OET Case Notes: OT Home Safety Referral (Beginner)
An occupational therapist writes to a patient's GP following a home safety assessment that identified moderate fall risk. This is a straightforward beginner referral: one key finding, one recommendation, and a clear handover. Ideal for practising the referral letter format before tackling complex multi-system cases.
Letter type
Referral
Write to
General Practitioner (GP)
Target length
180–200 words
The case notes
Patient: Mrs Dorothy Walsh, 78 years old
Living situation: Lives alone in a two-storey home; family nearby but not co-resident
Reason for assessment: Home safety assessment requested by GP following a recent near-fall on the stairs
Assessment findings: Moderate fall risk (Berg Balance Scale 42/56); staircase handrail absent on left side; bathroom has no grab rails; step thresholds throughout
Current mobility: Ambulant independently but reports dizziness on rising
Medical background: Type 2 diabetes, managed hypertension — no recent medication review
Modifications arranged: Stair grab rail installation arranged; fall-prevention programme recommended
OT plan: Review in 6 weeks once modifications in place; requesting GP medication review for dizziness on rising
Writing task
Write a referral letter to Mrs Walsh's GP, Dr James Brennan, outlining the home assessment findings, the risks identified, and requesting a review of her medications in relation to the reported dizziness.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
-
The reason for assessment and the specific fall risk found
Purpose must be clear in the opening sentence; an examiner should understand the reason for the letter before the second line.
-
The dizziness on rising and the request for a medication review
This is the clinical handover — the key action being transferred to the GP. Omitting it makes the letter incomplete.
-
The home modifications already arranged
Telling the GP what has already been done frames the remaining gap clearly and prevents duplicate action.
Leave out
-
The full Berg Balance Scale scoring methodology
One score with context is sufficient. Explaining the tool wastes words and shifts focus from the clinical message.
-
Detailed management of the diabetes or hypertension
These are context only. The GP manages them — your job is to flag the postural-dizziness link, not re-manage the conditions.
Criterion in focus · Organisation & Layout
A referral letter has a clear three-part structure: reason for writing, findings, action requested. Markers notice when the action (medication review) appears before the findings, or when recommendations are buried mid-paragraph. Organise chronologically: assessment, what you found, what you have done, what you need from the reader.
Now write the letter — and find out what is blocking your Grade B
Write a 180–200 words referral letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.