Reading The Case Notes: What To Include, What To Leave Out

You are not scored on the case notes. You are scored on what you did with them: one of the six criteria asks whether content from the case notes is accurately represented, and another whether the length is appropriate with no irrelevant information included. OET publishes 19 real candidate letters with an assessor commentary and a grade badge on each, and we read all 19 for one question: where does selection go wrong. 

In 17 of them the assessor names a specific detail the candidate should have included, should have left out, or changed the meaning of on the way into the letter. Both of the two letters graded A are among the 17. This page sets out what the notes contain, what the five minutes allow, and what that evidence says about choosing. For the mark scheme those choices feed, see OET Writing.

The five minutes are reading time, and OET’s test-day guide says you may not write in them

The Writing sub-test runs 45 minutes, split into five minutes of reading time and 40 minutes of writing time. On paper, OET’s own test-day guide describes invigilators handing out the papers by profession and reminding candidates that you cannot write anything during the first five minutes of the test. OET does not say whether underlining counts, so the only safe reading of a sentence that says you cannot write anything is that the first pass over the notes happens in your head. 

One related rule is settled: OET’s advice on taking a sample test lists what may be on the desk for the paper test, pens, pencils, eraser, sharpener and a bottle of water, and says highlighters are not permitted during the test.

Two details soften that, and both come from OET rather than from exam folklore. The notes do not go away when the five minutes end: you can consult the task and the case notes at any point during the 40 minutes allocated for writing, not just during the reading time. And the 40 minutes are signposted, with invigilators warning you when ten minutes are left and again at five. So the five minutes are for deciding, the first minutes of the 40 are for marking up, and the two warnings tell you when checking has to start.

We have found that instruction stated only for the paper test. OET’s test-day guide for the computer modes does not repeat it, so treat the rule as confirmed for paper and check your own venue’s instructions if you are sitting on a computer.

The task instructions sit after the case notes, and they name the reader

What you are handed is three things, not one. The OET Test Handbook lists the stimulus material as background information on the context, profession-specific case notes or relevant documents, and the task instructions. Two of those three are reading; the third is the brief. 

The instructions are the part that tells you who the letter goes to and why, and OET’s writing guide puts them after the notes rather than before them, with the last section of the notes sitting just above the writing task.

That ordering is the reason to read backwards. The OET Ultimate Writing Guide says that where the task does not give you everything you need, you can usually find it in the final section of the case notes, just above the writing task, and it says separately that towards the end of the notes you will find reminders of the genre and style to use, such as expanding the relevant notes into complete sentences and not using note form. 

A candidate who reads the history first and the instructions last has spent the scarce minutes memorising details without knowing which reader they are for.

The instructions also fix the recipient’s title and address, which OET’s Writing preparation page says to use as specified. Which letter type that implies is a separate decision, and it changes what counts as relevant: a discharge letter and a referral built from the same notes do not carry the same content.

Relevance is decided by two questions about the reader, not by what the notes contain

OET’s guide gives a selection test, and neither half of it is about the notes. How you select information depends on whether there is an existing professional relationship between the patient and the reader, and on which aspect of the patient’s care that reader will be involved with. Everything in the notes survives or goes on those two answers.

The guide then works the same case twice to show how much the answers matter. A hospital occupational therapist discharging a patient to an occupational therapist at a care centre is writing to someone with no existing relationship with the patient, so the letter has to establish the patient’s current abilities and inabilities from scratch. 

Change the reader to the patient’s regular GP and the content changes shape: the abilities still matter, but as an update on how they have changed since the GP last saw the patient rather than as new information.

OET also gives the finishing test, which is about the reader again. By the end of the letter the reader should have a clear understanding of the situation and no more questions about further care, and the guide says plainly that if they do have questions, you have not included enough. That test is worth more than a word count, because it is the one the six writing criteria are built to measure.

OET names the social history as the first thing to drop, and its assessors name it in five letters

In the worked example above, the guide is specific about what goes. The case notes supply details of the patient’s children, grandchildren, profession and financial status, and the guide says these will not be needed for the reader because they will not impact the care they provide. 

In the second version, writing to the patient’s own GP, it repeats that the social history is still not necessary to include.

Then read the graded letters. Social detail is the single most frequently named irrelevant inclusion in the booklet, named in five of the 19 commentaries: the social history and habits of the patient in a Dentistry letter, social information in a Nursing letter, less relevant social details in a Medicine letter, social detail in a Physiotherapy letter that the assessor says the GP will already know, and in an Occupational Therapy letter the blunt finding that the social details included are irrelevant to the patient’s GP. A sixth letter is faulted for history of a different kind, a previous medical history that is slightly lengthy and partly irrelevant.

Three of those five letters were graded B or above, which tells you two things at once. Including the social history is the commonest selection error OET’s assessors record, and it is survivable on its own. What it does is spend words you have very few of. The task range is 180 to 200 words, and OET says there is no automatic penalty for writing over it, but that a letter significantly over the range has probably included irrelevant material or is poorly organised, so the length is read as a symptom of the selection rather than punished on its own. That is the mechanism behind the errors that cost a band.

Across 19 graded letters, leaving out and putting in go wrong about equally often

The booklet’s letters came from real candidates sitting sample test 5 for the first time, without access to the sample answer, so the commentaries describe first-attempt decisions rather than polished models. We classified all 19 by reading each commentary for three faults: something the assessor says should have been included, something the assessor says the reader did not need, and a detail whose meaning changed between the notes and the letter. 

The second covers content the reader did not need whether or not the assessor itemises it, which is why a letter faulted for a substantial amount of information the doctor already knew counts. Overlength and repetition on their own do not, and they are counted separately further down.

Here is the same reading letter by letter, so any row can be checked against the booklet.

Omission and over-inclusion appear at almost the same rate, which means the task is not a test of restraint and not a test of thoroughness but of judgement between them. And 17 of 19 means an unfaulted selection is rare even among the letters OET publishes as graded samples, which the booklet is careful to say are not templates: assessors can tell when a candidate repeats a learned template, because the letter is then not a good match for the case notes. 

One of the two A-graded letters is faulted for omitting the number of alcohol units a week and the date of discharge and commencement on medication, and the same commentary praises its excellent selection of case note details in the next sentence. The B-graded letter praised hardest for selection, told it has only selected the most relevant details, is faulted for three omissions in the two sentences before it. A letter can miss specifics and still read as well selected.

Every Medicine letter carries a date fault, and four of the five the discharge date

Because the five Medicine letters answer one brief, they work as a controlled comparison. All five are faulted on dates. The discharge date goes missing in four of them, and in three of those four the date the medication was commenced goes with it.

Four of the five lose the discharge date, in three different ways: omitted outright, left unclear, or misreported as a month when the notes said a week. The fifth loses a date somewhere else again, off the top of the letter. The grade spread across the five runs from C to A. The lesson is not that dates decide the grade, because clearly they did not. It is that a detail can be missed by everyone and still be the cheapest thing on the page to fix. 

When the case turns on a medication, the dates on which it started and the patient left hospital are what the reader needs to judge the timeline, which is why they are what to locate in the five minutes and what to put down first in the fortieth.

Paraphrase breaks accuracy in two ways OET names, and the graded letters add a third

Summarising means paraphrasing, and OET says the risk is changing the meaning while staying grammatical. Its guide names two mechanisms: not matching the exact meaning of a word in the case notes with the word you choose, and altering the timeframe by changing the tense. Its worked example is a patient who is moving to Centreville to live with a daughter, rendered in the letter as relocating to be nearer his daughter. The sentence is correct English and the wrong living arrangement.

Eight of the 19 letters, 42 per cent, are faulted for accuracy, and several carry more than one fault. The largest group is the first mechanism, a word that does not match: the notes’ home care written as care home, an independent living assessment rendered as monitored and assessed regularly, what the patient used to eat misreported, an oro-motor exam written up as a swallowing assessment, 20 cigarettes a day compressed into 20 PPD, and an exercise frequency the assessor calls not quite correct. 

The second group is dating: a timeline carried only by Before 3 months ago, today’s appointment turned into recently, and one week after discharge turned into a month ago. Worth noticing is that none of those three is the tense change OET describes. Its named mechanism is altering the timeframe by changing the tense; what its assessors actually fault is vague or wrong intervals, which a tense check will not catch. One fault belongs to neither mechanism: a Physiotherapy letter is marked for the inaccurate inclusion of embellished medication and further management details that were not in the case notes at all, which is invention rather than mistranslation.

A candidate posting in August 2026 in an OET forum for international medical graduates put it in one line: I wrote pruritic periorbital edema for itchy bulls-eye rash. I didn’t notice when I was taking the exam. That is the first mechanism in its sharpest form: fluent clinical vocabulary, applied to the wrong finding, in a rash whose shape is the diagnostic clue. Clinical knowledge is what makes the swap feel safe, which is one of the reasons OET is not a medical exam in the way candidates expect.

A letter is a summary of the notes, not a reordering of them

The structural failure that follows from poor selection is a letter that reads as the case notes in sentences. OET’s band descriptors price it directly. Heavy reliance on case note structure appears in the lowest described band for Organisation and Layout, band 1, and the graded booklet puts a grade B at 5 out of 7 on that criterion, so a letter that reads as the notes rearranged is not a near miss. The Conciseness and Clarity criterion asks how well the case is summarised rather than how completely it is transferred.

OET names three mistakes candidates make when deciding what is not relevant, and together they describe how the list forms. Candidates include information the reader already knows or that is outside the scope of the patient’s care; they provide too much background or historical detail to the current situation; and they fail to group similar information together, which OET says is what keeps the reader from having to re-read the letter. The third is the one that turns a summary into a list, because an ungrouped letter reads as the notes in the order the notes gave them.

OET sets them out in its guide post on Conciseness and Clarity. They show up in the booklet as organisation notes rather than content ones. A Nursing letter graded B is told its post-fall care requests would have been better summarised at the end instead of social information being introduced there, and a Speech Pathology letter graded B is told its results paragraph is slightly too long and that splitting it into swallowing detail and oro-motor detail may have aided the reader. Both are grouping decisions made during selection rather than during writing, which is why a grouping error survives the final read-through that a one-page writing checklist is built for.

The shorthand in the notes is the writer’s, and expanding it is a reader decision

Case notes are written in abbreviations because clinicians write notes for themselves. Your letter is written for one named reader, and OET prices abbreviation against that reader rather than against a list, grading it under Genre and Style. The criterion sets a default before it sets a scale: the use of abbreviations should not be overdone, thereby assuming common prior knowledge. 

OET’s Writing assessment criteria then give three steps, from a colleague in the same discipline, through a colleague in a different discipline or a specialist writing to a GP, to a readership that includes the patient. The band descriptors behind them do not grade the steps separately; they ask only whether abbreviations are used appropriately for document and recipient at the top, whether over-reliance may distract the reader in the middle, and whether mis-use or over-use causes strain at the bottom, which is the scale we set out band by band in the assessment criteria.

No published OET list of permitted abbreviations exists that we can find, and the criterion explains why one would not help. The test is fit to reader, so the same abbreviation can be correct in one letter and a fault in the next. What the graded letters show is the failure in the other direction: a Medicine candidate who kept the note form and wrote 20 PPD for twenty cigarettes a day was marked for it, and marked under coverage of the case details rather than under style, because the shorthand that was efficient in the notes had stopped carrying the information. 

The guide adds a second test that has nothing to do with the reader’s seniority. Where a condition has more than one abbreviation in global use, atrial fibrillation being AF to some readers and AFib to others, write it out, because an abbreviation the reader has to decode interrupts the reading. The exceptions it names are the abbreviations that are more common than the full form to patients and healthcare professionals alike: MRI, BMI, CT and ECG.

The case notes themselves tell you which way to go. OET says the reminders near the end of the notes instruct you to expand the relevant notes into complete sentences and not to use note form, so the instruction to unpack is in the paper in front of you.

What to do in five minutes you are not allowed to write in

Put the evidence together and the five minutes have a shape. Read the task instructions first, because they are at the end and they name the reader and the request. Answer the two reader questions before any history goes in: does this reader know the patient, and which part of the care are they taking on. Then read the notes once with those answers fixed, and what you are looking for is not interesting detail but the small set of facts the reader needs in order to act, plus the dates that make the sequence legible.

The three faults in the booklet tell you what to check as the 40 minutes start and you can finally write. Have you kept a detail the reader already holds, which is where social history usually sits. Have you dropped something the reader needs to act, which is where dates and recommendations usually sit. And does every phrase you paraphrased still mean what the notes meant, which is where near-synonyms and tenses usually sit. 

Practising those three questions on real briefs is more useful than collecting more case notes, and OET’s own pacing advice points the same way: one sample test every two to three weeks, with the weeks between spent on whatever caused the errors rather than on another test.

If you want to see the decision made end to end on one brief rather than described, our worked nursing letter in OET writing for nurses takes a single set of notes through selection, grouping and the marked result.

Frequently asked questions

How much reading time do you get for OET case notes?

Five minutes, inside a 45-minute sub-test that is split into five minutes of reading time and 40 minutes of writing time. OET’s test-day guide for the paper test says invigilators remind candidates that you cannot write anything during those first five minutes, and that you are warned when ten minutes remain and again at five. You may consult the task and the case notes at any point during the 40 minutes, so the reading time is for deciding rather than your only chance to read.

Can you write or annotate during the five minutes of reading time?

Not on the paper test. OET’s own test-day guide states that invigilators remind candidates they cannot write anything during the first five minutes. OET does not say whether underlining counts as writing, so plan on a first pass with nothing in your hand. Highlighters are out in any case: OET lists pens, pencils, eraser, sharpener and water as what you may have for the paper test, and says highlighters are not permitted. We have not found the no-writing instruction stated for the computer modes, so check your venue’s instructions if you are sitting on a computer.

How do you decide what to include from the case notes?

OET’s guide gives two questions, both about the reader rather than the notes: is there an existing professional relationship between the patient and the reader, and which aspect of the patient’s care will that reader be involved with. The finishing test is also the reader’s: by the end of the letter they should have a clear understanding of the situation and no more questions about further care.

Should you include the patient’s social history?

Usually not. OET’s writing guide names the patient’s children, grandchildren, profession and financial status as details that will not be needed because they do not affect the care the reader provides, and repeats that the social history is still not necessary when the letter goes to the patient’s own GP. Social detail is also the most frequently named irrelevant inclusion in OET’s graded samples, named in five of the 19 commentaries, with a sixth faulted for a lengthy previous medical history.

What happens if you include everything in the case notes?

The cost lands on Conciseness and Clarity, where irrelevant information distracts from overall clarity, and often on Organisation and Layout, where heavy reliance on case note structure sits in band 1, the lowest described level, against the 5 out of 7 the graded booklet says a B needs on that criterion. In practice the letter also runs long against a 180 to 200 word range. Eight of the 19 letters in OET’s graded booklet are noted as overlength, and one, graded C at around 300 words, is marked as having an impact on the score awarded. OET says there is no automatic penalty for length itself, only that writing significantly over the range usually means irrelevant material was included.

Should you expand the abbreviations in the case notes?

It depends on the reader. OET’s criteria document says judicious abbreviation is entirely appropriate to a colleague in a similar discipline, that a colleague in a totally different discipline or a specialist writing to a GP needs more explanation and less shorthand, and that where the readership includes the patient, medical jargon should be minimised. There is no published list of accepted abbreviations. The reminders near the end of the case notes also instruct you to expand the relevant notes into complete sentences and not to use note form.

Can you copy words straight from the case notes?

You will have to paraphrase to summarise, and OET warns that this is where accuracy breaks. It names two mechanisms: choosing a word that does not match the exact meaning in the notes, and altering the timeframe by changing the tense. Its own example is case notes reading that a patient is moving to live with his daughter, rendered in a letter as relocating to be nearer his daughter, which is grammatical and wrong.

What is the most common case-note mistake in OET Writing?

On our reading of all 19 assessor commentaries OET publishes, leaving out a needed detail and putting in an unneeded one occur at almost the same rate, in 13 and 11 of the 19 letters. Eight letters are faulted for changing the meaning of a detail. Seventeen of the 19 carry at least one of the three, including both letters graded A.

Where are the task instructions in the case notes?

At the end. OET lists the stimulus as background information on the context, profession-specific case notes or documents, and the task instructions, and its guide says that where the task does not give you everything you need, you can usually find it in the final section of the case notes just above the writing task. That final section also carries the reminders about expanding the notes into complete sentences.

Do you need the dates from the case notes in your letter?

Where the case turns on a sequence, yes. In OET’s graded booklet all five Medicine letters, written from the same case notes and graded from C to A, are faulted on dates. Four of the five lose the date of discharge, omitted outright, left unclear, or misreported as a month ago when the notes said one week, and three of those four lose the date the medication was commenced as well. The fifth loses a different date, the one that belongs at the top of the letter.