OET Writing - MEDICINE - Discharge Letter

 OET Writing - MEDICINE - Discharge Letter


Pt Name: Cindy Larson 

DOB: 07/05/1935 (87 y.o.)

Social background: Retired Secretary at a law firm


Organisation


1. Intro: Pt name, Pt profile, Purpose, Present condition

2. BP 1: Initially, date, presented the ED with the complaints       of...., Pt condition, CT head- no brain bleeding,  US: Rt                 shoulder dislocation, Referral to admission.

3. BP 2: (Mar 04 - Mar 14): Admission,  normal saline +                ibuprofen, Pt still disoriented, developed high fever on                  Mar 12, Zosyn , Two days later (Mar 14) Fever, MSRA,                Zosyn discontinued, vancomycin initiated.

4. BP 3: (Mar 21 - 29) Recovered, vancomycin discontinued, arm  sling removed.

5. BP 4: (Mar 31- Apl 04) Physio commenced, OT - home safety,    Discharge on Apl 04, ibuprofen, follow-up.

6. BP 5: Conclusion, sign off.





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