He is married and has three children (Compound)

- He is married with three children.

His lipids have improved and his cholesterol has fallen to 3.2.

Do, Take, Have, Come, Come back, see, get, give, keep, But, so, say, tell
Furthermore, Nonetheless, Besides, so, but
Ask for, Ask, more than, give, if, needs, before, can/could, can’t, about, Can you?
Want, Check, Start/begin, Take medicine by herself, After, Get over, Get better, Get worse,
Come with, Make sth happen, Happen, clear, naturally, live on one’s own/alone/by oneself, get,
come back, on and off/off and on, all the time, give(advice), make a plan, after the operation,
doesn’t help, fail to make, do, go to

The patient wants to go back to work because he has been away from work for 3 months.
 The patient is eager to return to work because he has been away from work for 3
months.
 The patient is eager to return to work as he has been off work for 3 months.

The problem started 2 weeks ago.

 The problem commenced 2 weeks ago.
 The problem had begun about 2 weeks ago. (Past perfect - 2 actions require, one action
must be completed before another action)
 The problem commenced 2 weeks ago.

The patient failed to lose weight as I told him.

 The patient is not able to lose weight which I advised him previously.
 The patient has not succeeded in losing his weight.
 He has failed in his attempt to lose his weight.
 The patient has not been able to lose his weight as recommended.
(Should use present perfect. Past simple need definite time)

Can you check Mr Collister’s condition ASAP to see if my diagnosis is correct and suggest a
management plan?
 I would appreciate it if you could assess Mr Collister’s condition immediately to know if
my diagnosis is correct and advise further management.
 I would be grateful if you could assess Mr Collister’s condition at your earliest
convenience to confirm the preliminary diagnosis and recommend a management plan.

His condition is getting better.

 His condition is improving.
 There has been an improvement in his condition.
His condition is not getting any better.
 There has been no improvement in his condition.

His investigation results say his condition is getting better.

 His investigation results show his condition is improving.
 His investigation results show improvement in his condition.

The problem had begun about 2 weeks ago.

 The problem occurred 2 weeks ago.

Although he has consulted a dietitian and attended weight loss programs, he doesn’t seem to
have lost much weight.
In spite of consultation with a dietitian and attending weight-loss programs, he has not (been)
able to lose much weight. (front and back forms must be same)
 Despite advice from a dietitian and attendance at weight-loss programs, he has not
been able to lose his weight significantly.

Although he was taking antacids, his symptoms were not relieved.

Despite treating himself with antacids, his symptoms were not relieved. (subjects – he, his
symptoms) thus false.
Despite him treating himself with antacids, his symptoms were not relieved.

He doesn’t listen to my advice.

 He does not follow my advice.

The patient failed to lose weight as I advised him.

If you need any more information about this patient, please contact me.
 Should you require any further information regarding this patient, please do not
hesitate to contact me.

Can you take care of this patient for more management?
 I would appreciate it if you could examine this patient for further management.
 I would appreciate it if you could see/ attend to this patient for further management.

The patient first came to my clinic saying that he has had dysphagia for two weeks.
 The patient initially visited/ presented to my surgery as he has had dysphagia for two
weeks.
  Initially, the patient presented to my surgery complaining of a two-week history of
dysphagia.

Two weeks later, the patient came back to tell me that—

 Two weeks later, the patient returned to my surgery to inform that ….

For these reasons, I want him to see you for more management.
 In view of the above, I wish him to meet you for further management.
 In view of the above, I am referring this patient to you for further management.

She can go home from hospital only if she can walk by herself.
 She will be able to return home from hospital only if she can mobilize by herself.
 She is allowed to return home from hospital provided that she is able to mobilize by
herself.
 She will be discharged from hospital on condition that she is able to ambulate
independently.

She first came to me because she was worried about her poor blood sugar levels.
 Initially, she visited my surgery as she was concerned about her poor blood sugar levels.
 Initially, she presented to my surgery as she was concerned that her blood sugar levels
were poorly controlled.
 She initially visited my surgery as she was concerned about her poorly-controlled blood
sugar levels.
 She initially attended my surgery as she was concerned that her blood glucose levels
were no longer well-controlled.
Alice, who scored three goals in the first game, is the only player to perform well.
Clare, who I work with her, is doing the London marathon this year.

Mr Barry Jones 45 Forklift driver injured his back 3 months ago ready to return to work.
 Mr Barry Jones, a 45-year-old forklift driver, has his back injured 3 months ago, is now
ready to return to his work.
 ,
Thank you for seeing Mr Barry Jones a 45-year-old forklift driver that injured his back 3
months ago, is ready to return to work.
 Mr Barry Jones, a 45-year-old forklift driver who injured his back 3 months ago, is ready
to return to work.
 Mr Barry Jones, a 45-year-old forklift driver whose back was injured 3 months ago, is
ready to return to work.


Mr Barry Jones, injured his back 3 months ago ready to return to work
  Mr Barry Jones, who injured his back 3 months ago, is ready to return to work.

A secondary school teacher

She presented today with 2 wks history of gastro-oesophageal reflux with possible stricture.
- I referred a secondary school teacher who presented today with a 2-week history of
gastro-oesophageal reflux with possible stricture to a gastroenterologist for further
investigation.
Past perfect means already completed. So it is not reason for referral.

An academic
60 years old
Retired
Very painful left first toe consistent with gout
- I examined a 60-year-old retired academic who has a very painful left first toe which
consistent with gout.
- I examined a 60-year-old retired academic who has very painful left first toe consistent
with gout.

Ms Foster
68 years old
Type 2 Diabetes
I am writing to refer Mr Foster, a 68-year-old type 2 diabetic, for further management.
I am writing to refer Mr Foster, who is a 68-year-old type 2 diabetic, for further management.

Ms Duval
24
Demonstrated features suggestive of hypothyroidism
- I am writing to request an urgent review of Ms Duval, a 24-year-old, who demonstrated
features suggestive of hypothyroidism.
- I am writing to request an urgent review of Ms Duval, a 24-year-old patient, who has
demonstrated features suggestive of hypothyroidism.

Mr Jones
52
Features consistent with reactive depression + anxiety
- Thank you for seeing Mr Jones, a 52-year-old, whose features are consistent with
reactive depression and anxiety.
- Thank you for seeing Mr Jones, a 52-year-old man, whose features are consistent with
reactive depression along with anxiety for further management.
Mr Davidson
Admitted to hospital for exacerbation of asthma
Ready to discharge today
- I am writing to refer Mr Davidson, who admitted to hospital for exacerbation of asthma,
is ready to be discharged today.
- I am writing to refer Mr Davidson, who was admitted to hospital for an exacerbation of
asthma, is ready to be discharged today.

Verb - Present – past simple ok

Others – Past
 Introductory Paragraph writing
Thank you for seeing…
I am writing to refer … to you for (purpose)
I am writing to refer…, who require
I am writing to refer…, whose feature
I am writing to request (purpose) for (patient)

Thank you for seeing this patient, Mr Foster, a 68-year-old type 2 diabetic, for further
management.
I am writing to request an urgent review of Ms Duval, a 24-year-old patient, who has
demonstrated features suggestive of hypothyroidism.
has complained of

Reason for referral- present simple/ present perfect/ present perfect continuous/ present
continuous

Past simple= who presented today with….

Reason for referral – Ix results --

Introductory paragraph – problem- reason for referral – Past simple, Present simple/ perfect/
presented today/ experience
I am writing to …. Who sustained (short/ long) short/ one time action - past simple
MPT – manner, place, time
I am writing to refer…… to you for further management.
Accuracy
Conciseness
Variety
Register
Mrs Priya Sharma
60 year old
Type 2 diabetic
Further management/ blood sugar levels
- I am writing to refer Mrs Priya Sharma, a 60-year-old type 2 diabetic, for further
management of his blood sugar levels.

Ms Hall
45 secondary school teacher
She presented today with 2 wk history gastro-oesophageal reflux with possible stricture.

- I am writing to refer Ms Hall, a secondary school teacher, who presented today with a 2-
week history of gastro-oesophageal reflux with possible stricture for further
investigation.

Mr Jones
40 years old
A forklift driver
Back injury/ at work (3 months)
Ready to return to work
Workplace assessment
- I am writing to refer Mr Jones, a 40-year-old forklift driver who sustained back injury at
work 3 months ago and is ready to return to work, for workplace assessment.
- I am writing to refer Mr Jones, a 40-year-old forklift driver who sustained back injury at
work 3 months ago, is ready to return to work for workplace assessment.
- I am writing to refer Mr Jones, a 40-year-old forklift driver, who sustained back injury at
work 3 months ago and is ready to return to work for workplace assessment.
-

Joshua (boy)
2 months old
Constipation and symptoms suggestive of mild dehydration
For further assessment and management
- I am writing to refer Joshua, a 2-month-old male infant, who has constipation and
symptoms suggestive of mild dehydration for further assessment and management.

Mrs Smith
32 years old
Hotel receptionist
Symptoms are suggestive of severe depression and possible bipolar disorder
- Thank you for seeing Mrs Smith, a 32-year-old hotel receptionist, whose symptoms are
suggestive of severe depression and possible bipolar disorder for further management.
 Which + Preposition

Period– during which

Event – during which time
Reception – at which
In year – in 2014
In month – in October
On date – on 12/
On/ during visit
At – location (at the airport, at the bus-stop, at the restaurant)
In – something inside (in the kitchen, in the restaurant)
In, during – season

Early in the Autumn Term there is a reception.

You can meet current staff and students.
- Early in the Autumn Term there is a reception where you can meet current staff and
students.
- Early in the Autumn Term there is a reception at which you can meet current staff and
students.
- There is a reception early in the Autumn Term, during which you can meet current staff
and students.

Go immediately to the terminal. The flight departs from as soon as you’ve cleared security.
- Go immediately to the terminal from which the flight departs from as soon as you’ve
cleared security.

Her years at the university were happy ones. During those years, she made many life-long
friends.
- Her years at the university were happy ones during which she made many life-long
friends.

You have an hour to complete the exam. During that time

I know a restaurant where the food is excellent.

- I know a restaurant in which the food is excellent.

There isn’t a day when I don’t feel rushed off my feet.

- There isn’t a day on which I don’t feel rushed off my feet.

Do you know the reason why the shop is closed today?

- Do you know the reason for which the shop is closed today?
She was in a car accident. She got a whiplash injury in the accident.
- She was in a car accident in which she got a whiplash injury.
- She was involved in a car accident in which she sustained a whiplash injury.

She got a whiplash injury. She didn’t get any treatment for that.
- She got a whiplash injury for which she didn’t get any treatment for that.
- She sustained a whiplash injury for which she did not receive any treatment.

She has a history of dermatitis 2014. She was prescribed oral and topical cortisone for that.
- She has a history of dermatitis 2014 in which she was prescribed oral and topical
cortisone for that.
- She has a history of dermatitis (2014) for which she was prescribed oral and topical
cortisone.

A recent X-ray of her left knee confirms severe osteoarthritis with osteophyte and loss of joint
space. I believe this is the reason for her worsening symptoms.
-

It, This, That – refer to the whole sentence in the following examples.
, which
My friend didn’t invite me to her wedding. It upset me.
- My friend didn’t invite me to her wedding, which upset me.

He showed me round the town. It was very kind of him.

- He showed me round the town, which was very kind of him.

There’s going to be a new headteacher in September. That’s good. It’s time for a change.
- There’s going to be a new headteacher in September, which is good. It’s time for a
change.

She had to get up and walk all the way to the other side of the room. It isn’t easy with a bad
back.
- She had to get up and walk all the way to the other side of the room, which is not easy
with a bad back.

I lived in Seoul for two years. I enjoyed the city.

- I lived in Seoul for two years during which I enjoyed the city.

During the Korean War, many people were killed. The war ended in 1953.
 - The Korean War, during which time many people were killed, ended in 1953.

You have an hour to complete the exam. During that time, there must be no talking.
- You have an hour to complete the exam, during which time, there must be no talking.

Her fasting blood sugar levels are usually in the 16+ range. That’s high.
- Her fasting blood sugar levels are usually in the 16+ range, which is high.

The results showed elevated readings in random glucose, fasting glucose and HbA levels, which
are also consistent with type 2 diabetes
- The results showed elevated readings in random glucose, fasting glucose and HbA levels,
which are also consistent with type 2 diabetes

A recent X-ray of her left knee confirms severe osteoarthritis with osteophyte and loss of joint
space. I believe this is the reason for her worsening symptoms.
- A recent x ray of her left knee confirms severe osteoarthritis with osteophyte and loss of
joint space, which I believe is the reason for her worsening symptoms.

Dr Jason Roberts
Gastroenterologist
Newtown Hospital
111 High Street
Newtown

18 June 2018

Dear Dr Roberts

Re: Ms Anne Hall

DOB: 19.09.72

I am writing to …..

Should you require any further information regarding this patient, please do not hesitate to
contact me.

Yours sincerely

Doctor
Dr Lisa Smith
Endocrinologist
City Hospital
Newtown

10 February 2019

Dear Dr Smith

Re: Mrs Priya Sharma

71 Seaside Street, Newtown
DOB: 08.05.58

I am writing to …

Should you require any further information regarding this patient, please do not hesitate to
contact me.

Yours sincerely

Doctor

Ms Jane Graham
Occupational Therapist
Newtown Occupational Therapy
10 Johnston Street
Newtown

30 August 2019

Dear Ms Graham

Re: Mr Barry Jones

54 Woods Street, Newtown
DOB: 11.06.1973

I am writing to …

Should you require any further information regarding this patient, please do not hesitate to
contact me.

Yours sincerely

Doctor
Registrar
Emergency Department
Royal Melbourne Hospital
Flemington Road
Parkville 3052

30 April 1997

Dear Sir or Madam

Re: Mr Derek Romano, 46 years old

I am writing to …

Should you require any further information regarding this patient, please do not hesitate to
contact me.

Yours faithfully

Doctor

Dr Jan Walker
Pulmonologist
Epstein Clinic
393 Victoria Road
Richmond

27 February 2019

Dear Dr Walker,

Re: Ms Susan Forrest

DOB: 19/05/97

I am writing to refer this patient, a sports enthusiast who is suspected to be suffering from
community acquired pneumonia and has an underlying history of asthma, for further
assessment and evaluation.
She has been suffering from asthma since her age of 4, and was admitted two times due to
asthma related problems. Her symptoms were ecacerbated by cold and damp weather.
Her regular medications are Ventolin (albuterol) and Symbicort (budesonide/ formoterol) for
asthma, Zyrtec (cetrizine) for allergic rhinitis, and topical over-the-counter hydrocortisone for
eczema.
On regarding past medical history, she has a history of extensive eczema covering her thorax.
She has a family history of asthma in her father; moreover, her brother had an episode of acute
bronchitis.
On 25/02/19, she presented with a 2-day history of shortness of breath and a 7-day history of
persistent cough. Although Ventolin usage was increased, she felt rundown. At that time, her
PEF was 330. Chest X-ray and full blood count were ordered.
At a review visit on 27/02/19, her symptoms had not improved. Hacking cough and green
phlegm were detected. Physical examination described low-grade fever and chest X-ray findings
presented consolidation in right lung. PEF at this time was 200L/min.
smoker
it would be greatly appreciated if you could confirm the diagnosis as well as submitting Ms
Forrest for a CT scan. Further, please review her current medications in addition to reinforcing
the benefits of quitting smoking.

Simple aspect
- One time action
- In single block of time
- Factual information
- Repeated action (habitual)
Social history
She stopped smoking 16 years ago.
Regular medication
She has been taking Aspirin for 7 years.
Current state
His condition is improving.
Marital status
She is married and has 10 children.
BMI
She is obese.
Weight
She has lost 2 kg in the last month.
Diet
She eats healthy diet.
Allergy
She has no history of allergy.
Symptoms
She has been suffering from mouth ulcers off and on for 3 months.
Ix findings (reason for referral)
According to investigation findings, you
Chronic conditions
She is suffering from diabetes for 6 years.
Past medical history
She has a history of eczema when she was 8 years old.
 Present perfect
Problem> Treatment> Result
Past simple> Past simple> Present perfect

Her blood pressure was high. As a result, I commenced her on antihypertensives. Since then,
her blood pressure has been within range.

Pathology report: HbA1C 10% Chol 6.2

Metformin changed to 750mg b.d. Lipitor 20mg 1 mane
Chol 3.2
- Her pathology report showed her HbA1C level was 10% and her cholestrol level was 6.2.
As a result, I increased her metformin dose to 750mg b.d. and added Lipitor 20mg 1
mane. Since then, her blood cholestrol level has fallen to 3.2.
-
- Pathology report revealed high levels of HbA1C (10%) and cholestrol (6.2). As a result,
her metformin dose was increased to 750 mg twice a day and Lipitor 20 mg mane was
added. Since then, her cholestrol level has fallen to 3.2.

Plan: Refer to Physiotherapy

Increase analegics
Discuss the X-ray result and the possible treatment options
- I have referred this patient to a physiotherapist for further management.
- Her analgesics dose has increased.
- The X-ray result and the possible treatment options has been discussed with the patient.
Physiotherapy= uncountable
- I have arranged some physiotherapy.
I have prescribed extra analgesics.
I have discussed the x try results and the possible treatment options with the patient.

- I have arranged some physiotherapy and prescribed extra analgesics.

Additionally, I have discussed the x-ray results and the possible treatment options with the
patient.

Plan: coffee/ alcohol consumption

Cease OTC product
- I have advised the patient to reduce his coffee and alcohol consumption and to cease
the OTC product.

Has demonstrated features

Thank you for seeing this patient, Mr Smith, who has sustained an injury after a fall at home.
That’s the reason why the patient’s being referred to.

Thank you for seeing this patient, Mr Smith, who sustained back injury, is now ready to return
to work
By 2025, I will have turned
By the time I am 40, I will have been fatter.

When I got home yesterday, my parents had dinner. (Past simple)

When I got home yesterday, my parents were having dinner. (Past continuous) Time
When I got home yesterday, my parents had had dinner. (Past perfect) Time

On admission, he was experiencing …

The patient is nervous as she hasn’t done this procedure before.

Yesterday the patient was nervous as she hadn’t done this procedure before.

Completed portion of ongoing – perfect continuous

Rung, was watching

Started, had explained
Was admitted, had been experiencing

Demographics- simple present

Medical history (Chronic condition)- past simple, present perfect, present continuous,
Drug history – past
Past surgical history- past simple, past perfect, present perfect
Mx- today present perfect
Initial- past simple
Hospital Mx now dc- past simple
Progress- present perfect, present continuous, present simple
Visit – initial – past simple

Admission – past simple, past continuous, past perfect con(time)

Discharge present simple, present continuous
Future mx –
After discharge- present perfect (mar htar)
Future continuous
Future perfect
Recent – Ix- past simple
Results reviewed today- present simple
Pt’s needs- present simple, future simple
Social/ medical/ family history – present simple
Changes in lifestyle/ diet/ symptoms – present perfect
ICE, pt believe – present simple
She tried over-the-counter medications, but her symptoms became more severe.
Her blood pressure increased; I prescribed Atacand.
She was treated at intensive care unit; however, her condition has not improved.

Advise someone to
Suggest +n
Suggest + that+Sub+ vinf
Suggest that s should Vinf
Suggest ving

Independent+ dependent- complex

While the physiotherapist was teaching breathing exercise, the patient was provided with
oxygen; however, oxygen saturation was still below 90%.

The urosurgeon advised the patient to remove JJ stent, but the nephrologist

A dietary…., but
Iikewise = also

11/12 months
3/7 days
2/52 weeks
Anna Hall, 45 year old secondary school teacher
Presented with dysphagia x 2 weeks with possible stricture for further management.

Two weeks ago, upper respiratory tract infection

Treated herself with OTC chinese herbal products unknown constituents
Accompanied by epigastric pain radiating to back, level of thoracic vertebra 12 and
1-2 kg weight loss

On examination,
Not anxious
No lump palpable
Recent increase in her coffee consumption
Takes asprin 2-3 times/month

Dyspepsia 2012
Dermatitis, prescribed oral corticosteroids
Allergic to codeine

Social drinker mainly spirits

Non-smoker
BMI 28.2
Family history of peptic ulcer

Suspected gastro-oesophageal reflux disease with or without stricture

Advised
Reduce coffee and alcohol intake
Cease otc product
Prescribed pantoprazole 40mg daily

Refer for opinion and endoscopy if required

Chief
Chief explain
Background
Start – Ms Hall , not she

Ms Hall/45/secondary/ 2wk/ dysphagia- solids/ further Ix

Problem started 2 weeks ago after? Patient idea URTI believes commenced after for which self-
prescribed an otc
treated with OTC Chinese herbal product – unknown contents ICE- present simple
Also epigastric pain radiating back T12, 1-2kg wt loss present continuous
No sensation of lump / signs of anxietypresent simple

Recently increase coffee intake present perfect

Aspirin 2-3times a month present simple
Non smoker (16 years) present perfect
social drinker – mainly spirits present simple
PMHx- dyspepsia (2012) has a history of
Dermatitis (2014) – oral and topical corticosteroids past simple
FHx- peptic ulcer has a history of
allergic to codeine present simple
BMI 28.2 present simple

My provisional diagnosis at this point is

Provisional diagnosis – gastro-oesophageal reflux with or without stricture present simple
Recommend to reduce coffee & alcohol consumption + to cease OTC product present perfect
Prescribe pantoprazole 40mg daily present perfect

Arrange an endoscopy if required for a definitive diagnosis

I would be grateful if you could arrage an endoscopy and provide someone with something
 Refer
Dr Jason Roberts
Gastroenterologist
Newtown Hospital
111 High Street
Newtown

18 June 2018

Dear Dr Roberts,

Re: Ms Anne Hall, DOB: 19.09.72

I am writing to refer Ms Hall, a 45-year-old secondary school teacher, who presented with a 2-
week history of dysphagia for solids for further management.

Ms Hall believes the problem commenced 2 weeks ago after an upper respiratory tract
infection for which she self-treated with an over-the-counter Chinese herbal product with
unknown constituents. She also reports epigastric pain radiating to her back (thoracic vertebra
12 level) and 1-2kg weight loss. On examination, there is no palpable lump or no signs of
anxiety.

Ms Hall has recently increased her coffee intake. She takes aspirin for 2-3 times a month. She
ceased smoking 16 years ago. She socially drinks mainly spirits. Her BMI is currently 28.2. She
has a past medical history of dyspepsia (2012) and dermatitis (2014) for which she was treated
with oral and topical corticosteroids. She is allergic to codeine. She has a family history of peptic
ulcer.

I suspect Ms Hall may have a gastro-oesophageal reflux disease with possible stricture.
Therefore, I have recommended that she reduces her coffee and alcohol consumption and
ceases the over-the-counter product. I have prescribed pantoprazole 40mg daily as well.

I would be grateful if you could arrange an endoscopy if required and provide Ms Hall with a
definitive diagnosis.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely,

Doctor

Prescribe – with , commence on

Report , complain – simple
Is experiencing
present continuous – now suffering with no time
Thank you for seeing Mrs Priya Sharma, a 60-year-old retired clerical worker, who has poorly
controlled type 2 diabetes for your expert management.

On 29/12/18, Ms Sharma presented worrying her blood sugar levels ranging between 6-
18mmol/l. On examination, her blood pressure was raised. Apart from this, she was well with
no complications like peripheral neuropathy. She has a steady BMI of 24.

According to Ms Sharma’s condition, full blood examination, urea and electrolytes, creatinine,
liver function tests, full lipid profile and HbA1c were requested. Atacand 4mg 1 tablet in the
morning was added.

When reviewing Ms Sharma’s pathology report on 12/01/19, her HbA1c was 10% (high) and her
cholestrol was 6.2 (high). As a result, metformin dosage was increased to 750mg twice daily.
Lipitor 20mg 1 tablet in the morning was added. Glipizide 5mg 2 in the morning was continued.
Since then, her blood pressure has been in control and

She has a 20-year history of type 2 diabetes for which she was prescribed metformin 500mg
twice daily and glipizide 5 mg 2 tablets in the morning.
Today

Fasting sugar 16+ (high)

Other – 7-8
Refer

Not physically active

Last eye check October 2017 no problem
Mrs Sharma, 60 type 2 diabetic further management blood glucose levels

Diagnosed 1999. Since then past perfect continuous

Metformin 500mg bd
Glipizide 5mg 2 mane
Monitor sugars & bp at home
No formal exercise
Strong family history
Allergic
Weight steady (BMI 24)
Eye check Oct 2017 – no issue

29/21/18 first visited concerned poorly-controlled glucose levels (6-18)

BP – 155/100 – Atacand mg 1 mane – within range

2 weeks later – pathology report – GFR greater than 60ml/min

HbA1c 10%
Cho 6.2
Metformin 750mg twice a day
Added Lipitor 20mg each morning
Sugars improved
Cholestrol fallen to 3.2

Reports non-fasting blood sugars 7-8 but fasting 16+ range

Referring to you for specialist advice on sugar level control

Her medication at that time was

Well-controlled
 Refer
Dr Lisa Smith
Endocrinologist
City Hospital
Newtown

10 February 2019

Dear Dr Smith,

Re: Mrs Priya Sharma

71 Seaside Street, Newtown
DOB: 08.05.58

Thank you for seeing Mrs Sharma, a 60-year-old type 2 diabetic, for further management of her
blood glucose levels.

Mrs Sharma was diagnosed with type 2 diabetes in 1999, for which she had been taking
metformin 500mg bd and glipizide 5mg 2 mane. Since then, she has been regularly monitoring
her blood sugar and blood pressure. She has a strong family history of diabetes. Her eye
examination in October 2017 indicated no issues. Despite lack of exercise, her weight is steady
(BMI of 24). She has a penicillin allergy.

On 29/21/18, Mrs Sharma first presented concerning her glucose levels which were running
between 6 and 18mmol/L. On assessment, her BP was 155/100mmHg. Atacand 4mg 1 mane
was commenced; as a result, her BP has been controlled.

Two weeks later, pathology report revealed GFR (>60ml/min), HbA1c (10%), and cholestrol
(6.2). Therefore, I increased her metformin dose to 750mg b.d. and added Lipitor 20mg 1 mane.
Since then, her blood sugar levels have improved and her blood cholestrol level has fallen to
3.2.

Today, Mrs Sharma reports that her non-fasting sugar levels range between 7-8mmol/l, but her
fasting sugar levels are in the 16+ range, which remain high. I would appreciate your specialist
advice on her sugar control.

Should you require any further information regarding Mrs Sharma, please do not hesitate to
contact me.
Yours sincerely,

Doctor

Word count- 206

Despite- followed by noun/ ving
Refer
Dr D Kurac
Surgeon
The Weight Centre
393 Victorian Road
Richmond
Melbourne

15 June 2018

Dear Dr Kurac

Re: Andy Williams, aged 65

Thank you for seeing Mr Andy Williams, a long-term sufferer of obesity, for further evaluation
and treatment including weight-loss surgery.

Mr Williams has been obese since childhood and has experienced a steady increase in weight
thoughout his life. His current weight is 155.5kg with a BMI of 46.4. On reviewing investigations,
his blood glucose levels ranged between 100-130mg/dl in the morning with triglyceride level of
201mg/dl and serum insulin level of 19 uIU/ml. He also has a strong family history of obesity.

Mr Williams has an underlying history of type 2 diabetes and hypertension, for which he is
taking NPH insulin 30 and 70 units before breakfast/ before or after dinner, metformin 850mg
b.d., atorvastatin 10mg, lisinopril, and nifedipine.

Mr Williams does not drink alcohol, but he occasionally eats fast food and does binge eating
when stressed. After a recent divorce, he reports that financial and work pressures are causing
him some depression.

In the past, Mr Williams participated in weight loss programs and consulted a dietitian, which
were not effective. It would be benificial for him if you could evaluate his condition and offer his
possible options includng bariatric surgery.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely

Doctor

Word count - 191

Purpose

Dr Desai
Gastroenterologist
City Hospital
Easton

30 August 2019

Dear Dr Desai

Re: Mr Adam Knowles

DOB: 22.08.1951

Thank you for seeing Mr Adam Knowles, a 68-year-old patient with suspected pancreatic
malignancy, for evaluation and possible treatment.

On 02/08/2019, Mr Knowels presented with heartburn for which he self-treated with over-the-
counter antacids although it was ineffective. He is physically active. He is a non-smoker for the
past 10 years, but he drinks socially. He also has a history of cholecystectomy due to gallstones.
Omeprazole 20mg twice daily for 8 weeks was prescribed.

Despite treatment, Mr Knowels returned to my surgery on 30/08/2019 with no improvement in

his reflux symptoms. In addition, he mainly complained back pain, accompanied by diarrhoea,
pale stools, abdominal pain on eating, and fatigue. There was a significant 2-killogram weight
loss (from 94kg to 92kg) in a month time.

On assessment, abdomen is distended and tendered with jaundice in his eyes and skin.
Pathological report revealed high levels of bilirubin (9mg/dl), amylase (400u/L), ALT (60u/l),
Albumin (6g/dl) and ALP (120u/lL).

I suspect the possibility of pancreatic malignancy and have discussed with Mr Knowles about his
examination findings and blood results. It would be benificial for him if you could assess him at
your earliest convinence and arrange for endoscopy.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely

Doctor

Word count - 193

  Despite advice from a dietitian and attendance at weight-loss programs, he has not
been able to lose his weight significantly.

.
Despite treating himself with antacids, his symptoms were not relieved. (subjects – he, his
symptoms) thus false.
Despite him treating himself with antacids, his symptoms were not relieved.
 Refer
Dr Desai
Gastroenterologist
City Hospital
Easton

30 August 2019

Dear Dr Desai

Re: Mr Adam Knowles, DOB: 22.8.1951

Thank you for seeing Mr Knowles, a 68-year-old retired management consultant, with upper
gastrointestinal symptoms for urgent assessment.

Mr Knowels has 2kg weight loss over the last 4 weeks. His abdomen is tender and slightly
swollen. There are signs of jaundice in his eyes and skin. On reviewing blood tests, his liver
function test revealed high levels of bilirubin, liver enzymes, and amylase (400u/L).

Mr Knowels first visited my surgery a month ago with indigestion which was not resolved
despite self-medicating with over-the-counter antacids. Therefore, PPI (omeprazole 20 mg
twice daily) was prescribed; he was planned to be reviewed in 4 weeks’ time.

Today, Mr Knowels reports new symptoms: back pain, diarrhoea, pale stools, abdominal pain
on eating, and fatigue accompanied with no improvement in his gastroesophageal reflux
symptoms.

Mr Knowels is physically active. He has been a non-smoker for 10 years, but he drinks socially.
He has a past history of cholecystectomy due to gallstones in 2008.

I suspect the possibility of pancreatic malignancy and have discussed his examination findings
and blood results with Mr Knowles. It would be benificial for him if you could assess him at your
earliest convinence and arrange for an endoscopy.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely

Doctor

Word count – 197

Discuss – something with someone, no about

Given his symptoms, I suspect/ I am concerned about
I suspect –may have

Thank you for seeing Mr Knowles, a 68-year-old retired management consultaant, with upper
gastrointestinal symptoms for urgent assessment.

Mr Knowels has lost 2kg weight over last 4 weeks. On examination, abdomen was tender and
slightly swollen. There are signs of jaundice in his eyes and skin. On reviewing blood tests, his
liver function test revealed high bilirubin and liver enzymes with an amylase level of 400u/L.

First visit, a month ago – indigestion not resolved despite self-medicating antacids/ PPI
prescribed (omeprazole 20 mg twice daily) plan to review in 4 weeks’ time

Today reports new symptoms – back pain, diarrhoea, pale stools, abdominal pain on eating and
fatigue no improvement in gastroesophageal reflux symptoms

Usually fit/ well (physically active) non-smoker (10 years)

Social drinker
Pmh – cholecystectomy (2008) – gallstones

Request – suspect pancreatic malignancy

Endoscopy ASAP

Main
Secondary
Risk factors
Past attempts

I am writing to refer Mr David Taylor, a 38-year-old landscape gardener, for further

management.

On 12/08/10, Mr Taylor presented with pain and swelling of his left knee joint, leading to
difficulty in strengthening his left leg. Examination revealed the swollen left knee joint with
tenderness on medial aspect that causes him limp. He is physically active and has a history of
twisting left knee 6 months ago which responded to painkillers. Voltarin 50 mg b.d. was
prescribed.
Mr Taylor is a chronic smoker who smoked 20-30 cigarettes/day in the past; however, he
currently smokes 15 cigarettes/day following my suggestion. Despite treatment with Voltarin,
he suffered intermittent attacks of pain and swelling of the joint causing impaired passive and
actice movement of his left leg.

I suspect injury of medial cartilage. MRI scan was ordered which revealed damaged medial
cartilage. Ms Taylor is now keen on to solve the problem as this injury is inhibiting his full
productivity, resulting in finicial problem. For him, I have already arranged an appointment with
you at 8am on 21/11/10.

It would be benificial for Mr Taylor if you could assess his injured left knee joint and remove
damaged cartilage.

Discharge
Admission
Hospital treatment, progress, procedure
Discharge medication, instruction, follow-up
Patient need, request

Without- past continuous

With duration – past perfect continuous
Dr Giovanni DiCoccio
Proud-hurst Family Practive
231 Bright field Avenue
Proudhurst

18 March 2018

Dear Dr DiCoccio

Re: Ms Bethany Tailor

Your patient, Ms Bethany Tailor, a 35-year-old patient with schizophrenia, is now ready to be
discharged and follow up at your clinic.

On 01/03/2018, Ms Tailor self-admitted to hospital for decompensated schizophrenia. She was

suffering from auditory commands and visual hallunications with delusion. On examination, she
was agitated, aggressive and responded to internal stimuli with though blocking and latency.

Given Ms Tailor symptoms, an antipsychotic medication (risperidone) was prescribed. Nursing

management was carefully provided to ensure medical compliance as her symptoms were due
to poor compliance of his medications in the past. Objective signs of psychosis were carefully
assessed, and she was redirected from delusion. We also helped to maintain her behaviors
under control and provided therapy if possible.

Ten days later, her condition improved. She ceased hallucinating with lesser disorganized
thinking, thought block and latency. She could focus on daily activities with minimal delusions.

On today’s assessment, Ms Tailor’s insight is good with fair judgement. She is discharged on
risperidone 4mg nightly by mouth; risperidone 1mg b.d. prn can be added if agitation or
psychosis develops. She will be followed-up at Proudhurst Mental Health Clinic.

Should you require any information, please do not hesitate to contact me.
Yours sincerely

Doctor

Word count – 193

Dear Dr. DiCoccio,

Re: Bethany 35 years of

Tailor, age

Your patient, Ms Tailor, admitted herself on 1 March 2018 with decompensated

schizophrenia. She is now ready for discharge and follow-up at your clinic.

On admission, she was experiencing significant thought disorders, including

thought blocking and latency. She was also exhibiting delusions and experiencing
auditory command and visual hallucinations.

During her stay in hospital Ms Taylor was placed back on her medications, and her
mental condition has stabilised and she is able to focus on her activities of daily
living. Her insight is now good and judgment is fair. Her nursing management in
the hospital focused on compliance with her antipsychotic medications,
behavioral control, and therapy. Since 10 March, she has not reported visual or
auditory hallucinations.

Ms Tailor is on oral Risperidone 4mg nightly. Additional oral risperidone 1mg can
be administered as needed twice daily for agitation or psychosis. She will be
discharged from the hospital to her apartment where she lives alone. She will
follow-up at Proudhurst Mental Health Clinic to continue her treatment of chronic
schizophrenia. She will follow-up with you in order to avoid non-compliance of
her medications or substance abuse.

If you have any queries, please contact me.

Yours sincerely,
Dr James Banerjee
Consultant Cardiologist
Sanditon City Hospital
Sanditon

15 May 2021

Dear Dr Banerjee,

Re: Ms Eleanor Bennet

32 Station Road, Oakville
DOB: 06.12.1975

I am writing to refer Ms Eleanor Bennet, a 45-year-old patient who underwent a heart attack,
for your specialist advice and review of her medications.

Ms Bennet, a commercial lawyer, experienced a heart attack at airport after long-haul flight on
08/2/2021. Emergency defibrillation was done; she was immediately admitted and stented at
Oakville General Hospital.

After her divorce, Ms Bennet is experiencing extreme stress as she is worried by her
exhusband’s care for her 2 daughters, causing a custody contested. She smokes 20
cigarettes/day, and she has increased her alcohol intake to 40 units/week since 2019. She only
exercises once per month. Her current BMI is 29. She also has a family history of heart disease.

Ms Bennet was discharged on atorvastatin 80 mg daily and captopril 50mg twice daily from
which she is suffering from side effects: dizziness, headaches and diarrhoea episodes. Drug side
effects and poor relationship with her caregiver (mother) are adding more stress to her. She
wishes to discontinue captopril and is reluctant to start a new medicaton. In addition, she does
not attend cardiac rehabilitation sessions.

It would be benificial for Ms Bennet if you could review her medications and encourage lifestyle
changes.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely,

Doctor
Ms Jane Graham

Occupational Therapist

Newtown Occupational Therapy

10 Johnston Street

Newtown

30 August 2019

Dear Ms Graham

Re: Mr Barry Jones

54 Woods Street, Newtown

DOB: 11.06.1973

I am writing to request a workplace assessment for Mr Barry Jones, a 46-year-old forklift driver
who has been off from work for three months after he injured his back at work trying to move a
heavy box off the floor.

On 31/5/2019, Mr Jones presented with severe lower back pain for which I prescribed
painkillers, arranged to take off from work, and referred to a physiotherapist. For the past 3
months, he has been compliant with his physiotherapy and is recovering from his injury as
expected. He currently works for 30 mins per day although he reports that as tiring.

Mr Jones is eager to return to work in some capacity but still suffers some discomfort in his back
after prolonged sitting. Please note that his job requires prolonged sitting or occational heavy-
lifting. I do not believe he is ready to return to work in his previous capacity, but may return if it
can be arranged for him to avoid heavy lifing and take regular breaks. His employer is supportive
of his return to work.

Could you please conduct an evaluation of Mr Jone’s workplace and provide advice as to what
duties he could perform there consistent with his recovery.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely

Doctor
 Refer
Dr Jan Walker
Pulmonologist
Epstein Clinic
393 Victoria Road
Richmond

27 February 2019

Dear Dr Walker,

Re: Ms Susan Forrest, DOB: 19.05.97

I am writing to refer Ms Susan Forrest, who may have contracted community-acquired

pneumonia for further assessment and evaluation of her condition.

Ms Forrest presented on 25/02/19 feeling rundown combined with shortness of breath, an

increased need for Ventolin and a week-long cough. Upon examination, her vital signs were
normal, and she had a PEF of 330L/min. As a precaution, a chest X-ray and full blood count
were ordered.

Two days later, Ms Forrest returned with worsening shortness of breath. The cough was now
accompanied by green phlegm and she was notably more fatigued. Her temperature indicated
a slight fever and her PEF had declined to 200L/min. Her chest X-ray revealed some
consolidation in the right lung, while her full blood count is yet to be confirmed.

Ms Forrest has smoked 10-15 cigarettes a day for 7 years, although she is physically active and
fit. Her father has asthma and her brother has bronchitis, and she has been asthmatic since
childhood. Her current medications include Ventolin and Symbicort.

It would be appreciated if you could confirm the diagnosis as well as submitting Ms Forrest for a
CT scan. Further, please review her current medications in addition to reinforcing the benefits
of quiting smoking.

Yours sincerely,

Doctor

Purpose
1st presentation
2nd presentation
Background information
Request
 Refer
Dr Grantley Cross
Endocrinologist
City Hospital
Suite 32
55 Main Road
Newtown

24 February 2019

Dear Dr Cross

Re: Mr Brette Collister, DOB: 21.12.1973

Thank you for seeing Mr Brette Collister, whose results are indicative of type 2 diabetes
mellitus, for assessment and management of his condition.

Since 26/11/2018, Mr Collister has steadily gained weight and now has a BMI of 36.2. He has
also complained of tiredness, sore eyes and dizzy spells, indicating possible orthostatic
hypotension. A range of tests were conducted, the results of which indicated high random and
fasting glucose, HbA1c and cholestrol levels.

In spite of his worsening symptoms, including a recent decline in visual acuity, Mr Collister has
been non-compliant with medical and dietary advices. Having also expressed concern, his wife
has consistently prepared healthier meals for him and the family, which he has declined to eat,
opting instead for fast food and snacks.

Mr Collister is a forklift driver who partakes in mostly sedentary leisure activities and drinks an
average of 30 units of alcohol per week.

In addition to Mr Collister’s ongoing management and treatment plan, kindly arrange a

personal blood glucose meter and educate him to use.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely

Doctor
 Refer
Dr Angela Melrose
Gynaecologist
Portsmouth Hospital
Portsmouth

3 January 2019

Dear Dr Melrose

Re: Mrs Helen Fielding, DOB: 15.11.1981

Thank you for seeig Mrs Helen Fielding for further investigation and diagnosis of possible
fibroids.

A mother of two, Mrs Fielding presented on 03/01/2019 with suspected menorrhagia after
experiencing heavy menstruation for a period of 9 months. She appeared pale and fatigued,
though her appetite was unchanged. Her systemic examination was unremarkable; however, a
pelvic examination found she has an enlarged uterus. The vaginal and speculum inspections
were also normal.

Mrs Fielding’s menstruation typically lasts 6 to 7 days and she uses both tampons and sanitary
pads which require frequent changing. Although she does not experience any intermenstrual or
post-coital bleeding, she passes large clots of blood. For this reason, she has been advised to
take Floradix iron supplements to help raise iron levels and replace aspirin with Panadol.

Blood tests have been ordered for Mrs Fielding, the results of which will be forwarded to you.
She is overdue for a pap smear, since her last test was 26 months ago. In addition, a
transvaginal ultrasound is needed to identify the cause of her unexplained bleeding.

It would be appreciated if you could attend Mrs Fielding’s immediate requirements as well as
arranging ongoing care.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely

Doctor
 Refer
Dr Fiona Watson
Gastroenterologist
Kings Cross Medical Centre
Kings Cross

6 Janurary 2019

Dear Dr Watson

Re: Mrs Judith Henning, aged 54

I am writing to refer Mrs Judith Henning for your professional assessment following recent
bouts of nocturnal chest pain. An endoscopy is required to confirm a diagnosis.

Mrs Henning experienced compression-like chest pains which were eased by elevating her
upper body using 2 pillows. These symptoms have occurred 3 times over the last 5 days and are
suggestive of gastroesophageal reflux disease. Her pain is only present when recumbent and
typically after comsuming large meals, especially at night. She feels no pain on exertion, and
she has been advised to avoid eating 2-3 hours before sleep.

Mrs Henning has chronic obstructive pulmonary disease for which she uses both combivent and
albuterol inhalers. For the last 6 months, she has been taking over-the-counter medications for
reflux. Although her physical examination was unremarkable, her COPD and medication have
not been ruled out as possible contributing factors to the new onset of chest pain.

Your assistance is appreciated in further investigating Mrs Henning’s condition to determine

whether she has GERD and if it is related to her COPD. In addition, please review if she should
continue with her current medications and forward me the results of her endoscopy as soon as
they become available.

If you have any queries do not hesitate to contact me.

Yours sincerely

Doctor
 Refer
Dr Jones
Newtown Memory Clinic
400 Rail Road
Newtown

1 August 2018

Dear Dr Jones,

Re: Mrs Patricia Welshman, DOB: 10/07/1933

Thank you for seeing Mrs Patricia Welshman who require further assessment for deteriorating
state of her memory.

Mrs Welshman presented with his daughter on 01/08/2018 following changes in her behavior,
including forgetfulness and erratic decision making. Three days prior, she went missing on a
shopping trip, and when found by the police acted in an aggressive manner which is consistent
with recent behavior. In addition, there has been a notable decrease in her weight over the last
10 months leading to doubts over how well she has been eating. It should be noted that she
was reluctant to attend today’s consultation.

On a previous visit, Mrs Welshman was given a Webster pack for managing her medication
which she has been compliant, and this is reflected in her pathology results.

Mrs Welshman has a positive family history of Alzheimer’s disease giving rise to concerns about
her recent behavior. A mini memory test was performed which found her short-term memory
to be poor and she was unable to recall the day, date or month.

It would be beneficial for Mrs Welshman if a full memory assessment could be undertaken to
confirm whether she has Alzheimer’s disease or another form of dementia.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely,

Doctor

Presented
Webster pack
family history
minimemory
 Refer
Dr D Kurac
Surgeon
North-western Weight Loss Surgery
393 Victorian Road
Plumpton

4 December 2021

Dear Dr Kurac,

Re: Mr Andy Williams, aged 65

I am writing to refer Mr Andy Williams, who is morbidly obese, for assessment of his suitability
for weight-loss surgery.

Mr Williams has been obese since childhood and has experienced a steady increase in weight
throughout his life. His current BMI is 46.6kg/m2; he has type 2 diabetes, hypertension and
sleep apnoea, for which he takes NPH insulin, metformin, lisinopril, and nifedipine. His father
and sister are also obese.

Normally, Mr Willliams has three meals a day, with the largest being dinner eaten late in the
evening. He reports consuming fast food approximately 4 times a month and binge eating when
under stress. In the past, he has undertaken medical and commercial weight loss programs,
consulted a dietician, but to no effect.

Mr Williams is now keen to get his weight under control. He has a supportive partner and is
prepared to to consider surgical intervention should you deem it necessary. Please note that in
the past he was reluctant to consider such a procedure due to the perceived risks.

It would be appreciated if you could evaluate and treat Mr Williams, including exploring his
options regarding bariatric surgery.

If you have any queries, please do not hesitate to contact me.

Yours sincerely,

Doctor

Plan
Background, diseases, medical history
Diet weight programs
Refer
Dr D Kurac
Surgeon
The Weight Centre
393 Victorian Road
Richmond
Melbourne

15 June 2018

Dear Dr Kurac

Re: Andy Williams, aged 65

Thank you for seeing Mr Andy Williams, a long-term sufferer of obesity, for further evaluation
and treatment including weight-loss surgery.

Mr Williams has been obese since childhood and has experienced a steady increase in weight
thoughout his life. His current weight is 155.5kg with a BMI of 46.4. On reviewing investigations,
his blood glucose levels ranged between 100-130mg/dl in the morning with triglyceride level of
201mg/dl and serum insulin level of 19 uIU/ml. He also has a strong family history of obesity.

Mr Williams has an underlying history of type 2 diabetes and hypertension, for which he is
taking NPH insulin 30 and 70 units before breakfast/ before or after dinner, metformin 850mg
b.d., atorvastatin 10mg, lisinopril, and nifedipine.

Mr Williams does not drink alcohol, but he occasionally eats fast food and does binge eating
when stressed. After a recent divorce, he reports that financial and work pressures are causing
him some depression.

In the past, Mr Williams participated in weight loss programs and consulted a dietitian, which
were not effective. It would be benificial for him if you could evaluate his condition and offer his
possible options includng bariatric surgery.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely

Doctor

Refer
Dr Jason Roberts
Gastroenterologist
Newtown Hospital
111 High Street
Newtown

18 June 2018

Dear Dr Roberts,

Re: Ms Anne Hall, DOB: 19.09.72

I am writing to refer Ms Hall, a 45-year-old secondary school teacher, who presented with a 2-
week history of dysphagia for solids for further management.

Ms Hall believes the problem commenced 2 weeks ago after an upper respiratory tract
infection for which she self-treated with an over-the-counter Chinese herbal product with
unknown constituents. She also reports epigastric pain radiating to her back (thoracic vertebra
12 level) and 1-2kg weight loss. On examination, there is no palpable lump or no signs of
anxiety.

Ms Hall has recently increased her coffee intake. She takes aspirin for 2-3 times a month. She
ceased smoking 16 years ago. She socially drinks mainly spirits. Her BMI is currently 28.2. She
has a past medical history of dyspepsia (2012) and dermatitis (2014) for which she was treated
with oral and topical corticosteroids. She is allergic to codeine. She has a family history of peptic
ulcer.

I suspect Ms Hall may have a gastro-oesophageal reflux disease with possible stricture.
Therefore, I have recommended that she reduces her coffee and alcohol consumption and
ceases the over-the-counter product. I have prescribed pantoprazole 40mg daily as well.

I would be grateful if you could arrange an endoscopy if required and provide Ms Hall with a
definitive diagnosis.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely,

Doctor
 Transfer
Dr Ben Jacobs
Registarar
Mount Pleasant Rehabilitation Unit
206 Railway Parade
Mount Pleasant

10 December 2021

Dear Dr Jacobs

Re: Mr Julian McDonald, DOB: 12/01/1950

Thank you for accepting Mr Julian McDonald into your care for further rehabilitation and
management post knee replacement surgery.

Mr McDonald underwent a routine left total knee joint replacement on 16/06/2019 resulting
from chronic osteoarthritis. Postoperatively, there were numerous issues with with his pain
management, and he has been slow to mobilise. His sleep patterns are disturbed and he snores
nightly. He normally consumes at least 10 units of alcohol per day and has shown signs of
withdrawal including DTs and agitation.

A retired serviceman, Mr McDonald has had PTSD since 1991, is hypertensive and has a BMI of
35. He lives with his pets in a caravan that lacks both plumbing and electricity. He is divorced,
estranged from his children and has few friends.

Kindly start Mr McDonald’s physiotherapy at the earliest possible opportunity. Please also
arrange a visit by social services to his residence in order to determine its suitability for longer
term recuperation. It would be also advisable to consult both a sleep specialist regarding his
snoring and a guidance counsellor to address his alcohol intake.

Finallly, Mr McDonald’s sutures are due to be removed on day 10 and an appointment has been
made to see his specialist on 01/08/2019. A complete list of Mr McDonald’s current
medications is attached to this letter.

Please contact us with any queries.

Yours sincerely

Doctor

I would be grateful if you could assess Mr Collister’s condition at your earliest convenience to
confirm the preliminary diagnosis and recommend a management plan.
 Discharge
Dr Arnold Zelmer
General Practitioner
10 Hotham Street
St Kilda

11 December 2021

Dear Dr Zelmer

Re: Mrs Anne Jenkins, DOB: 20/04/1929

Your patient, Mrs Anne Jenkins, will be discharged from our emergency department today
following a fall at home. While no specific injuries were found, there are concerns surrounding
her general level of self-care that we would like you to review.

Mrs Jenkin’s assessment showed some mild memory loss, long standing atrial fibrillation and
some leukocytes in her urine. Older bruises and grazing were noted on her elbows, which is
consistent with previous falls. X-rays of her chest, hips and pelvis, as well as her basic blood test
results, were all normal.

Attempts were made to contact Mrs Jenken’s adult children and messages were left. Her
neighbour reported that she has had several recent falls requiring assistance likely due to
having to move between the ground floor living space and her bathroom on the first floor. The
neighbour also observed evidence of possible cognitive decline.

It would be appreciated if you could conduct a geriatric review of Mrs Jenkin’s circumstances as
she may require home help or placement into care. In addition, please assess her TFT, digoxin
levels, and MSU results, which will be available on 09/08/2018.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely

Doctor

Purpose
Main issue
Secondary issue
Other details
Request
 Discharge
Dr Giovanni DiCoccio
Primary Care Physician
Proud-hurst Family Practice
231 Bright-field Avenue
Proudhurst

18 March 2018

Dear Dr DiCoccio

Re: Ms Bethany Tailor, aged 35

Your patient, Ms Bethnay Tailor, who self-admitted to the psychiatric ward of St. Mary’s Public
Hospital on 01/03/2018 with decompansated schizophrenia, is making a good progress and
ready for discharge today.

On admission, Ms Tailor was suffering from auditory commands, visual hallucinations and
delusions. In addition, she was agitated, aggressive, and had thought disorders including
thought blocking and latency.

During Ms Tailor’s stay in hospital, she was commenced on an antipsychotic medication

(risperidone). Her nursing management in hospital focused on compliance with her
antipsychotic medications, behavioral control, and therapy.

Since 10 March, Ms Tailor has not reported visual or auditory hallucinations. There are no signs
of thought blocking or latency with minimal delusions. Her insight is now good and her
judgment is fair. She is able to focus on her activities of daily living. She is discharged on
risperidone 4mg nightly by mouth. Additional oral risperidone 1mg can be administered as
needed twice daily for agitation and psychosis.

Ms Tailor will follow-up at Proudhust Mental Health Clinic to continue her treatment of chronic
schizophrenia. Kindly monitor Ms Tailor’s medication adherence and substance abuse as her
schizophrenia can decompensate if she is not on medications or abuse substances.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely

Doctor

Word count- 197

Treat, medicate- with, prescribe - with
Workplace assessment / Mr Jones/ keen to return to work after recovering from recent back
injury
Mr Jones 46 yrs old forklift driver in large warehouse
He requires prolonged sitting and occasional heavy-lifting

3 months ago, sustained back injury while lifting heavy box off the floor at work.
Seeing a physiotherapist over last 3 months
Has been compliant with physiotherapy
Recovering well- currently walks 30 mins a day- reports it is tiring

As he has been off work for 3 months, discouraged and eager to return to work.
Increased ROM – moving stiffly
Experiences pain after 20-30 minutes of sitting

I do not believe he will be able to perform his duties in previous capacity

However, he may return if arranged no lifting/ with regular breaks
His employer is supportive

Request: assess his workplace and advise on duties he can perform

Start – Background

Given his symptoms – Considering

Given + noun
Given that + S+ V
Ms Jane Graham
Occupational Therapist
Newtown Occupational Therapy
10 Johnston Street
Newtown

30 August 2019

Dear Ms Graham

Re: Mr Barry Jones

DOB: 11.06.1973

I am writing to request a workplace assessment for Mr Jones, who is keen to return to work
after a back injury.

Mr Jones is a 46-year-old forklift driver in large warehouse. His job requires prolonged sitting
and occasional heavy-lifting. Three months ago, he sustained back injury while lifting a heavy
box off the floor at work, for which he has been seeing a physiotherapist over the last 3
months, and has been compliant with his physiotherapy.

Currently, Mr Jones is recovering well despite him suffering some stiffness. He is able to walk 30
minutes a day although he reports it is tiring. As he has been off work for 3 months, he feels
discouraged and is eager to return to work. However, he still experiences pain after 20-30
minutes of sitting.

Therefore, I do not believe Mr Jones will be able to perform his duties in previous capacity;
however, he may return if it can be arranged for him to avoid heavy lifting and take regular
breaks. His employer is supportive of his return.

It would be benificial for Mr Jones if you could assess his workplace and advise on what duties
he could perform.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely

Doctor

Word count – 196

Your patient, Mrs Sally Fletcher 25 year old admitted to surgical ward of Fairbanks Hospital on
25/03/2018 for laparoscopic endometriotic cyst removal is now ready to be discharged and
follow-up at your clinic.

When admitted, Mrs Fletcher had been suffering from painful periods for 3 years, for which she
self-treated with naproxen, but the pain persisted. An ultrasound scan revealed a 6 cm cyst in
her abdomen. Since she has been trying to conceive for a year, she arrived at the ward this
morning and underwent laparoscopic surgery, which successfully removed the cyst without
complication.

Return to regular diet today

Encourage oral fluids
Ampulate as she tolerates.

Incision sites clean and dry

Driving is prohibited till 24-48 hours after the last dose of analgesics.
Sexual activity can be resumed in two weeks.