The pages that rank for this question tell you there are three letter types, or four, or five. So we stopped reading the advice and counted the tasks. OET publishes five sample tests for each of its twelve professions, which is 60 writing tasks, and we downloaded all 60 and read the instruction in each one.
The useful number is 26, which is how many of the 60 instructions tell you what kind of letter to write. In the other 34 you work it out, and this page is about how.
What the 60 official tasks show
- Twenty-six of the 60 instructions name a letter type, and referral accounts for 22 of those 26.
- In 12 more, a line inside the case notes names a letter the instruction does not. In 22, nothing names one.
- Letter of advice appears in none of the 60 instructions, and in none of 824 candidate forum threads we read.
- The reader is a clinician in 56 of the 60 tasks, and works outside the writer’s own field in 36 of them.
- Every one of the 60 papers prints the same rule for the five minutes of reading time: you must not write, highlight, underline or make any notes.
The instruction names a letter type in 26 of OET’s 60 published tasks
OET’s own description of the task is loose, and its numbers show how loose. The guide to its Purpose criterion says the test uses a range of letter types to assess writing skills, including referral, discharge, transfer etc, and that the writing task will often include the type of letter you need to write. Often is the operative word, and it is measurable. Across the 60 tasks on OET’s paper sample tests, the instruction names a type 26 times.
| Letter type named in the instruction | Tasks | Share of 60 | Professions it appears in |
|---|---|---|---|
| Letter of referral | 22 | 37 per cent | Eight of the twelve |
| Discharge, worded two ways | 2 | 3 per cent | Nursing only |
| Letter of transfer | 1 | 2 per cent | Veterinary Science only |
| Letter of explanation | 1 | 2 per cent | Radiography only |
| Letter of advice | 0 | 0 per cent | None |
| No type named in the instruction | 34 | 57 per cent | All twelve |
Two things fall out of that table. Referral is not one of four equals; it accounts for 22 of the 26 named types and 37 per cent of the 60 paper sample tasks. And the other three labels are each confined to one profession, which matters most for the letter of explanation: outside Radiography, no published paper task calls a letter that.
Medicine is the sharpest case of label dependence. Four of its five instructions name a referral and the fifth names nothing, so a candidate who drills the label alone has covered four tests and left the unlabelled one untouched, which is the kind of blind spot behind why strong doctors lose marks.
In 12 more tasks the case notes name a letter the instruction does not
OET tells you where to look. The OET Ultimate Writing Guide says that if the task has not given you what you need to understand the type of letter, you can usually find it in the final section of the case notes, just above the writing task.
We tested that against the 34 tasks whose instruction names no type, counting a case only where the notes add something the instruction withholds: a type word, a purpose, or a request. Twelve qualify. Ten sit inside the clinical record, half of those under a Plan, Treatment or Action heading and half as the last line of a dated entry. Two sit in the context paragraph above the record.
| Task whose instruction names no type | The letter instruction inside the case notes |
|---|---|
| Nursing, sample test 2 | Letter to transfer the Pt to the care of the community health nurse in Centreville, where the Pt is moving to live with his daughter |
| Dentistry, sample test 3 | Plan: Letter to Nurse-In-Charge re denture stomatitis & staff support of denture care |
| Medicine, sample test 3 | Letter to OT requesting assessment of workplace (advise on duties Pt can perform, etc.) |
| Pharmacy, sample test 4 | Plan: Letter to oncologist re Serepax not working effectively and risk of interaction with Unisom |
| Pharmacy, sample test 5 | Plan: Write to GP: Recommend review by Pt’s rheumatologist: comprehensive medication assessment |
| Podiatry, sample test 2 | Letter to paediatrician to explain findings and recommendations |
| Radiography, sample test 5 | Action: Write to Pt’s new doctor, Dr Brown – explain circumstances; suggest contacting Pt’s former Dr |
What these lines add is not the reader. In all twelve cases the instruction already names the reader, by name and usually by job title. The notes add the letter’s existence, its purpose, or a request the instruction leaves out. Pharmacy’s fifth test is the clearest: the instruction asks only for a letter to the patient’s GP discussing her medications and your recommendations, while the plan line specifies the recommendation, a review by the patient’s rheumatologist, which appears nowhere in the task.
Only one of the twelve applies an OET label to the letter. Nursing’s second task asks for a letter to the Community Health Nurse outlining the patient’s history and requesting ongoing monitoring, and the word transfer appears nowhere in it; the notes supply it. OET uses this very task as its worked example, saying the writing task does not include the type of letter but that it is supplied in the final note of the case notes. Pharmacy 3’s notes come closest after that, and the word they use is advice, which is a word OET’s instructions never use.
That leaves 22 tasks, 37 per cent of the set, where neither the instruction nor the notes name a letter at all. No instruction in Dietetics, Occupational Therapy or Speech Pathology names a type in any of their five tests. Those are the cases where you identify a reader and a request rather than a label, which is what makes reading the case notes a selection decision rather than a comprehension exercise.
Three places carry the answer, and OET’s guidance sets the order of the first two
Put the counts together and the first minute of the task has a sequence rather than a decision.
1. Read the instruction for a named type. It settles the question 43 per cent of the time.
2. Where it is silent, read the notes for a line naming a letter, which adds a purpose or a request in 12 more cases.
3. If both are silent, go back to the instruction for the two things it always gives you: who the letter goes to, and what you are asking them to do.
| Where you look | How often it answers | What you are looking for |
|---|---|---|
| The task instruction | 26 of 60 | A named type: letter of referral, discharge letter, letter of transfer, letter of explanation |
| The case notes | 12 of 60 | A line naming a letter, half of them under Plan, Treatment or Action |
| The reader and the request | 22 of 60 | Who receives the patient’s care next, and whether you are handing it over, ending it or advising |
One task shows why the label is the weaker signal. Physiotherapy’s fourth test asks in plain words for a letter of referral to a fellow physiotherapist, while the first line of its own case notes reads that the patient is about to go on vacation and requires transfer to a local physiotherapist. Label and substance disagree inside the same paper, and what the reader has to do with the patient is the part that survives the disagreement. The 40 minutes that follow this decision, and the six criteria that judge them, belong to the letter you have to write.
OET warns that I am writing to refer is the wrong opening for many of its tasks
The cost of guessing shows up in the first sentence. OET’s guide names the habit directly: many candidates start their letters with I am writing to refer, and it says that this is sometimes appropriate but that not all tasks ask you to write a referral letter. It makes no claim about how often, and neither will we. Twenty-two of the 60 instructions name a referral, which makes it the commonest single label but not a default, and some of the other 38 are referrals in substance without the word, so a count of labels is not a count of referrals.
OET then supplies the alternatives rather than leaving you to invent them. Its list of verbs that suit other letter types is transfer, discharge, update, recommend, see, accept, request and provide.
What each verb commits you to
- Transfer and discharge hand the patient on.
- Update and provide assume the reader already holds the case.
- Request and recommend ask the reader to act without moving the patient anywhere.
- Accept and see are what you write when the reader is taking the patient in.
The grading sits here too. The Purpose criterion examines how clearly the writing communicates the purpose of the document to the reader, and OET requires that purpose to be introduced early and then clearly expanded on later, often near the end. Its criteria document describes the thing being marked as a written handover document, with a referral letter as its example. An opening verb that names the wrong relationship starts that criterion badly, which is why the verb belongs on any list of what loses marks in Writing.
The four named types differ by one variable: what happens to the patient’s care
Strip the labels back and one question sits underneath them. A referral keeps the patient with you and borrows the reader’s expertise. A discharge ends your episode of care and hands the patient to whoever picks them up. A transfer moves ongoing care to the reader. A letter of explanation moves no patient at all. Everything else that differs, the opening verb, the register, the closing line, follows from that one variable.
| Named type | What happens to care | Reader in OET’s tasks | A task that shows it |
|---|---|---|---|
| Referral, 22 tasks | Stays with you; you borrow expertise or ask for investigation | A named specialist in 13 of the 22; a GP or local doctor in four, an allied health colleague in three, a doctor of unstated specialty in two | Write a letter of referral to Dr Smith, an endocrinologist at City Hospital, for further management of Mrs Sharma’s sugar levels |
| Discharge, 2 tasks | Ends with you; the reader picks it up on arrival | The receiving nurse at the destination, in both cases | Write a discharge letter to Ms Georgine Ponsford, Resident Community Nurse at the Community Retirement Home, 103 Light Street, Newtown |
| Transfer, 1 task | Moves to the reader, who may be the clinician who held it before | The professional taking the case on next | Write a letter of transfer to the client’s usual vet, Dr Grey, for a post-operative check and follow-up treatment |
| Explanation, 1 task | Nothing; no patient changes hands | A colleague who wants to know what went wrong | Write a letter of explanation in response to Dr Milne’s complaint |
The explanation letter is the one almost nobody teaches, and it breaks the pattern the other three share. Radiography’s first test hands you a written complaint from a surgical registrar whose patient went to theatre without the pre-operative chest X-ray he had requested, along with the request form and the patient transport log that show why. Its fourth test asks for an explanation of the events that led to a patient’s delay, rescheduling and cancellation. The clinical summary the other types are built around is not the content at all; the content is a timeline and an account.
The letter of advice is a coaching label, not an OET one, but the task behind it is real
The phrase letter of advice appears in none of the 60 published task instructions. Candidates do not use it either: across 824 public forum threads posted between February and September 2026, referral letter appears in 12, discharge letter in nine, transfer letter in three and letter of advice in none. Searching the phrase returns coaching pages and video, with no OET source on the first page of results.
The task behind the label is real even if the label is not. In four of the 60 tasks the reader is not a clinician: a patient’s daughter, a patient, a dog’s owner and a family, all four in Pharmacy or Veterinary Science. OET defines the task to allow exactly this, describing the letter as going to another healthcare professional or to a person related to the patient’s care.
Pharmacy’s third sample test is the clearest case, and the word advice sits in the notes rather than the task: a diabetic client is planning to travel abroad alone, and the record reads that you decide to write down your advice and reassurances in a letter to the client. So the honest version of the advice letter is a register instruction rather than a letter type.
What that means for your preparation
- Pharmacy or Veterinary Science: four of your ten published tests send the letter to a lay reader, so the jargon problem is worth rehearsing.
- Any of the other ten professions: no published paper task has asked you to write to a patient or a relative, so a template for one spends time you do not have.
A medical doctor reads 36 of the 60 letters, and the reader decides the register
Letter type tells you what to do with the patient. Who receives it tells you how to write, and OET grades that under Genre and Style. The guidance there turns on one comparison: a medical colleague in a similar discipline makes judicious abbreviation entirely appropriate, a colleague in a totally different discipline or a specialist writing to a GP needs more explanation and less shorthand, and where the readership includes the patient the information must be worded appropriately with medical jargon minimised.
OET’s worked example shows the real variable is narrower than discipline. Writing to an endocrinologist, its guide says the abbreviation NIDDM would be very familiar and the condition is central to the patient’s reason for seeing them, so abbreviating is appropriate; for a medical specialist less familiar with the condition, an orthopaedic surgeon for example, the same abbreviation is less appropriate and the condition should appear in full. The test is whether this reader knows this condition, not whether they share your job title. Field distance is the closest thing that can be counted across 60 tasks, so that is what the table counts, as a proxy for OET’s test rather than the test itself.
| The reader, relative to the writer | Tasks | Share of 60 | What it means for shorthand |
|---|---|---|---|
| Inside your own field, including a specialty of it | 20 | 33 per cent | Abbreviation is appropriate where the condition is central to the reader’s work, and not otherwise |
| A clinician outside your field | 36 | 60 per cent | Explain more and abbreviate less, however senior the reader is |
| Not a clinician at all | 4 | 7 per cent | Minimise jargon; OET’s wording names the patient, and two of these four readers own an animal patient |
Two numbers in that set are worth keeping apart, because they happen to match. A medical doctor is the named reader in 36 of the 60 tasks, counting every GP, consultant, surgeon and ophthalmologist. A reader outside the writer’s own field also appears in 36 tasks. They are not the same 36: Medicine’s four specialist readers are medical doctors and inside the writer’s field at once, while four readers outside the writer’s field are not doctors at all, a nurse-in-charge in Dentistry, an occupational therapist in Medicine and two physiotherapists in Podiatry.
The same-field group is also larger than the job titles suggest, at 20 tasks, because all four nurse readers in Nursing, all three dental specialists in Dentistry and all three vets in Veterinary Science sit inside the writer’s own field. Optometry is the counter-case: all five of its tasks go to an ophthalmologist, which is a medical specialty rather than a specialty of optometry, so all five sit outside. How the bands score any of this is in the marking rubric.
OET prescribes no layout, and fixes only the recipient’s title and address
Candidates lose sleep over the letterhead. One posted in June 2026 that a discharge letter had gone in without Dear Dr and without a reference line, and asked how much it would cost. OET’s answer to that worry is published and relaxed: a number of different formats are accepted by health professionals in different local contexts, and there is no particular format or layout that you have to use in the Writing sub-test. The test fixes something narrower. You should use the title and address details specified in the task instructions, which makes the recipient block the one layout element that is not yours to choose.
Printed on all 60 papers, whatever the letter type
- The word range is 180 to 200 words. OET says there is no automatic penalty for writing over or under it, only that a letter significantly over the range has probably included irrelevant material or is badly organised.
- Reading time is five minutes, and the instruction is in capitals: you may study the writing task and notes, and you MUST NOT write, highlight, underline or make any notes.
- Use the back page for notes and rough draft only. Notes and rough draft will not be marked.
- Cross out anything you do not want the examiner to consider.
Nineteen graded letters cannot show that labelled tasks score better
It would be convenient if the unlabelled tasks were the hard ones. The evidence will not say. OET publishes 19 real candidate letters with a grade on each, all written to the fifth sample test, so every letter can be matched to a task whose instruction either named a type or did not. Eleven of the 19 answered a named-type task and eight answered an unnamed one.
| Letters graded | Named type | No named type | What this says |
|---|---|---|---|
| A | 1 | 1 | The top grade appears in both groups |
| B | 6 | 4 | The commonest grade in both, 55 and 50 per cent |
| C+ | 2 | 0 | Only in the labelled group |
| C | 2 | 3 | 18 per cent of the labelled group against 38 per cent of the unlabelled |
| Total letters | 11 | 8 | 19 letters across nine professions |
Read that table honestly and it shows a gap in the C row and nothing you can rely on. Eleven letters against eight, spread over nine professions and nine different sets of case notes, cannot separate the effect of a missing label from the effect of a harder case or a weaker candidate. A label guarantees nothing, and the booklet shows it: the five Medicine letters all answered a named referral and still ran from C to A.
The sharpest case is the pair of Speech Pathology letters. Their instruction names no type and sends the letter to a speech pathologist in another town where the patient is relocating, which is a transfer in substance and a same-field reader at once. It produced one A and one B. Identifying the type is not what earns the grade. What it stops is the wrong opening verb, the wrong register and the wrong closing request, and those are scored under three different criteria.
Four questions to settle before you read a single clinical detail
All four are answerable from the instruction and the last lines of the notes, and none of them needs a clinical detail.
1. Does the instruction name a type? If it does, the decision is made.
2. If not, does a line in the notes name a letter, a purpose or a request the instruction left out?
3. Is the named reader inside your field, outside it, or not a clinician at all?
4. What are you asking them to do: take the patient on, pick the patient up, act without taking the patient, or manage at home?
Answer those and the opening sentence writes itself, because the verb is chosen and the register is set before any history goes in. For the sequence run end to end on a real brief, a nurse’s referral letter, assessed takes one set of notes from the instruction through to the marked result.
The harder problem is knowing whether your own choice held up, because the three criteria this decision touches are Purpose, Genre and Style, and Content, and none of them is something you can mark yourself. That is what feedback against all six criteria is for: a trainer reads the letter against the task it answers, which is the only way to find out that the verb committed you to a relationship the case notes never described.
None of this is a template, and the letters OET publishes are not templates either. Its own booklet says assessors can tell when candidates are repeating learned templates, because the letter is then not a good match for the case notes. The point of identifying the type is not to retrieve a shape. The point is to know, before you write anything, what the reader is being asked to do with your patient.
Frequently asked questions
How many letter types are there in OET?
OET does not publish a fixed number. Its guide to Purpose names referral, discharge and transfer and then writes etc, and across the 60 writing tasks in its paper sample tests the instructions name four different types: letter of referral in 22 tasks, a discharge in two, letter of transfer in one and letter of explanation in one. The remaining 34 instructions name no type. So a count of three or four describes the labels OET uses rather than the range of letters you can be asked for.
How do you know which OET letter type you have been given?
Three places, in this order. A named type sits in the instruction in 26 of the 60 published tasks. If it does not, a line in the case notes names a letter in 12 more, half of them under a Plan, Treatment or Action heading. If neither says it, you identify the letter from the named reader and the request, which is the case in 22 of the 60.
What is the most common letter type in OET Writing?
The referral letter, by a wide margin. It is named in 22 of the 60 official paper tasks, which is 37 per cent of the whole set and 22 of the 26 tasks that name any type at all. It appears in eight of the twelve professions, and in Dentistry, Medicine, Optometry and Podiatry it is named in four of the five tests. No other named type reaches four per cent.
Is there such a thing as an OET letter of advice?
Not as an OET label. The phrase appears in none of the 60 published task instructions, and in none of 824 public forum threads we read from February to September 2026. The task behind the label is real: in four of the 60 tasks the reader is a patient, a relative, a carer or a pet’s owner, and OET’s handbook defines the letter as going to another healthcare professional or to a person related to the patient’s care. All four of those tasks are in Pharmacy or Veterinary Science, and in one of them the word advice appears in the case notes rather than the instruction.
Does OET ask doctors to write discharge letters?
Not with that label in its published paper tasks. Only Nursing’s instructions name a discharge, in two of its five sample tests. Medicine’s five tasks are four named referrals and one unnamed letter to an occupational therapist. That does not mean a doctor will never meet a discharge, because 34 of the 60 instructions name no type and a discharge can be described without being labelled. OET’s own guide points at one: the Occupational Therapy task that sends a letter to the therapist at the centre where the patient is to be discharged is a task OET itself calls a discharge letter.
What verb should you start an OET letter with?
Whichever one matches the letter type, and OET warns specifically against the default. Its guide notes that many candidates start with I am writing to refer, says this is only sometimes appropriate, and lists the alternatives: transfer, discharge, update, recommend, see, accept, request and provide. Twenty-two of the 60 instructions name a referral, which makes it the commonest single label but not a safe default, and some unlabelled tasks are referrals in substance.
Does the letter type change the layout?
Less than candidates expect. OET states that a number of different formats are accepted by health professionals in different local contexts and that there is no particular format or layout you have to use. The one fixed element is the recipient block, because you are told to use the title and address details specified in the task instructions. The word range is 180 to 200 words for every type.
Who is the reader in OET writing tasks?
A clinician in 56 of the 60 tasks and a lay reader in four. What matters for register is the distance from your own field: in 20 of the 60 the reader works inside it, including every nurse reader in the Nursing tasks and every medical specialist in the Medicine tasks, and in 36 the reader is a clinician outside it. OET’s own test is narrower still and is about whether this reader knows this condition: its guide says an abbreviation central to an endocrinologist’s work should be written out in full for an orthopaedic surgeon.
Can you write or underline on the case notes while deciding the letter type?
No. All 60 sample test papers print the same instruction for the five minutes of reading time: you may study the writing task and notes, and you MUST NOT write, highlight, underline or make any notes. The papers also say to use the back page for notes and rough draft, and that notes and rough draft will not be marked.
Does identifying the letter type affect your grade?
The 19 letters in OET’s graded samples booklet cannot answer that. Eleven answered an instruction naming a type and eight answered one naming none, with one A in each group and B the commonest grade in both, which is far too few letters across too many professions to separate the label from the case. What the type decides is the opening verb, the register and the closing request, and those are scored under Purpose, Genre and Style, and Content.
