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Case Notes 36.1 Julian Marco

Occupational English Test – Writing (Nursing)


  • You have 45 minutes to write this letter.
  • During the first 5 minutes, you should not pick the pencil.
  • Start writing only when you are told.
  • During the Reading Time, try to understand the case notes.

Melons Steps

  • Eliminate (E) irrelevant information.
  • Launch (L) the letter with DADR.
  • Open (O) the letter with PRPDD or PRPTT.
  • Narrate (N) the remaining paragraphs using V or W.
  • Sign (S) the letter with S/F.

Melons Errors

  • Punctuation “Marks”.
  • Follow “Expansion” Rules.
  • Obey “Language” Rules.
  • Have an “Order” (DADR, PRPDD, V/W, S/F)
  • Do not change “Names”.
  • Sex (Mr, Ms, Mrs, His, Her).

Details to Fill In:


Read the case notes below and complete the writing task which follows.


Imagine that today’s date is January 8, 2024 and you are a community nurse from Sun District Health Community, visiting Mr Marco at his residence for the last 3 months.

Patient Details:

  • Julian Marco.
  • Age: 80 years
  • 123 Maple Street, Sunnyvale, CA 94085.

Medical History:

  • January 2021: Diagnosed with chronic arthritis. On Ibuprofen 400 mg PRN; Methotrexate 10 mg weekly.
  • March 2021: Diagnosed with Alzheimer’s disease. On Donepezil 10 mg daily, Memantine 10 mg daily.
  • June 2022: Diagnosed with cancer, underwent chemotherapy. Various chemotherapeutic agents as per oncology guidelines.
  • July 2022: Catheter placed due to urinary retention.

February 15, 2023:

  • Severe joint pain, swelling knees.
  • Presented to GP at MMH, Sunnyvale.
  • Diagnosis: Arthritis flare-up.
  • ↑ Methotrexate 15 mg qw., Prednisone 10 mg q.d., for 2 weeks.

May 10, 2023:

  • Memory loss, confusion.
  • Second visit to GP at MMH.
  • Progression of Alzheimer’s disease.
  • ↑ Donepezil to 20 mg daily, added Rivastigmine 4.6 mg patch daily.

August 5, 2023:

  • Difficulty urinating, pain in lower abdomen.
  • Catheter blockage.
  • Catheter replaced, prescribed Ciprofloxacin 500 mg twice daily for 7 days.
  • Under the care of Nurses from Sun District Health Community.

November 20, 2023:

  • Cut finger while preparing food, needed stitching.
  • Dx Laceration.
  • Wound cleaned and stitched, prescribed Amoxicillin 500 mg three times daily for 5 days

December 15, 2023:

  • Increased confusion and agitation.
  • Alzheimer’s disease exacerbation.
  • Adjusted Memantine dosage to 20 mg daily, recommended behavioral therapy

January 5, 2024

  • Patient fell at home, sprained ankle.
  • Wife significantly concerned about his well-being, ability to manage at home.
  • Provided supportive care for the sprain, advised rest, and prescribed Naproxen 250 mg twice daily.

January 8, 2024

  • Fall and arthritis causing joint pain and limited mobility.
  • Alzheimer’s disease affecting memory and cognitive functions.


  • 2 weeks of respite care in an aged care facility to ensure proper management.
  • Provide relief to wife (primary caregiver).

Writing Task

Using the information in the case notes, write a letter to an aged care centre for respite care for the patient: Address the letter to the Manager, Sunshine Aged Care Home, 789 Elm Street, Sunnyvale, CA 94085.

In your answer: 

  • Expand the relevant notes into complete sentences
  • Do not use note form
  • Use letter format

The body of the letter should be approximately 180–200 words.

(You will find a sample letter on this letter here soon. Keep visiting).

  • Question of

    Is this a known case?

    • Yes
    • No

    Correct Wrong

    This is an unknown case. The Manager of the Aged Care has no prior information about Mr Marco. Mr Marco was never before admitted to this Aged Care nor did the writer contact the Aged Care to discus Mr Marco's condition. Known case is when the recipient (R1) knows the patient (P1). Patient's GPs and in some cases, Community Nurses are examples for known cases.

  • Question of

    Is the patient’s condition diagnosed?

    • Yes
    • No

    Correct Wrong

  • Question of

    Is this a Transfer Letter or Discharge Letter?

    • Transfer.
    • Discharge.

    Correct Wrong

    You are transferring the patient from the patient's own home to an Aged Care facility.

  • Question of

    Who is the Recipient of this letter?

    • A nurse working in an aged care home.
    • Manager of an aged care home.
    • A male manager of an aged care home.
    • A female manager of an aged care home.

    Correct Wrong

  • Question of

    How will you address the recipient?

    • Dear Manager,
    • Dear Sir,
    • Dear Madam,
    • Dear Sir / Madam,

    Correct Wrong

  • Question of

    How will you sign this letter?

    • Your faithfully,
    • Yours faithfully,
    • Your’s sincerely,
    • Your’s faithfully,

    Correct Wrong

    Since you greeted the recipient formally (Dear Sir / Madam,), you need to sign the letter with "faithfully." Note, there is no apostrophe for "Yours."

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Listening Mini 36.1

Passive Voice 36