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OET 2.0
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A. Ghazouly
 Final Revision Writing Subtest

Sample Letters

A. Ghazouly

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OET 2.0 A. Ghazouly
 ‫ﺑﺴﻢ ﺍﻟﻠﻪ ﺍﻟﺮﺣﻤﻦ ﺍﻟﺮﺣﻴﻢ‬

‫‪3‬‬
‫‪OET 2.0‬‬ ‫‪A. Ghazouly‬‬
Some useful cohesive devices which can help you present your
ideas clearly and logically:

Time: At that time, On review today, On consultation today, Recently, Over the past 3
weeks...., Two weeks later, On her next visit, During, Since that time, Initial examination...,
On 19/08/10...

Location: During hospitalisation, Initial examination at my clinic revealed..., On

examination....

More information: In addition, Moreover, Also, Apart from this..

Advice: it is important to….. please ensue that….. I recommend that you

Contrast: However, Despite, In spite of, Although, Though,

Result: Therefore, Consequently, Hence, As a result, For this reason...

Emphasis: Please note, May I remind you, My main concern is...., What concerns me most
is.....

Sympathy: Unfortunately, Regrettably, Fortunately,

Subject: In terms of her social history..., With regard to her medication....,Based on the
blood test results....., Regarding her medical history....., Her dental history shows..., The
risk factors include....., Treatment to date includes...

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OET 2.0 A. Ghazouly
January 2014

Admitting Officer
Emergency Department
Children Hospital Newtown

18.01.2014

Dear Sir/Madam,
RE: Joshua Vance, D.O.B: 17.11.2013

I am writing this letter to urgently refer Joshua Vance, a 2 month-old full-term absolute
breastfed infant, as his mother has reported that he had not passed any stools for 5 days
and he had poor feeding pattern. Your immediate assessment and further management
would be highly appreciated.

Or

Thank you for seeing Joshua, a 2 month-old full-term absolute breastfed infant, who has
features suggestive of constipation. Your further assessment would be highly
acknowledged.

Initially, Joshua, who was born vaginally without any complications, presented with his
mother to me for his 6-week postnatal checkup. Although his physical examination showed
no abnormalities, his mother was utterly concerned about his poor bowel motion; as he was
passing only one bowel motion every 3 consecutive days. Therefore, I reassured her and
advised her to try to express her breast milk into a bottle and feed him with it after mixing
the milk with previously boiled water. Then, review two weeks later was arranged.

On review, unfortunately, Joshua’s condition had not improved. At that time, he started
having unbearable abdominal cramps every half an hour which was awakening him at
night. Although his cramps were severe, his physical examination was completely normal.
Accordingly, a trial of Coloxyl drops was prescribed along with expressing milk bottle feeds.

Today, Joshua’s condition became worse; he had an absolute constipation. Moreover, his
physical examination showed mild dehydration and generalised abdominal tenderness.

At this stage, a referral to the Emergency Department is urgently needed. If you need any
further information, do not hesitate to contact me.

Yours sincerely,

Doctor X

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Jan 2014

Admitting Officer
Emergency Department
Children’s Hospital
Newtown

13.01.2014

Dear Admitting Officer,

Re: Joshua Vance DOB 17.11.13

Thank you for seeing Joshua, a 2-week-old male infant, who has recently developed
constipation with mild dehydration. Your urgent management would be highly appreciated.
Joshua, who was delivered vaginally at 38 weeks’ gestation with a birth weight of 3250g, is
the first child of his parents.
On 31.12.13, Joshua was brought for the routine 6-week check by his mother who was
concerned regarding his bowel action because it was once every 3 days; however, he was
making wet nappies, feeding well, demanding feeding and sleeping through the night.
Therefore, the mother was advised to express milk from one feed once daily and to give
him in a bottle with some previously boiled and cooled water.
Two weeks later, no improvement was noticed in his condition; furthermore, Joshua started
to wake up crying and pulling his legs up to his chest every half an hour at night. On
abdominal examination, there were hard faeces. As a result, a trial of Coloxyl drops daily
was prescribed and the mother was requested to express milk from two feeds daily.
On today’s visit, Joshua’s mother reported that he had not been passing a bowel action
over the last five days and he had been refusing feeds. Moreover, he stopped making wet
nappies and vomited once. On general examination, he was irritable, with a progressive
weight reduction and mildly dehydrated: he had dry mucous membranes, while on
abdominal examination, there was mild generalized tenderness; however, neither guarding
nor rebound tenderness was noticed.

Based on this, Joshua is being referred for rehydration and further assessment. Should
there be any queries, please do not hesitate to contact me.
Yours sincerely,

6
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February 2014

Associate Professor Simon Anderson

Surgeon
Suite 65
City Hospital
25- 29 Main Road
Centreville

15.02.2014

Dear Dr. Anderson,

Re: Mr. Daniel McCrae, DOB 17.10.1962

Thank you for seeing Mr. McCrae, a 62-year-old barrister, who has been recently
diagnosed with adenocarcinoma of the ascending colon. Your surgical assessment would
be highly appreciated.

Mr. McCrae is married, and has 4 children. He is a smoker; however, there is no family
history of colorectal carcinoma, colonic polyps or inflammatory bowel disease. Initially, Mr
McCrae presented to the clinic with an attack of chest infection which was treated
symptomatically.

On 08.02.14, Mr. McCrae reported that he had been suffering from abdominal discomfort,
gases, diarrhea shifted with constipation and fatigue. On examination, he was overweight;
however, his vital signs were normal. His diagnosis was unclear; therefore, some
investigations were ordered including a complete blood count, faecal occult blood test
(FOBT) and colonoscopy.

On today’s visit, Mr. McCrae reported being unwell. Additionally, his investigations revealed
anemia as well as a decrease in the white blood cell count and a positive FOBT while the
colonoscopy result revealed a malignancy detected in the ascending colon. Therefore, a
biopsy had been taken and he has been diagnosed with adenocarcinoma in the ascending
colon.

Based on the above information, I am referring Mr. McCrae for further assessment as soon
as possible. Should be any queries, please do not hesitate to contact me.

Yours sincerely,
Dotor

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March 2014
Dr. Susan Clayton
Endocrinologist
Woman’s Health Center
11-13 Bell Street
Newtown

28/03/2014

Dear Dr. Clayton

Re: Miss Tracy Bowen, D.O.B: 22/07/1988
Thank you for seeing Miss Bowen, a 26- year- old lady, who has presented with symptoms
suggestive of PCOS.
Miss Bowen is known to be asthmatic which is aggravated by exercise and upon exposure
to dust, smoke, cat fur or weather changes. Plus, she has a history of recurrent bronchitis.
Consequently, she is on salbutamol and beclomethasone inhalers. It is worth mentioning
that she lives in a smoky atmosphere as her father is a heavy smoker. Regrettably, she has
been living under stress for 12 years because of her parent’s divorce.
Miss Bown has been a patient of mine since 28/08/2004 when she presented with irregular,
painful and infrequent menses. Further, she suffered from adolescent acne. Her physical
examination was completely normal, so that she was diagnosed with idiopathic
oligomenorrhea and primary dysmenorrhea for which she was prescribed Diane and
analgesia after reassuring her. On 21/09/2005, she presented with deep inflamed acne
which required oral and topical antibiotics treatment. Two months later, she came back with
no improvement. Moreover, the condition was complicated by scar formation which let me
refer her a dermatologist for isotretinoin treatment.
Today, Miss Bown presented to the clinic, after she had been married, with a different
complaint. To illustrate, she has been suffering from amenorrhea with subsequent failure to
conceive. Additionally, she noted that she had had electrolysis for hirsutism. Being
overweight together with her hormonal assay results; high free androgen index, high FBS
and hyperprolactinemia made PCOS diagnosis highly suspected. Consequently, Climen
was prescribed and pelvic ultrasound was arranged. Based upon the patient’s request, a
referral to an endocrinologist was done.
In view of the above, my provisional diagnosis is PCOS. Your further evaluation and
management would be highly appreciated. Kindly check the attached copy of the laboratory
results. Please, contact me for more queries.

Yours sincerely
Doctor

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May 2014

Dr. Malcolm Still

Rheumatologist
5 Grant Street
Fairmont

03/05/2014

Dear Dr. Still,

Re: Mr. James Seymour, DOB: 19/09/1953

Thank you for seeing Mr. Seymour, a 60-year-old retired academic, who has been suffering
from features suggestive of gout. Your further evaluation would be highly appreciated.

Mr. Seymour is divorced with no children, and lives alone. He has quit smoking since 1994;
however, he is a heavy drinker. Regarding his medical history, he has been suffering from
regular episodes of inflammation in his first toe, which was diagnosed as gout in 2010, for
which he was prescribed colchicine, to be taken during the attack, indomethacin and
allopurinol which was started after the last attack with no improvement to his symptoms.
Additionally, his father was diagnosed with rheumatoid arthritis at the age of 28.

On 25/04/14, Mr. Seymour presented with a new bout of the same complaint of 4 week
duration and it was the third one during the last eight months. Unfortunately, colchicine was
taken at sub-therapeutic levels. On examination, his left first toe was moderately inflamed
and painful. As a result, he was prescribed paracetamol and oxycodone, and he was
encouraged to comply with his medications and improve his dietary compliance by
decreasing both purines and alcohol. Kindly note, some significant investigations were
ordered.

Today, the results revealed minor degenerative changes of the left first
metatarsophalangeal joint on the x-ray, while the FBE showed a mild elevation in the mean
corpuscular hemoglobin, urate was mildly elevated and CRP was highly elevated.
Therefore, he has been diagnosed with gout and was prescribed allopurinol. I discussed
with him the probability of taking a synovial fluid sample on the next episode.

For further queries, please do not hesitate to contact me.

Yours sincerely,

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June 2014
Dr Charles White
Thyroid Specialist
Bayview Private Hospital
81 Canyon Road
Bayview

01/06/2014

Dear Dr White,
Re: Ms Lola Duval D.O.B: 27/05/1990

Thank you for seeing Ms Duval, a 24-year-old student whose features are suggestive of
Grave’s disease. Your further assessment and management would be highly appreciated.
In terms of Ms Duval’s medical history, she has had laryngitis for two years and has been
suffering from anxiety and insomnia.

Yesterday, Ms Duval attended the clinic and informed me that she had lost 10 kgs over the
last 2 months despite having a good appetite and eating well. After further discussions, she
reported that she had been experiencing tremors, palpitations, sweating and heat
intolerance over the same period and those complaints have been recently associated with
fatigue.

Ms Duval’s examination revealed a slight non-tender enlargement of the thyroid gland as

well as fine tremors in her hands. Furthermore, there were exophthalmos and lid lag on the
eye examination. At that time, hyperthyroidism was suspected; therefore, thyroid functions
and electrocardiography (ECG) were ordered. Further, other blood tests were arranged.

Today, unfortunately, her thyroid functions confirmed the diagnosis; as they showed a
decrease in the TSH level along with elevated free T3 and T4. Moreover, the ECG
indicated sinus tachycardia. As a result, thyroid auto-antibody tests and a thyroid scan were
ordered after discussing the likely diagnosis with her.

In view of the above, my provisional diagnosis at this point is Grave’s disease type of
hyperthyroidism. Thus, I am referring her to you for an early review as she is utterly
concerned about her condition. For more queries, please do not hesitate to contact me.
Yours sincerely,

10
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August 2014
Dr. M McLaren
Neurologist
Suite 3
67 The Crescent
Newtown

09.08.2014

Dear Dr. McLaren,

Re: Mr. Michael Weir, DOB 20 September 1970

Thank you for seeing Mr. Weir, a 44-year-old real estate agent, who has been recently
diagnosed with probable multiple sclerosis. Your further assessment would be highly
appreciated.

Mr. Weir is married, and has 3 children. He has an unhealthy lifestyle: he is a smoker as
well as an overweight man because he has neither time for exercise nor relaxation.
Furthermore, he has a medical history of depression, for which he is currently on Zoloft.

On 29.06.2014, Mr. Weir attended the clinic for a general check-up. In addition, he reported
that he had been feeling tired, stressed and lazy. Furthermore, he experienced a feeling of
weakness in his left leg. Based on this, investigations were ordered and he was diagnosed
with hypercholesterolemia. Because of this, he was requested to decrease his dietary
saturated fat, incorporate regular exercise, and stop smoking.

On today’s visit, Mr. Weir complained of dizziness and two fainting attacks: each of which
has sustained for few minutes. Moreover, he reported tingling in his hands with a
continuation of his left leg weakness. On examination, there was loss of sensation on the
left and right hands, and a diminished left patellar reflex was noticed. Therefore, head and
lumbar computed tomography were requested.

In view of the above, Mr. Weir is being referred into your care for a full neurological
examination and for a magnetic resonance imaging, if needed.

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

Yours sincerely,

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September 2014

Admitting Officer
Emergency Department
Newtown Hospital

13.09.2014

Dear Sir/ Madam,

Re: Ms. Sally McConville, aged 38

Thank you for seeing Ms. McConville, a single administrator asthmatic patient who has
presented with clinical manifestations of acute asthma with a probable pneumonia. Your
urgent management would be highly appreciated.

Ms. McConville is an asthmatic patient, for which she is on fluticasone and salbutamol.
However, she does not have any known allergies.

On 10.09.2014, Ms. McConville attended the clinic with a complaint of a viral upper
respiratory tract infection which had been present for 2 days. Plus, it was associated
with infective exacerbation of asthma which was treated accordingly with Ventolin and
fluticasone.

Two days later, Ms. McConville presented with complaints of shortness of breath and a
wheeze, which had been present over the last 24 hours. On examination, there was a
deterioration of her medical condition because there had been a mildly increased work of
breathing with a widespread wheeze over the chest. Accordingly, Amoxicillin, 500mg three
times daily, and prednisolone, 25mg three times daily, were prescribed.

On today’s visit, 13.09.2014 at 10:30am, Ms. McConville’s shortness of breath became

worse despite taking her medications. On general examination, there has been shortness
of breath at rest, an increased respiratory rate, an obvious accessory muscle use and an
increased work of breathing while on chest examination, there has been a widespread
wheeze with bibasal crepitations. Based on the above, she has been diagnosed with acute
asthma with probable pneumonia. As a result, she was given Ventolin nebules. After 15
minutes, there has been no improvement, because of which she is being referred urgently
into your care.

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

Yours sincerely,
Doctor

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November 2014

Dr John McLennan
Psychiatrist
Royal Mental Health Clinic
177 Park Avenu
Newtown

29/11/2014

Dear Dr McLennan,
Re: Ms. Dolores Hoffman, D.O.B.: 22/06/1986

Thank you for seeing Ms. Hoffman, a 28-year-old patient, whose features are suggestive of
depression and anxiety. Your further assessment and management would be highly
appreciated.

Ms. Hoffman is a single sales assistant who has recently broken up with her boyfriend and
lives alone. Please note, she is also a smoker, and is allergic to penicillin.
On 2/9/2014, Ms. Hoffman presented with symptoms of URTI and was worried about the
possibility of having infectious mononucleosis. Nevertheless, the ordered blood tests were
unremarkable. Last week, she presented with orofacial HSV, for which systemic and topical
acyclovir were prescribed. After further discussions, she informed me of the recent split-up
with her boyfriend and the increased stress she was having at her work, which made her
consider quitting from her work. Moreover, she complained of having several depressive
symptoms including: nightmares, insomnia, loss of appetite and libido, along with poor
memory and concentration. At that time, temazepam was commenced.

On today’s review, with no improving regarding her symptoms, she reported that she had
not been taking temazepam; as she had not been interested in taking medications.
However, she agreed to be referred to a psychiatrist although she refused this idea a week
before.
In view of the above, my diagnosis at that point is reactive depression and anxiety.
Therefore, I am referring her to you for your careful assessment and treatment. For more
queries, please contact me.

Yours sincerely,

Doctor.

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January 2015

Dr Grantley Cross
Consultant Endocrinologist
City Hospital
Suite 52
55 Main Road
Newtown

24.01.2015

Dear Dr Cross,
RE: Brett Collister, D.O.B: 20.11.1970

Thank you for seeing Mr Collister who has been presenting with tiredness and dizziness
over the past few months. Your further assessment and management wound be highly
appreciated.
Or
I am writing to refer Mr. Collister, a 45 -year- old factory foreman, who has been recently
diagnosed provisionally with diabetes. Your further management would be highly
appreciated.
Or
I am writing to refer Mr. Collister, a 45 -year- old factory foreman, whose features are
suggestive of type 2 diabetes mellitus. Your further management would be appreciated.

Mr Collister, who works as a factory foreman, is a 45-year-old married man, and has 3
children. Kindly note that he has been a regular patient of mine for ten months.

Initially, he attended the clinic with uncomplicated upper respiratory tract infection which
responded well on amoxicillin. Plus, he had a rotator cuff tear and osteoarthritic knee pain,
which were treated with both pain killers and a life style modification. Then, review, after 3
months for further assessment, was arranged.

On 04.01.2015, when Mr Collister came to the clinic, he reported that he had been
feeling dizzy, run down and had had sore eyes for 3 weeks. Although he was
previously advised to modify his life style, he did not follow the instructions and his weight
became above the average. Accordingly, some important blood tests were ordered, and he
was asked to come for review when the results come out.

On review, unfortunately, his condition did not improve. Moreover, his investigations
revealed that his random and fasting blood sugar were significantly high. Furthermore, his
cholesterol level was above the average, which was consistent with type two diabetes
mellitus.

At this stage, specialist advice was recommended. If you need any further information, do
not hesitate to contact me.

Yours sincerely,
Doctor.

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February 2015

Dr Jack Thomas
Department of Gastroenterology
City Hospital
Main Road
Stillwater

12.02.2015

Dear Dr Thomas,

Re: Mr Patrick Newton D.O.B: 06.07.1969

I am writing this to refer Mr Newton, a patient of mine, who has been presenting with
chronic mild diarrhoea and lower abdominal pain for about 4 months; which is consistent
with irritable bowel disease. Your assessment and further management would be highly
appreciated.

Mr Newton is a 46-year-old heavy smoker who has been working as an accountant for
almost 25 years. His abdominal symptoms put him in many embarrassing situations, which
led to tremendous stress and anxiety. Kindly note that he has a past history of joint pain in
his both wrists, nevertheless, he is a regular squash player; thus, he has been receiving
Ibuprofen tablets to control this pain.

When Mr Newton presented to my clinic today, he, over the last four months, has been
complaining of diarrhoea, abdominal pain, lethargy and weight loss. Further, he tried to
modify his diet in order to relieve his symptoms; however, this was unsuccessful. Moreover,
he has not seen a doctor in spite of his dreadful symptoms, believing that these symptoms
can be managed by a life style modification and OTC medications. On examination, he
seemed to have no abnormalities, whereas, his fecal occult blood testing was positive and
his CRP was elevated. Accordingly, specialist advice was highly recommended.

Thank you for seeing Mr Newton. If you need any further information, do not hesitate to
contact me.

Yours sincerely,

Doctor

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OET 2.0 A. Ghazouly
September 2015

Dr David Smith
Cardiologist
Emergency Department
Main Hospital
Coast City

20.09.2015

Dear Dr Smith,

RE: Mrs Lucy Clarke D.O.B: 11.03.1951

I am writing this letter to urgently refer Mrs Clarke, a patient of mine, who has been
presenting with central crushing chest pain over the past week. Your immediate
assessment and urgent management would be highly appreciated.

Mrs Clarke, who lives with her husband, is a 64-year-old retired lady. She has a past history
of diabetes mellitus which is controlled by insulin and sitagliptin. Moreover, she suffers from
hypertension and hyperlipidaemia as well, for which she takes irbesartan and atorvastatin,
respectively. Please note that Mrs Clarke’s mother had an acute myocardial infarction at
the age of 57; and she died of an ischaemic stroke 2 years later.

Today, when Mrs Clarke presented to the clinic, her chest pain was severe and central.
She reported that her pain had been usually triggered by exertion and relieved by rest.
Additionally, it was associated with shortness of breath and radiating to the left arm,
whereas, she denied having any palpitations or orthopnoea. Although her symptoms were
severe, her physical examination and resting ECG revealed no abnormalities, accordingly,
hospital admission and urgent assessment were highly required.

In view of the above, I believe, Mrs Clarke has unstable angina. Should be any queries, do
not hesitate to contact me.

Yours sincerely,

Doctor.

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Sep. 2015

Dr. David Smith

Cardiologist
Emergency Department
Main Hospital
Coast City

20.09.15

Dear Dr. Smith,

Re: Mrs. Lucy Clarke, DOB: 11.03.1951

Thank you for seeing Mrs. Clarke, a 64-year-old office clerk, whose features are suggestive
of unstable angina. Your urgent assessment would be highly appreciated.

Mrs. Clarke is a married independent woman who lives with her husband. She is a non-
smoker; however, she is a social drinker. Kindly note, she has had diabetes mellitus type II
since 2001, hyperlipidemia since 2003 and hypertension since 2005 and has been treated
accordingly. Moreover, her mother was diagnosed with acute myocardial infarction at the
age of 57 and died of an ischaemic stroke at age of 59.

On today’s visit, Mrs. Clarke presented with a one week history of three episodes of severe
exertional central chest pain radiating down to the left arm, each one of them has lasted for
less than 15 minutes. They have been associated with dyspnea and relieved with rest.
However, she denied the presence of palpitations, orthopnoea or paroxysmal nocturnal
dyspnea. As a result, an examination and a resting electrocardiogram (ECG) have been
done, and revealed no abnormality.

Unfortunately, Mrs. Clarke has been diagnosed with unstable angina. Therefore, she was
informed about the serious risk of myocardial infarction and is being referred into your care
to be hospitalized for an urgent evaluation.

For further queries, please do not hesitate to contact me.

Yours sincerely,

17
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May 2015
Dr Lorna Bradbury
Stillwater Medical Clinic
12 Main Street
Stillwater

23.05.2015

Dear Dr Bradbury,

RE: Ms Isabel Garcia, D.O.B: 01.01.1995

I am writing this letter to refer Ms Garcia to your care after being discharged from the
Emergency Department. Since Ms Garcia was treated for bacterial meningitis, your
assessment and follow up would be highly appreciated.

Initially, Ms Garcia presented to the Emergency Department and reported that she had
had painful stiff joints for about one week, along with headache, neck stiffness and skin
rash. Moreover, her physical examination showed bruises on her left arm and petechial
rash over her abdomen; however, her temperature was normal in spite of her severe
illness. Accordingly, some blood tests were ordered and an urgent lumbar puncture was
done.

Unfortunately, the results of the investigations of Ms Garcia illustrated a serious infection

with Neisseria meningitides. To illustrate, her lumber puncture revealed an elevated level of
the white blood cells which was consistent with bacterial meningitis. Therefore, she was
given immediately Ceftriaxone 2g IV injection and Dexamethasone 10 mg. Besides, I
discussed with Ms Garcia and her family the importance of the family members’
immunisation.

Today, Ms Garcia is being discharged from our hospital into your care, and I believe that
she needs medical attention for any red flags that might develop. In addition, providing
prophylactic treatment for her family members and close contacts is urgently required.
If you need any further information, do not hesitate to contact me.

Yours sincerely
Doctor

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Dr. Lorna Bradbury
General Practitioner
Stillwater Medical Clinic
12 Main Street

23/05/2015

Dear Dr. Bradbury,

Re: Ms. Isabel Garcia D.O.B: 01/01/1995

Ms. Garcia, who has been recently treated for bacterial meningitis, is being discharged from
our hospital into your care today. Your further follow-up would be highly appreciated.
Initially, on 23/05/2015, Ms. Garcia presented to the Emergency Department with
complaints of painful stiff joints, sensitivity to light and bruising. Further discussions
revealed that she also had headache, neck stiffness, photophobia and rash. On
examination, the patient had bruises on the left arm, petechial rash on the abdomen and
the legs, and was unable to touch her chin to her chest while she was lying on her back;
therefore, specific laboratory tests such as: FBC, C-RP, lumbar puncture and blood cultures
were immediately requested.
Regarding Ms Garcia’s treatment, after the results of the blood tests had been received,
which were diagnostic for Neisseria Meningitides, the following medications were
prescribed for the patient: dexamethasone, ceftriaxone and benzyl penicillin. Fortunately,
the patient responded properly to the treatment. Kindly note that the Department of Human
services was notified about the patient’s diagnosis.
As for the discharge plan, it is highly recommended to ensure that all of her family members
were immunized, and to encourage the patient’s relatives to seek medical advice if any
signs of illness develop. Additionally, chemoprophylaxis for any person who has been
recently in contact with Ms. Garcia is highly recommended. For any queries, please contact
me.

Yours sincerely,

Doctor

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May 2015
Dr. Lorna Bradbury
Stillwater Medical Clinic
12 Main Street
Stillwater

23.05.2015

Dear Dr. Bradbury,

Re: Ms. Isabel Garcia, DOB 01.01.1995

Thank you for caring about Ms. Garcia who was referred with signs and symptoms
suggestive of suspected meningitis. Your further follow-up would be highly appreciated.

On 23.05.2015, Ms. Garcia attended the Emergency Department with a complaint of painful
stiff joints which had been present for one week. That complaint was associated with
sensitivity to light and an increase in bruising. Furthermore, she has been suffering from
headache, neck stiffness, photophobia and rash. On examination, there were bruising on
her left arm and some petechial rash on the abdomen and the legs. Additionally, she was
unable to touch her chin to her chest while lying supine. As a result, some investigations
have been ordered; including, a full blood count, a renal function test, a liver function test, a
C-reactive protein (CRP), blood cultures and a lumbar puncture.

Please be noted that the results revealed an increase in both of the white cell count and
CRP while the lumbar puncture showed an elevated white cell count with
polymorphonuclear predominance as well as an elevated protein, while the glucose was
decreased. For more confirmation, a subsequent microscopy and a culture had been
ordered upon which the diagnosis was confirmed as Neisseria meningitis.

Ms. Garcia had received her medications including ceftriaxone 2g intravenous and
dexamethasone 10mg intravenous while benzylpenicillin 1.8g was added following the
lumbar puncture results. She responded well to the treatment. However, her close family
and friends are in need to be immunized and Ms. Garcia needs to be educated about
seeking an immediate medical attention on observation of any signs of an unexplained
illness for which she is being referred back into your care.

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

Yours sincerely,

March 2015

20
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Dr. Tony Jones
Private Practice
12 New Street
Stillwater

21.03.2015

Dear Dr. Jones,

Re: Ms. Betty Johnson, aged 81 years

Ms. Johnson is being discharged from our hospital into your care today after undergoing a
right total knee replacement.

On 25.02.2015 Ms Johnson underwent an R.TKR, and fortunately the operation had been
done without any complications. She started Clexane instead of her current warfarin
medication which had been ceased 5 days preoperatively. She returned to the ward post-
operatively while she was vitally stable; however, her hemoglobin was low hence a blood
transfusion transfusion was given to compensate the blood loss during the surgery.
Additionally, she was prescribed an intravenous Cephalothin.

On subsequent check-ups, Ms. Johnson’s wound was clean and the dressing was
removed. She resumed her warfarin and newly started oxycodone upon request. However,
Clexane was ceased. Her hemoglobin had become better; therefore, she was prescribed
Feratab. On 06.03.2015, she was transferred to the rehabilitation where she started her
mobility using a stick together with some gentle exercises. Subsequently, she showed
better independence.

Today, the patient was discharged with a home nursing assistant for personal hygiene and
home care. The discharging medications include: warfarin, Feratab in the morning,
paracetamol and oxycodone. Plus, she was advised to see you in one week and to repeat
the FBE and the INR to adjust her medications.
Should be any queries, please do not hesitate to contact me.

Yours sincerely

21
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Dr. Tanya Williams
Respiratory Specialist
Bayview Private Hospital
81 Canyon Road
Bayview

18.10.2014
Dear Dr. Williams,
Re: Mr. Zach Foster, DOB 25.10.1991

Thank you for seeing Mr. Foster, a 22-year-old patient, who has been suffering from
unstable asthma. Your further assessment would be highly appreciated.

Mr. Foster is a single builder. He is smoker although he has been asthmatic since he was
three years old, and he has a positive family history of asthma. In addition, he has eczema
as well as cats and hay fever allergies. Kindly note that he is currently on Pulmicort
200mcg, one puff twice daily, and Ventolin, when needed.

On 11.10.2014, Mr. Foster attended the clinic with clinical manifestations which were
consistent with gastro-oesophageal reflux disease (GORD) with unclear compliance of
Pulmicort. As a result, a chest X-ray and a full blood count had been ordered and he was
diagnosed with unstable asthma, possibly due to GORD; for which, pantoprazole was
prescribed. Therefore, I advised him to stop smoking and to be compliant to his
medications.

On today’s visit, Mr. Foster presented for the follow-up, and unfortunately, he is still a
smoker. Furthermore, he was not compliant to Pulmicort, however he was taking Pentazole
regularly which was effective in alleviating the GORD symptoms. Therefore, Pentazole was
recommended for further seven weeks. Additionally, a plan about how to take Pulmicort
missed dosage was discussed, and smoking cessation was discussed again.

Based on the above, Mr. Foster is being referred into your care for a lung function test and
advice regarding his asthma management. Should be any queries, please do not hesitate
to contact me.

Yours sincerely,

22
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June 2015
Ms. Jane Graham
Newtown Occupational Therapy
10 Johnston Street
Newtown

20.06.2015

Dear Ms. Graham,

Re: Mr. Barry Jones

D.O.B: 01.04.1972

I am writing to request an evaluation of the work place of Mr. Jones who has recently
recovered from back pain. Your kind assessment would be highly acknowledged.
Or
Thank you for assessing Mr. Jones’ work place. Mr. Jones is a 44-year-old driver who has
recently suffered from a lower back strain. Your evaluation of his workplace would be highly
appreciated.

Mr. Jones is a 44-year-old married gentleman, and has three children. He works as a forklift
driver at a warehouse, which requires him to sit for a long time and to lift heavy objects
occasionally. On 21.03.2015, he presented to my clinic with a complaint of severe back
pain following lifting a heavy box at work. Fortunately, his x-ray showed no disc prolapse;
therefore, he was prescribed pain killers to relieve that pain, and a sick leave was
recommended. Plus, over the past three months, he has visited the clinic many times for
review. At that time, he reported a gradual improvement of his condition. With regard to
physiotherapy, he started it directly after the incident. Hence, he witnessed a good recovery
with only residual pain and stiffness.

Today, Mr Johns attended the clinic since/because he got bored as, currently, he is staying
home doing nothing. Consequently, he requested to return to his work. Upon assessment, I
figured out that he can walk for thirty minutes a day. Please note, as Mr Jones is getting
better, I have decided to allow him to go back to his work under some special precautions:
he will not be allowed to carry heavy objects while working, and regular breaks will be
taken.

In view of the above, I am writing to you to request an assessment of his workplace. For
more queries, please contact me.

Yours Sincerely,

Doctor

23
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September 2015

Dr. David Smith

Cardiologist
Emergency department
Main Hospital
Coast City

20.09.2015

Dear Dr. Smith

Re: Mrs. Lucy Clarke, D.O.B: 11.03.1951

I am writing to refer Mrs. Smith, a 69-year-old office clerk, who has symptoms of acute
coronary syndrome. Your urgent management would be highly acknowledged.

Mrs. Smith is a married lady who lives with her husband. Despite drinking socially, she is a
non-smoker.

Today, 20.09.2015, Mrs Smith came to my clinic complaining of central crushing chest pain
which was exertional, radiating to her left arm, and it was associated with dyspnea. Taking
this into account, she was extremely irritated and concerned about her condition. With
regard to her risk factors, she has had type II DM since 2001, hyperlipidemia since 2003
and hypertension since 2005. Therefore, she has been receiving sitagliptin, Insulin,
Atorvastatin and Irbesartan. Please note that she has a family history of ischemic vascular
diseases as her mother had acute myocardial infarction and her father died from an
ischemic stroke at the age of 59.

My provisional diagnosis is unstable angina despite the presence of normal resting ECG.
Hence, she was counseled and advised on the serious risk of myocardial infarction.

Thank you for your urgent intervention to save her heart. For more queries, please do not
hesitate to contact me.

Yours Sincerely,

Doctor,

24
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April 2015

Dr. Jones
Newtown Memory Clinic
400 Rail Rd
Newtown

19.04.2015

Dear Dr. Jones,

Re: Mrs. Patricia Welshman, D.O.B: 28.03.1930

I am writing to refer Mrs. Welshman who has features suggestive of an early stage of
Alzheimer’s disease. Your assessment would be highly appreciated.

Mrs. Welshman is an 85-year-old widow who lives alone despite having five adult children.
Kindly note that she has a family history of Alzheimer’s disease. With regard to her medical
history, she has been my long-term patient and she has osteoporosis and dyslipidemia.
Therefore, she receives atorvastatin, Vitamin D, metoprolol and pain killers.

On 14.12.2014, she attended the clinic for a routine review. Her assessment was accepted,
apart from borderline high blood pressure and a deranged lipid profile. Further discussions
revealed that she has a difficulty in remembering medication times. In terms of her home
care, the occupational therapist had done some modifications to let her avoid falls.

On 19.04.2015, Mrs Welshman visited the clinic accompanied by her daughter who was
concerned about Mrs. Welshman’s memory. At that time, the patient’s daughter confirmed
many facts about her mother’s conduct: she forgets hair dresser, dinner engagements and
she misses many social events. Moreover, she was worried about her mother’s behavioural
and social changes. On mini memory assessment of Mrs. Welshman, she was worried, but
successfully confirmed the year. However, she could not remember the date and day.
In view of the above, I am referring her for more assessment regarding her memory. For
more queries, please contact me.

Yours Sincerely,

Doctor,

25
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February 2014
Dr. Simon Anderson
Associate Professor
Surgery Department
City Hospital
25-29 Main Road
Centreville

22nd February 2011

Dear Dr. Anderson

Re: Mr. Daniel McCrae, D.O.B: 17th October

Thank you for seeing Mr. McCrae, a 52-year-old barrister, who has been recently
diagnosed with adenocarcinoma of the ascending colon.

Mr. McCrae is a married gentleman with four children. He has been a patient of mine for a
long time. He first came to me on 14.09.2013 with a complaint of an attack of chest
infection, which was treated symptomatically.

Five months later, Mr McCrae presented with abdominal discomfort, fatigue and alternating
diarrhea with constipation. On examination, his abdomen was lax without palpable masses.
With regard to the risk factors, he has no family history of colorectal cancer. Therefore,
some investigations were arranged.

Today, 27.01.2014, when Mr McCrae attended the clinic, there was no improvement in his
condition. Plus, he came with the results investigations which were disappointing. To
illustrate, his FOBT was positive and adenocarcinoma of the ascending colon was detected
after colonoscopy and biopsy had been done. Please note that his blood tests showed
anemia and today’s examination was unremarkable.

In view of the above, I am referring Mr. McCrae for an urgent surgical assessment. Should
you have any further queries, please do not hesitate to contact me.

Yours sincerely,

Doctor X

26
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July 2015

Dr. M Jones
Psychiatrist
23 Sandy road
South Seatown

25-07-2015

Dear Dr. Jones,

Re: Mrs. Katherine Walter, D.O.B: 26.11.1975

Thank you for seeing Mrs. Walter who has features of depression. Your further
management would be highly appreciated.

Mrs. Walter is a 40-year-old married lady, and has 2 children. Her past medical history is
remarkable for chronic feet fungal infection and asthma; hence, she takes Clotrimazole
cream and Pulmicort inhaler. Please note that she has a strong family history of
depression.

On 19.11.2014, Mrs Walter came to my clinic for a check-up when she reported a feeling of
tiredness. Upon examination, she was overweight, and she had a flare up of her feet
infection; therefore, she was advised to lose weight and miconazole was prescribed. After 6
months, she presented to me when she reported that she had been feeling well and
energetic. Moreover, she acknowledged her involvement in her children-school-activities.
Surprisingly, she lost weight after she had joined a gym.

Today, Mrs Walter came back to me after a month of her last visit as she had experienced
dramatic changes regarding her life. To illustrate, she reported that she had not been able
to cope up with her life, which made her unable to sleep well. Further, she had lost her
appetite, had felt tired and had had a strong desire to die. On examination, she extensively
lost more weight.

In view of the above, I am referring her to you for urgent management and to respond
seriously to her suicidal thought. Please, contact me for more queries.

Yours sincerely,

Doctor X 3

27
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Dr. M Jones
23 Sandy Road
South Seatown

25.07.15

Dear Dr. Jones,

Re: Mrs. Katherine Walter, DOB: 26.11.1975

Thank you for seeing Mrs. Walter, a 39-year-old housewife, whose features are suggestive
of severe depression with possibility of bipolar disorder. Your urgent evaluation and
management would be highly appreciated.

Mrs. Walter is patient following in my general practice. She is married and has two children;
however, her extended family lives in other states. Her past medical history is remarkable
for chronic feet fungal infection and asthma; hence, she takes Clotrimazole cream and
Pulmicort inhaler. She has no particular hobbies and does not practice sports. Moreover,
she has a family history of depression to four members of her family.

On today’s visit, Mrs. Walter reported that she had not been able to cope up with her life
and that she had been overwhelmed with responsibilities. In further details, she has been
complaining of sleeping badly although she was feeling tired and unenergetic. Plus, she
could not complete the household tasks. Furthermore, she does not want to eat and
expressed her wish as she has suicidal thoughts. On examination, there was no
abnormality detected.

My provisional diagnosis is severe depression with possibility of bipolar disorder which

requires urgent treatment. Kindly note, I contacted her husband and child care and
household maintenance have been discussed.

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

Yours sincerely,

28
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October 2014

Dr. Tanya William

Respiratory Specialist
Bay view Private Hospital
31 Canyon Road
Bay view

18th October 2014

Dear Dr. William,

Re: Mr. Zach Foster, D.O.B: 25th October 1991

Thank you for seeing Mr. Foster, a 22-year-old single builder, who has features of
worsening bronchial asthma.

Mr. Foster has been treated for bronchial asthma for 3 years with 2 previous hospital
admissions. His medical records reveal that he has been smoking for 4 years and suffers
from eczema. Please note that he has allergy to cats and has hay fever.

Initially, Mr. Foster came to me, complaining of a burning sensation in his chest, which
increased after meals. On assessment, his chest was clear with a peak of 500 L/min.
Therefore, he was diagnosed with unstable-asthma which was triggered by GORD.
Consequently, he was advised to stop smoking and Pantoprazel was added.

Today, 18.10.2014, Mr Foster presented to the clinic when he had acknowledged a good
effect of Pantoprazl, but he, unfortunately, did not stop smoking, and he was missing doses
of his Pulmicort inhaler. Thus, my decision was to continue the same treatment and I
offered him treatment options to help him give up smoking. Furthermore, a CXZ had been
arranged which showed a clear chest.

Based on the above data, I am referring Mr. Foster for further management as I believe he
needs respiratory function tests. Please, contact me for any queries.

Yours sincerely,

Doctor

29
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January 2015

Dr Grantly Cross
Endocrinology Consultant
City Hospital
Suite 2z
55 Mile Main Road
Newtown

24th January 2015

Dear Dr. Cross,

Re: Mr. Brett Collister, D.O.B: 20.11.1970

Thank you for seeing Mr. Collister, a 45-year-old factory fareman, who has features of type
2 DM.

Mr. Collister has been a patient of mine for a long time. He is married with 3 children. His
medical reports reveal that he is an overweight gentleman and he had an attack of
infectious mononucleosis in 2003.

At first, Mr. Collister came to me on 22.03.2014, complaining of chest infection which was
treated symptomatically. One month later, he attended with another attack of chest
infection which responded well to arrexicillin.

Over the last 3 months, Mr. Collister has presented many times with right knee and left
shoulder pain. Consequently, he was referred to a physiotherapist after he had been
advised to lose weight and to do exercises. However, he did not change his lifestyle and
he was reluctant to lose weight.

On 04.01.2015, he attended with a complaint being tired and dizzy. Therefore, some blood
tests were arranged. Twenty days later, he came for the tests' results which were
disappointing, as they showed high blood sugar and cholesterol.

Based on the above data, my provisional diagnosis is type 2 DM. I am referring him to you
for further treatment. Please, contact me for more queries.

Yours sincerely,

Doctor

30
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August 2014

Dr. M Mclaren
Neurologist
Suite 3
67 The crescent
Newtown

09th of August 2014

Dear Dr. Mclaren

Re: Mr. Michael Weir, D.O.B: 20 September 1970

Thank you for seeing Mr Weir, a 44-year-old real estate agent, who has features suggestive
of multiple sclerosis.

Mr. Weir has been a patient for a long period of time. He is married, and has 3 children. His
medical records reveal that he has been overweight, smoker and under treatment for
depression with sertraline.

At first, he came to me on 29.06.2014 for a general check-up when he reported feeling of

tiredness and stress. For that, some blood tests were arranged. One week later, he
attended for the tests' results which confirmed the presence of anemia and
hypercholesterolemia. Additionally, he reported weakness of his left leg. Therefore, he
was given lifestyle changes advice and I urged him to quit smoking.

Today, 09.08.2014, he presented to me when he complained of dizziness, stress and

recent blackouts. On examination, he had left leg weakness, loss of sensation in both
hands and a diminished left patellar reflex.

Based on the above data, my provisional diagnosis is multiple sclerosis; hence, a CT scan
of head and lumbar spines was requested. He was referred into your care for full
neurological assessment and to assess the need for an MRI. Thank you for your care. For
further queries, please contact me.

Yours sincerely,

Doctor

31
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Jan. 2015

Dr. Grantley Cross

Consultant Endocrinologist
City Hospital
Suite 32
55 Main Road
Newtown

24.01.15

Dear Dr. Grantly,

Re: Mr. Brett Collister, DOB 20.11.1970

Thank you for seeing Mr. Collister, a 45-year-old factory foreman, who has been
complaining of signs and symptoms suggestive of diabetes mellitus type 2. Your further
management would be highly appreciated.

Mr. Collister is married, and has 3 children. He is overweight because there is no

adjustment to diet or exercise; however, he is interested in watching football, playing darts
and fishing. Please be noted, he has a non-significant past medical history and there are no
known allergies.

On 04.01.15, Mr. Collister presented complaining of a 4-week history of tiredness and sore
eyes that have been associated sometimes with dizziness and this was suspected to be
due to orthostatic hypotension. Therefore, I ordered blood tests to review his cholesterol
level and his blood sugar level.

On today’s visit, Mr. Collister attended the clinic with the same complaints; furthermore, he
reported some deterioration in his vision. Unfortunately, the results of his investigation
revealed an increase in all the blood sugar levels including the random glucose, the fasting
glucose and the glycosylated hemoglobin. Regarding the blood lipid profile, there were
increase in all of the cholesterol, LDL and triglyceride levels.

Based on the above information, Mr. Collister has been diagnosed with diabetes mellitus
type 2 and being referred into your care for further assessment. Should be any queries,
please do not hesitate to contact me.

Yours sincerely,

32
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Feb. 2015
Dr. Jack Thomas
Department of Gastroentrology
City Hospital
Main Road
Stillwater

21.02.2015

Dear Dr. Thomas,

Re: Mr. Patrick Newton, DOB 06.07.1989

Thank you for seeing Mr. Newton, a 25-year-old accountant, who has been complaining of
signs and symptoms suggestive of inflammatory bowel disease. Your further assessment
would be highly appreciated.

Mr. Newton is a smoker. He is single, and he lives with his parents. He is a regular squash
player. Please be noted, his uncle is known to have Crohn’s disease.

On today’s visit, Mr. Newton presented with a 4-month history of chronic mild diarrhea.

Or
On today’s visit, Mr Newton came to the clinic with a complaint of chronic mild
diarrhea which had been present for four months. That complaint has been associated
with low-grade intermittent right lower abdominal pain. In addition, he has complained of
lethargy, decreased appetite and decreased weight for about 3 kg in 4-month duration.
Furthermore, his symptoms have had a bad impaction on his social participation as he
stopped attending Friday evening squash matches. He expressed trials to alleviate
symptoms, without seeking medical advice, including dietary modification and using over-
the-counter medications with no improvement. On abdominal examination, there was
generalized tenderness; however, no splenomegaly or hepatomegaly has been noticed.
Additionally, the blood tests revealed an increase in the white cell count, C-reactive protein
and the erythrocyte sedimentation rate while the red cell count and the hemoglobin
revealed a decrease plus a positive faecal occult blood test.

Mr. Newton has been advised to quit smoking and has been diagnosed with possible
inflammatory bowel disease, either Crohn’s disease or ulcerative colitis.

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

Yours sincerely,

33
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April 2015

Dr. Jones
Newtown Memory Clinic
400 Rail Road
Newtown

19.04.2015

Dear Dr. Jones,

Re: Mrs. Patricia Welshman, DOB 28.03.1930

Thank you for seeing Mrs. Welshman, an 85-year-old patient, who has features suggestive
of an early stage of Alzheimer’s disease. Your further assessment would be highly
appreciated.

Mrs. Welshman is a widowed mother having 5 children; however, she lives alone. She is a
hypertensive and a dyslipidemic patient on regular medications. Please be noted, she has a
family history of Alzheimer’s disease.

On 14.12.14, Mrs. Welshman’s blood pressure was high and her pathology results revealed
an unsatisfactory lipid profile levels because she was incompliant on her medications and
as a result, she was advised to use a Webster pack to ensure not to forget her medications
again; however she was reluctant to use it. Two months later, there was more deterioration
in her pathology results; hence she agreed to use the Webster pack.

On today’s visit, Mrs. Welshman’s blood pressure and pathology results showed an
improvement; however, both of her and her daughter discussed some memory issues
about Mrs Welshman. For more details, she reported forgetting her hair dresser and dinner
engagements as well as missing social events. Moreover, some behavioral changes and
decision-making issues have been noticed. As a result, Mrs Welshman’s family was
concerned about these behavioural changes. Accordingly, a mini-mental examination had
been performed and revealed a poor short-term memory.

Mrs. Welshman, who has been diagnosed with dementia most probably due to Alzheimer’s
disease, is being referred into your care for a full memory assessment and for confirming
the diagnosis.

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

Yours sincerely,

34
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Dr Jones
Newtown Memory Clinic
400 Rail Road
Newtown

19/04/2015

Dear Dr. Jones,

Re: Mrs. Patricia Welshman, D.O.B: 28/03/1930

I am writing to refer Mrs. Welshman, an 85-year-old lady, whose features are consistent
with an early stage of Alzheimer’s disease. Your further assessment would be highly
appreciated.
Mrs. Welshman has been my patient for a while. Although she is a widow and has 5 adult
children, she lives alone. Regarding her medical history, she has osteoporosis and
hyperlipidemia; therefore, she takes Lipotor, Oste-vitD and pain killers. Kindly note that she
has a family history of Alzheimer’s disease.
On 14/12/2014, when the patient attended my clinic, apart from hyperlipidemia, low levels
of vitamin D and irregularly taking her medications, she seemed well. I, wherefore,
suggested using a Webster pack.
Today, Mrs Welshman presented to my clinic with her daughter who was worried about her
mother’s memory. Her daughter reported that the patient had been forgetting hair dressers,
social events and dinner engagements, for which her family was worried. Moreover, the
patient expressed behavioural changes and was indecisive. A further assessment revealed
that the patient was unable to recognize the day and the date, although she recognized the
year correctly.
In view of the above, my provisional diagnosis is an early stage of Alzheimer’s disease;
therefore, I am referring this patient into your care for further assessment of her memory.
For any queries, please contact me

Yours sincerely,
Doctor

35
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May 2015

Dr. Lorna Bradbury

Stillwater Medical Clinic
12 Main Street
Stillwater

23.05.2015

Dear Dr. Bradbury,

Re: Ms. Isabel Garcia, DOB 01.01.1995

Thank you for caring about Ms. Garcia who was referred with signs and symptoms
suggestive of suspected meningitis. Your further follow-up would be highly appreciated.

On 23.05.2015, Ms. Garcia attended the Emergency Department with a complaint of painful
stiff joints which had been present for one week. That complaint was associated with
sensitivity to light and an increase in bruising. Furthermore, she has been suffering from
headache, neck stiffness, photophobia and rash. On examination, there were bruising on
her left arm and some petechial rash on the abdomen and the legs. Additionally, she was
unable to touch her chin to her chest while lying supine. As a result, some investigations
have been ordered; including, a full blood count, a renal function test, a liver function test, a
C-reactive protein (CRP), blood cultures and a lumbar puncture.

Please be noted that the results revealed an increase in both of the white cell count and
CRP while the lumbar puncture showed an elevated white cell count with
polymorphonuclear predominance as well as an elevated protein, while the glucose was
decreased. For more confirmation, a subsequent microscopy and a culture had been
ordered upon which the diagnosis was confirmed as Neisseria meningitis.

Ms. Garcia had received her medications including ceftriaxone 2g intravenous and
dexamethasone 10mg intravenous while benzylpenicillin 1.8g was added following the
lumbar puncture results. She responded well to the treatment. However, her close family
and friends are in need to be immunized and Ms. Garcia needs to be educated about
seeking an immediate medical attention on observation of any signs of an unexplained
illness for which she is being referred back into your care.

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

Yours sincerely,

36
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June 2015

Ms. Jane Graham

Occupational Therapist
Newtown Occupational Therapy
10 Johnston St.
Newtown

20.06.2015

Dear Ms. Graham,

Re: Mr. Barry Jones, DOB 01.04.1972

Thank you for assessing Mr. Jones’ work place. Mr. Jones is a 44-year-old driver who has
recently suffered from a lower back strain. Your evaluation of his workplace would be highly
appreciated.

Mr. Johns is married and has 3 children. He drives a forklift at a large warehouse where he
is used to sitting for a lone time lifting heavy objects occasionally.

On 21.03.2015, Mr. Johns presented with a 4-day history of a severe lower back strain
following lifting a heavy box from the ground at work. Therefore, he was treated
accordingly, advised to walk daily with a gradual increase in time and distance, referred to a
physiotherapist and was given 30 days off work. One month later, his leave was extended
to another 30 days due to the persistence of his symptoms. However, after another month,
although he started to recover properly, his leave was extended to another 30 days to
ensure his ability to get back to work.

On today’s visit, Mr. Johns attended with some pain and stiff movements; however, there
was an increase in his range of movement. Moreover, he got bored and showed his
willingness to return to work. Accordingly, returning to work has been permitted unless
there would not be lifting heavy objects. There would be regular breaks for him.
Should be any queries, please do not hesitate to contact me.

Yours sincerely,

37
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August 2015

Dr. Penny Clifton

Department of Cardiothoracic Surgery
Central Hospital
Main Street
Stillwater

22.08.15

Dear Dr. Clifton,

Re: Mrs. Mary Clarke, DOB: 17.09.1960

Thank you for seeing Mrs. Clarke, a 55-year-old office clerk, who has been suffering from
features suggestive of bronchogenic carcinoma. Your further assessment would be highly
appreciated.

Mrs. Clarke is married and lives with her husband and son. She has unknown allergies;
however, she has been a heavy smoker for more than thirty years. Furthermore, her
mother died at age of 66 with laryngeal carcinoma and her father died at age of 54 with a
mining-related lung disease.

On today’s visit, Mrs. Clarke attended the clinic with a complaint of a non-productive cough
which has been present for seven weeks and has been associated with mild shortness of
breath, especially at night, and a strange sensation of heaviness in her chest. Apart from
this, she denied the presence of fever, night sweats or rigors. Additionally, she reported her
proper ability to exercise, do shopping and to walk up two sets of stairs. On respiratory
examination, there were signs of consolidation associated with a monophonic wheeze in
the right middle zone. As a result, investigations were ordered including sputum cytology, a
chest x-ray and a chest computed tomography. The results revealed normal sputum
cytology; however, the chest x-ray and CT scan showed right middle lobe atelectasis and
an enlarged right hilum.

In view of the above, Mrs. Clarke has been diagnosed with possible bronchogenic
carcinoma and is being referred for follow-up investigations including bronchoscopy and
biopsy.

For further queries, please do not hesitate to contact me.

Yours sincerely,

38
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