them knows what the whole letter is about.

1. The patientNamed, with the title. Full name in the Re: line, last name in the body.
2. The complaint or diagnosisWhat is wrong, taken from the assessment line, worded once and held.
3. The purposeUrgent assessment. Further management. An update. Stated, not explained.

Remove any one of the three and the introduction is incomplete. Add a fourth and you have started the body too early. The introduction announces. The body explains.

Small, concise, up to the mark. People write big introductions and explain the purpose in detail. Do not. The introduction announces. The body explains.

And one more rule for these opening lines. Minimize your mistakes at the start. Tenses, articles, capitalization, punctuation. If the examiner meets mistakes in your first lines, a red button switches on in his mind, and he reads the rest of your letter looking for more. Your first impression decides how your whole letter is judged.

The Rearrangement Logic

Here is the heart of the system. All three letter types use the same information. The exam is checking one skill: can you rearrange it correctly? The logic is clinical common sense.

The Rearrangement Logic

One letter. Three orders.

The information does not change between letter types. Its position does, and the position follows clinical common sense. Watch where the current condition sits.

Urgent referral

1. Introduction, with the urgency stated
2. Current condition
3. Relevant background and history
4. The plan

Discharge

1. Introduction
2. History, medications, allergies, social
3. Admission: how he presented, what was found
4. Current condition and progress
5. Discharge plan

Transfer

1. Introduction, “I am writing to transfer”
2. History, medications, allergies, social
3. Admission: how he presented, what was found
4. Current condition and progress
5. Transfer plan

Fixed opening The block that moves Same content, same wording

In an urgent referral the current condition sits at position two. In a discharge it sits at position four. Nobody managing an emergency reads the family history first. Transfer is the discharge letter with one word changed.

Urgent referral. The patient needs help now, so the current condition comes first, directly below the introduction. Nobody managing an emergency reads family history first.

Discharge letter. The story is complete, so tell it in order. Past medical history can come early: ongoing diseases, medications, allergies, smoking and drinking, and the social history if the reader does not already know it. Then the admission paragraph: how the patient presented and what was found. Then the progress paragraph: current status and how the condition evolved. And at the end, the discharge plan.

Transfer letter. The exact same pattern as the discharge. Only the purpose word changes: I am writing to transfer. Nothing else moves.

Two small rules inside the body. First, the medication rule: for long term medicines, mention the name but not the dosage, and save the current dosages for the discharge plan, where they belong. Second, the paragraph rule: every new paragraph starts with the patient's name, never with a pronoun. Mrs. Jagosh presented, not she presented. It keeps the letter professional and the reader anchored.

The Story Method

Now the skill that separates letters that flow from letters that stumble. Before you write one word, build the story in your mind. From my class example: the patient presented with a heart attack, she was unstable, the first treatment had no effect, her condition worsened, Clopidogrel was added, she improved, and she left with a discharge plan. That is a story. Six beats. Once the story sits in your mind, the letter writes itself, because a letter IS a story in formal clothes. Students who skip this step copy case notes line by line and produce a list. Students who build the story first produce a letter. And combining information is part of the story skill: instead of copying five management lines, you write one: a general treatment plan for myocardial infarction was commenced, and diagnostic workup revealed ECG changes. Summarize like a clinician handing over, not a clerk copying.

The Name Rule and the frame of the letter

The frame, top to bottom: recipient address, taken from the writing task. The date, and do not stress about its exact position, wherever you write the date is fine. The salutation: Dear Dr. Arora. The regarding line, and here is the name discipline: full name in the regarding line, last name in the body. Regarding: Mrs. Sabrina Jagosh. Body: Mrs. Jagosh. And the old style of calling adult patients by their first name alone is obsolete, keep it only for children. Then your three line introduction, your body by the Rearrangement Logic, the plan, and the standard closing line: please do not hesitate to contact me for further information.

Want your letters corrected by a trained eye before the exam judges them? See the writing correction programme.

The 215 Word Truth

Let me kill the biggest myth in OET Writing: that more words mean more marks. In my own exam, I wrote 215 words and scored 400. A friend of mine wrote around 290 words and scored about 330. The difference was not effort. It was summarizing. The exam rewards the writer who says everything in less, because that is what real clinical handover sounds like.

Practical rules. Your words are counted from the introduction, I am writing to refer, down to the closing, please do not hesitate to contact me. And never count word by word at the end, it burns two minutes you do not have. Use the multiply trick: count the words in your first line, count your total lines, multiply. Ten words a line across eighteen lines is roughly 180. Thirty seconds, done.

One final red flag warning: never write fragmented sentences. Incomplete sentences are the loudest alarm a letter can ring. Every sentence complete, every sentence connected. My sentence formation guide builds this skill from zero: the starter frames, the connector chain and the compression rule.

And build one daily habit: read good graded letters. When you read a strong letter, you absorb how information is presented, and your own letters start sounding like it.

See a real correction

Reading about the structure is one thing. Seeing a letter marked against all six criteria is another. These are two complete correction reports, exactly as a student receives them, with the score for every criterion, what cost the marks, and the rewritten letter at the end.

Structure learned. Now it needs a trained eye. My writing correction program takes your real letters and returns them marked by the exam's standards, mistake by mistake, so every letter you write teaches you the next one.

Get Your Letters Corrected

About the author. Dr. Nasir Bukhari, MBBS, is an OET Certified teacher. He completed OET's official Teacher Training in all four skills, Reading, Listening, Writing and Speaking, certified by OET's Head of Education. He has taught OET to healthcare professionals in more than 40 countries. He is the founder of CliniVerba, the house behind OET HQ.