OET Letter Types Compared: Referral, Discharge, Transfer and Advice

The OET Writing sub-test asks you to produce one letter from a set of case notes. The most common letter types are referral, discharge, transfer, and advice. Each one shares a common skeleton but differs in audience, purpose, and the weighting that the examiner applies to the rubric. Understanding these differences is the single fastest way to move a Grade C+ writer to Grade B. This article walks through each type, with conventions, opening and closing phrases, and a comparison table at the end.

The shared structure underneath all four types

Before the differences, the common ground. Every OET letter follows roughly the same skeleton. There is a salutation, a Purpose statement in the opening paragraph, two or three body paragraphs covering relevant history and current status, and a closing paragraph that restates the request and offers a contact route. The word count window is 180 to 200 words. The register is professional and measured. Names are written in full at first use and as titles plus surname thereafter. Dates are written in full to avoid ambiguity, so “12 May 2026” rather than “12/5/26.”

What varies between letter types is the purpose, the audience, the register, and which parts of the case notes count as relevant. For a fuller walkthrough of the general writing process, see our how to write an OET letter guide.

The referral letter

A referral letter requests specialist input on a patient under your care. The recipient is another clinician, usually a specialist consultant or another health professional with specific expertise. The Purpose is a clear, specific request. The 2026 rubric is particularly strict about Purpose in referral letters, because vague openings like “Please see this patient” are now penalised more heavily than they were in 2024.

A strong referral opening leads with the request. “I am writing to refer Mrs Khan, a 67-year-old woman with a six-month history of progressive shortness of breath, for cardiology assessment.” That single sentence covers patient, key clinical feature, and the specific specialist input requested.

The body paragraphs should cover relevant history, investigations to date, current medication, and any red flags. Irrelevant historical detail is a common pitfall. A cardiology referral does not need the patient’s appendicectomy from 1998 unless it affects the current presentation.

Closing phrases that work well: “I would appreciate your assessment and any recommendations for ongoing management. Please do not hesitate to contact me on extension 4421 if you require further information.”

For a fuller worked example, see our OET referral letter page.

The discharge letter

A discharge letter is written when a patient is leaving an inpatient setting and care is being handed back to a community provider, usually the GP. The recipient assumes some background but needs to know what happened during the admission and what ongoing care is required.

The Purpose statement in a discharge letter is a confirmation of discharge plus an outline of ongoing care needs. “I am writing to inform you that Mrs Khan was discharged from Ward 12 today following a successful elective hip replacement, and to outline her ongoing care requirements.”

Discharge letters reward thoroughness in three areas: the reason for admission, the procedure or treatment given, and the current status with ongoing needs. Medication changes are particularly important. If a long-term medication was stopped or a new one started, this must be explicit.

The closing typically asks the GP to take over routine follow-up. “I would be grateful if you could arrange a routine review within two weeks. The community physiotherapy team will be in contact directly to schedule home visits.”

For a deeper walkthrough, see our OET discharge letter page.

The transfer letter

A transfer letter hands over active care from one clinical setting to another, for example from a ward to a rehabilitation facility, or from an acute hospital to a step-down unit. The recipient is taking over active management immediately, often within hours, so the information needs are different from a discharge letter.

The Purpose statement is a handover. “I am writing to transfer the care of Mrs Khan, a 67-year-old patient currently on Ward 12, to the rehabilitation unit at St Mary’s for ongoing recovery following hip replacement surgery.”

Transfer letters reward current detail over historical detail. The recipient needs current medication with doses and times, current observations, any outstanding investigations, and any active care decisions. A transfer letter that reads like a discharge letter, with lots of background and not much current detail, loses Content marks under the 2026 rubric.

The closing should confirm continuity. “Mrs Khan’s daughter has been informed of the transfer and will be available by telephone. Please contact me directly if any clarification is required before her arrival.”

For a worked example, see our OET transfer letter page.

The advice letter

The advice letter is the outlier of the four types because the audience is not a clinician. It is usually a patient, a family member, or a non-clinical caregiver. The register shifts. Medical terminology should be either avoided or explained in everyday language. Sentence length tends to be shorter, and the tone should be supportive without being condescending.

The Purpose statement explains why the letter is being written and what the reader needs to know. “I am writing to provide advice on managing your blood pressure at home following your recent clinic visit, and to outline the lifestyle changes that we discussed.”

Advice letters reward clarity and structure. Bullet-style instructions work well in this letter type, although they should still be written as full sentences rather than fragments. The closing should encourage contact if the reader has questions. “Please do not hesitate to call the practice if you have any questions or if your readings rise above the levels we discussed.”

For a worked example, see our OET advice letter post.

Side-by-side comparison

The pattern that emerges from this table is that the four letter types are not interchangeable, even though they share a skeleton. Choosing the wrong opening, the wrong audience, or the wrong register can cost you a full band even when the writing is technically clean.

Phrase banks worth memorising

Memorise phrase banks, not full templates. Templates are visible to markers; phrase banks blend into your own writing. Useful openings include “I am writing to refer,” “I am writing to inform you,” “I am writing to transfer the care of,” and “I am writing to provide advice on.” Useful closings include “I would be grateful if,” “Please do not hesitate to contact me on,” and “I look forward to your assessment in due course.”

For a curated set of phrase banks and structures, see our OET letter templates page.

What examiners weight differently across types

Under the 2026 rubric, the examiner applies the same six criteria to every letter, but the emphasis shifts. Referral letters are weighted most heavily on Purpose and Content. Discharge letters are weighted on Content and Organisation. Transfer letters are weighted on Conciseness and Clarity, because the recipient needs to act quickly. Advice letters are weighted on Genre and Style, because register is the defining feature of that letter type.

Understanding this shift is the single biggest difference between a Grade C+ candidate and a Grade B candidate. The Grade C+ candidate writes every letter the same way. The Grade B candidate adjusts the emphasis based on the letter type in front of them.

Final thoughts and next steps

The four letter types are different tools for different jobs. The skeleton is the same, but the proportions change. Once you internalise these differences, you stop writing every letter as if it were a referral, and you start matching the letter to the purpose. That shift alone is worth a full band for most candidates at the Grade C+ ceiling.

If you would like targeted feedback on the letter type you find hardest, our human correction at OET writing services is the fastest way to identify your patterned weaknesses and close them before the exam. You can also explore the full pricing options at pricing.