Introductions

There are a variety of ways to write introductions and with practice you can
develop a formula that works for you. For the purpose of this document, the
opening salutation and subject will be included as part of the introduction.

Salutation: If the name of the person is included in the case notes then it should
be used. This can be followed by either a comma or full colon.

o Dear Dr. Wilson,

o Dear Dr. Wilson:

If the name of person is not mentioned then you can begin with Sir/Madam

o Dear Sir/Madam,

Subject: The subject is a place where information such as the name & age of the
patient can be included. This can save you words in the body of the letter, but be
careful not include too much information here, and definitely no phrases or
sentences. Both Re & RE are acceptable.

o Re: Dylan Charles D.O.B. 04/12/2009

o RE: Dylan Charles D.O.B. 04/12/2009

Handy Tip 1
You can save on word length by added some detail after Re, such as the patient
name and age. However, take care not to write too much here, and always use
note form i.e nouns only (no articles, verbs, adjectives)

Basically, the introductory sentence of the letter can contain the following:

1. Background information such as name, age, occupation, marital status

and gender of the patient if relevant and not mentioned in the subject line
2. A brief summary of the chief complaint, purpose of writing or your main
concern

It will usually be only 1 or 2 sentences long and detailed information about the
patient's history and condition should go in the main body of the letter.

Important Grammar Rules

The important patterns to learn are as follows:

Example 1
Relative Clauses: A relative clause is a useful sentence structure to use in the
introduction. It allows the write to demonstrate the ability to write a complex
sentence, which is a basic necessity to get B grade of higher.

1. Thank you for seeing this patient. He presented at my clinic today. He

has painful wisdom teeth.
2. Thank you for seeing this patient who presented at my clinic
today with painful wisdom teeth.
Example 2
Appositives: This is a noun or a noun phrase that is placed after another noun
to explain or identify it, and a comma is required to separate these nouns. It has
a very important use in the introductory sentence of referral letters as in the
example below.

1. I am writing to refer Mrs. Betty Booth. She is 68 years old. She is a

pensioner. She is a widow. She presented with a complaint of painful
wisdom teeth.
2. I am writing to refer Mrs. Betty Booth, a 68-year-old widowed
pensioner who presented at my clinic today with a complaint of a swollen
cheek.

Example 3
Age: There are specific rules regarding how to refer to a patient's age. The first is
that it must be hyphenated when used before a noun such as man/woman, and
the second is that an article is required. For more details refer to Year Vs Years in
the Grammar and Vocabulary Clinic.
Incorrect Correct
• I am writing to refer this patient, a • I am writing to refer this patient, a 63-
63 years old man who lives alone. year-old man who lives alone.
• I am writing to refer this patient, • I am writing to refer this patient who is
63 years old man who lives alone. 63 years old and lives alone.

Handy Tip 2
Mastery of the patterns above will ensure that you start your letter on a positive
note.

Sample Introductions
Introduction
Dear Dr. Howard,
Re: Mr. Malcolm Latham DOB: 29/11/1985
Thank you for seeing this patient who presented to
my clinic today with the complaint of painful
wisdom teeth.
Dear Dr. Hope:
I am writing to refer Mrs. Betty Booth, a 68-year-
old widowed pensioner who presented at my clinic
today with a complaint of a swollen cheek.
Analysis
• Does not include patient name or age as
this is clearly stated after Re
• Uses relative clause sentence structure
which demonstrates ability to use
complex sentences
• Summarises the chief complaint
• Does not use Re. Therefore, includes a lot
of background information concisely
including full name, age, marital status
and occupation
• Uses appositive and relative clause
sentence structure which demonstrates
ability to use complex sentences
• Note comma placement and use of
relative clause

Dear Dr. Kwang, • Includes name written in shortened form

• Summarises the current situation and
Re: Mrs. Sheila Macbeth diagnosis

Thank you for seeing Mrs. Macbeth, a 74-year-old

widow who has recently undergone a sleep study
and was diagnosed with obstructive sleep apnoea
in February 2010.
Dear Doctor, • Does not include patient name or age as
this is clearly stated after Re.
Re: Christina Hollis • Summarises the current condition of most
DOB 20/03/1950 recent visit

Thank you for seeing this patient who presented at

my surgery with a re- occurrence of inflamed gums
and shiny red patches in the mouth, tongue and
both the cheeks.
Dear Dr. Lee, • Purpose of writing stated clearly
• Informs that Mr. Racket is a mutual
Re: Mr. Carl Racket patient
DOB: 17/01/1950 • Summarises treatment required

I am writing this letter to seek advice from you

regarding this patient’s cardiovascular status and
medication prior to the commencement of surgery.
Mr Racket, who is a patient of yours, requires
surgical extraction of his lower left first molar.

Common Errors
Incorrect Correct
Dear Dr. Jones, Dear Dr. Jones,

Re: Mr. Adrian Lamp DOB: 10/10/1965 Re: Mr. Adrian Lamp DOB: 10/10/1965

Thank you for seeing this patient. Mr. Adrian lamp
presented to my clinic today with the complaint of
painful wisdom teeth.
Explanation: No grammatical errors, but it lacks
sophistication in the use of simple sentences. Also,
it repeats the patient name in full which is not
necessary and repetitive since it was written
directly above in the subject line.
Thank you for seeing Mrs. Saunders, an 80-year-
old dementia patient,presented to my clinic on
05/09/2008 with a complaint of loose upper partial
denture.
Explanation: Relative pronoun required.
Dear Dr. Howell,
Thank you for seeing Mrs. Jabore a 69-year-old
lady who presented at my surgery today,
complaining of swelling in her left cheek.
Explanation: Incorrect comma usage
Thanks for seeing Mr. David Lee who presented at
my clinic today complaining of sever pain
associated with the teeth 2.6 and 2.7.
Explanation: Two errors. 1. Thanks is a casual
expression. 2. common spelling error with sever
I am referring Mr Roberts to you because he
presented to my clinic today with a complain of a
painful wisdom tooth.
Explanation: Incorrect word form: Complain is a
Thank you for seeing this patient who presented at
my clinic today with the complaint of painful
wisdom teeth.
Thank you for seeing Mrs. Saunders, an 80-year-
old dementia patient who presented to my clinic on
05/09/2008 with a complaint of loose upper partial
denture.
Dear Dr. Howell,
Thank you for seeing Mrs. Jabore, a 69-year-old
lady who presented at my surgery today
complaining of swelling in her left cheek.
Thank you for seeing Mr. David Lee who
presented at my clinic today complaining
of severe pain associated with the teeth 2.6 and 2.7.
I am referring Mr Roberts to you because he
presented to my clinic today with a complaint of a
painful wisdom tooth.
verb and the noun form is required here.

Study Strategy
When writing introductions, find a style which you like and use it for all tasks.
However, take care to understand the basic grammar rules and always remember
to include the chief complaint and/or purpose of writing. Practice writing
introductions using the sample case notes provided in your course.

Body Paragraphs
Most referral letters will contain 2 or 3 body paragraphs located between the
introduction and the conclusion. Each of the paragraphs should have a main idea
which the writer needs to convey to the reader. All the sentences with the
paragraphs must relate to this main idea. The length of the paragraphs will vary,
but an approximate guideline to meet the required word length of 180~200
words in OET is as follows:

• Introduction: 25 words
• Body paragraph 1: 40 words
• Body Paragraph 2: 40 words
• Body Paragraph 3: 70 words
• Conclusion: 25 words

Paragraph Structure
A good paragraph will contain 3 main elements:

1. A Topic Sentence which introduces the reader to the main idea of the
paragraph. In many cases it will identify and/or summarise an area of
concern regarding the patient. Quite often it is written in original words
rather than from words in the case notes.
2. Supporting sentences which may contain the detail regarding patient
history, descriptions of symptoms, significant aspects from the treatment
record, causes and effects, trends and so on. Quite often this information
can be taken directly from the case notes, and written as full sentences.
However, you will need to paraphrase the information into your own
words. This includes
o Changing verbs to nouns: complain=complaint
o Changing nouns to adjectives: diabetes=diabetic
o Using synonyms
o For more details on how to paraphrase, follow this link: Paraphrase
3. Signal words link sentences together so that the information flows
smoothly and is easy to read.

Common signal words which can help you present information clearly and
logically include:

o Time: At that time, On review today, On consultation today,

Recently, Over the past 3 weeks...., Two weeks later, On her next
visit, During, Since that time, Initial examination..., On 19/08/10...
o Location: During hospitalisation, Initial examination at my clinic
revealed...,On examination....
 o More information: In addition, Moreover, Also, Apart from this..
o Contrast: However, Despite, Although
o Result: Therefore, Consequently, As a result, For this reason...
o Emphasis: Please note, May I remind you, My main concern is....,
What concerns me most is.....
o Sympathy: Unfortunately, Regrettably, Fortunately,
o Subject: In terms of her social history..., With regard to her
medication....,Based on the blood test results....., Regarding her
medical history....., Her dental history shows..., The risk factors
include....., Treatment to date includes...
o Advice: It is important to..., I recommend that you....., Please
ensure that....
o Chronology: Firstly, Secondly, Finally,

Example 1
Case Notes
Medical History
GP Dr Roslyn Andrews (07)
4568 2487
Hypothyroidism
High blood pressure
Medications: Thyroxine 150
mg daily, Karvea 150mg daily
February 2010 diagnosed with
obstructive sleep apnoea
Weight loss advised along
with dental consultation
regarding mouth guard to
control snoring.
Dental History
Patient at this practice for 35
yrs.
Regular 6 month check-up,
scale and clean
Dental hygiene very good
Amalgam fillings
Adverse to needles - generally
refuses to consider
Good diet
Paragraphs
Regarding her medical history,
Mrs. Macbeth has
hypothyroidism and a high
blood pressure. She regularly
takes Thyroxine 150mg and
Karvea 150 mg daily. Her
doctor has advised her to
reduce weight and referred her
to our clinic for assessment
regarding the possibility of a
mouthguard to control her
snoring.
Her dental history shows that
she has regular dental check
ups with scaling and cleaning
twice a year. In addition, her
oral hygiene is very good
although amalgam fillings
have been done.
Analysis
• Topic sentence is introduced
with the phrase: Regarding her
medical history
• Supporting sentences
transform case notes into
complete sentences
• The information is
paraphrased
• Topic sentence is introduced
with the phrase: Her dental
history shows
• Supporting sentences
transform case notes into
complete sentences
• Signal words connect ideas
and express contrast
o In addition,
o although

Examination Today’s examination • Topic sentence is introduced

15/03/2010
All teeth present
Amalgams fillings 16, 35, 36,
37, 46, 47
Gums in good condition
Provided basic information on
how mouth guard works and
success rate claimed
Advised necessity of a
professionally manufactured
and fitted mouth guard – not
obtained from shop.
revealed no missing teeth in
her oral cavity and most of the
molars were filled with
amalgam. In addition, her
gums are in good condition. I
have already explained to her
about the mouth guard and
how it works and the success
rate after using it.
I also advised her that a
professionally manufactured
and fitted mouthguard is the
most suitable for her.
with the phrase: Today's
examination revealed.....
• Supporting sentences
summarise case notes into
complete sentences
• Signal words connect ideas
and express contrast
o In addition,
o also
Example 2
Case Notes
Medical history
High blood pressure
Type 2 Diabetes
Smoker- Social
Taking anti-depressants
Treatment Record
18/04/09
Edentulous
Soft tissue healthy
20/04/09
Impression F/F (full upper
and lower denture)
25/04/09
Bite registration mould/
shade selection A 3
30/04/09
Trial fit
10/05/09
Fit F/F
20/8/09
Examination
Dry mouth. Occlusal wear
and heavy calculus. Deposits painless and has been
on F/F. Soft fluctuant
swelling left cheek increasing size over the last week. In
and decreasing over last
week. No pain. Suspected
salivary gland swelling.
Prescribed Amoxil 500mg. deposits on the upper and
Paragraphs
Regarding her medical
history, the patient is
hypertensive and a type 2
diabetic. In addition, she
takes anti-depressant drugs
and has a habit of smoking.
Mrs.
Jabore initially presented at
my clinic for a complete
upper and lower denture on
18/04/09. At that time, an
examination revealed healthy
soft tissue. Two days later, I
commenced with the
impressions of full lower and
upper denture and after 5
days bite registration along
with shade selection were
done, followed by try-in on
30/04/09. Complete dentures
were delivered to Mrs Jabore
on 10/05/09, the fit of which
was good.
Today, the patient presents
with a soft fluctuant swelling
on the left cheek which is
increasing and decreasing in
addition, an examination
revealed there is occlusal
wear and heavy calculus
lower dentures. Moreover,
Mrs. Jabore suffers from dry
mouth. In my view, it is most
likely a salivary gland
swelling. Please note that I
have prescribed amoxicillin
500mg.
Analysis
• Topic sentence is introduced with
the phrase: Regarding her
medical history
• Supporting sentences transform
case notes into complete
sentences
• Displays paraphrasing techniques
including use of synonyms and
changing nouns to adjectives
o High Blood
Pressure:hypertensive
o diabetes: diabetic
• Signal words connect ideas
• Topic sentence is introduced with
the phrase: Mrs. Jabore initially
presented.....
• Supporting sentences transform
case notes into complete
sentences
• Signal words create a clear time
line
o ...initially...
o At that time,
o Two days later,
o ...along with...
o ...followed by...
• Topic sentence is introduced with
the phrase: Today,
• Supporting sentences expand
case notes into complete
sentences including correct use of
articles
• A wide range of signal words are
used
o In addition,
o Moreover,
o In my view,
o Please note,
Some useful sentences for writing:

• Thank you very much for the referral of Peggy to our office for
an orthodontic evaluation.

• Thank you very much for referring Courtney to our office for
an orthodontic
evaluation. We

• I saw Ann for a consultation appointment to present my

diagnostic findings and recommended treatment. This letter
and summary are to inform you of the pertinent findings and
my recommendations for Ann.

• After a thorough examination, and discussion of the

orthodontic concerns,…

• This letter is a review of the diagnosis and treatment plan we

discussed at Carla’s recent orthodontic
• consultation. My evaluation of her teeth reveals:

• I recently saw Carla for an Adjustment visit appointment. She

presents with the following findings.

• Your patient, Carla Joiner, recently visited our office and will
be undergoing orthodontic treatment.
• We completed a Full Phase orthodontic consultation for Carla
that presented the following findings:

• Orthodontic treatment is definitely indicated and we

recommended that comprehensive diagnostic records be
taken. However, Jim decided not to schedule this appointment
at this time. We have provided him with a report that includes
our examination findings, preliminary treatment plan,
appliance description,
• and recommended next step. We hope that this information
will help to reinforce our discussion and enhance
understanding of the problems. If Jim schedules an
appointment for diagnostic records, I will be sure to
summarize my complete diagnosis and treatment plan for
you.

• After our discussion of the orthodontic problems, we decided

to proceed with full diagnostic records, and we scheduled this
appointment while she as here. Following our consultation
 appointment I will provide you with a summary of our full
diagnosis and treatment plan.

• At the appropriate time, we will take comprehensive

diagnostic records and following our consultation
appointment, I will provide you with the details of my
diagnosis and recommended treatment.

• With pressure applied, both jaws elicited pain, a sign of

inflammation. It appears that one or more teeth have failed to
erupt normally. Probing between the teeth and gums found
excessively deep pockets.
• Noticeable wear on the biting surface of some teeth was
present. Prior trauma to the head and face may become a
factor.

• After completing and evaluating Carla’s diagnosis, I developed

the plan for her, outlined below:

• I recommend the following treatment plan:

• I suggest comprehensive orthodontic therapy addressing all

noted problems. Removal of four premolar teeth. A removable
upper expander which can be taken out for eating and
brushing. An appliance to help resolve the previously
mentioned oral habits. Removal of skin around rotated teeth
to enhance long-term stability.

• I estimate Carla’s orthodontic treatment to be approximately

24 months. The actual treatment time will be largely
dependent upon her cooperation, such as keeping teeth and
appliances clean, avoiding hard or chewy foods, and keeping
all appointments

• I have provided Peggy with a report summarizing my

examination findings, and have enclosed a summary for your
records. I have enclosed my examination findings and
preliminary treatment plan.
• If you have any questions or comments, please do not
hesitate to give me a call.
• During our discussion, I stressed the importance of Ann
returning to your office for regular dental checkups and
cleanings. We will keep her and your office reminded of when
it is time for these appointments.

• Carla has been told the importance of keeping regular visits

with you. If she fails to come in for an appointment, please
 call our office and we’ll be glad to reinforce the importance of
periodic checkups.

• If you have any questions about my findings or my

recommendations against treatment, please give me a call. I
welcome any comments or suggestions regarding Carla's
treatment.. Thank you again for this kind referral.

• My goal is to provide the very best orthodontic treatment

available, and part of this care includes keeping the lines of
communication open with all of Ann's care providers. Your
comments and questions will help me to provide this type of
care. Thanks again for the privilege of working with you and
your patients.

• I am referring Emily to your office for an evaluation. I have

enclosed a summary of my diagnostic findings and treatment
recommendations for your records. If you have any questions
regarding Emily's proposed treatment, please give me a call.
Once you have completed your evaluation, please forward
copies of your findings for my records and contact me so that
we may more fully discuss an appropriate treatment plan.
 FORMAT FOR A REFERRAL LETTER - OET WRITING

Date your letter

Dr Joe Bloggs
Emergency Department Please see p.2 of this
Colac Hospital formatted letter for examples
COLAC 3250 of wording.

Dear Dr Bloggs

Re Catherine Robinson 75 y.o.

FIRST PARAGRAPH
Short and sweet. Sums up what you want the specialist to do and why this person is
being referred.

NEXT PARAGRAPH
Medical History
History of medication taken over recent years.

NEXT PARAGRAPH
Current problem
Current medication

NEXT PARAGRAPH
Any special “social / lifestyle” considerations that need to be advised.

NEXT PARAGRAPH
What do you want this specialist person to do? (Repeat – more fully – what was
alluded to in the very first paragraph.) Do you want the specialist to examine and
report back to you? Do you want him/her to make an assessment? Perhaps you are
referring this patient to a hospital / rehabilitation unit / an aged care facility – to
take over the care and management of this patient? Are you enclosing xrays or test
results for this specialist’s information?

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

Yours truly,

DOCTOR.