Body Paragraphs



Most referral letters will contain 2 or 3 body paragraphs located between the introduction
and the conclusion. Each of the paragraphs should have a main idea which the writer
needs to convey to the reader. All the sentences with the paragraphs must relate to this
main idea. The length of the paragraphs will vary, but an approximate guideline to meet
the required word length of 180~200 words in OET is as follows:
• Introduction: 25 words
• Body paragraph 1: 40 words
• Body Paragraph 2: 40 words
• Body Paragraph 3: 70 words
• Conclusion: 25 words
Paragraph Structure

A good paragraph will contain 3 main elements
1. A Topic Sentence which introduces the reader to the main idea of the
paragraph. In many cases it will identify and/or summarise an area of
concern regarding the patient. Quite often it is written in original words rather
than from words in the case notes.
2. Supporting sentences which may contain the detail regarding patient history,
descriptions of symptoms, significant aspects from the treatment record,
causes and effects, trends and so on. Quite often this information can be
taken directly from the case notes, and written as full sentences. However,
you will need to paraphrase the information into your own words. This
includes:
o Changing verbs to nouns: complain=complaint
o Changing adjectives to nouns: lethargic=lethargy
o Using synonyms
o For more details on how to paraphrase, follow this link: Paraphrase
3. Signal words link sentences together so that the information flows smoothly
and is easy to read.
Common signal words which can help you present information clearly and logically
include:
o 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...
o Location: During hospitalisation, Initial examination at my clinic
revealed...,On examination....
o More information: In addition, Moreover, Also, Apart from this..
o Contrast: However, Despite, Although
o Result: Therefore, Consequently, As a result, For this reason...
o Emphasis: Please note, May I remind you, My main concern is....,
What concerns me most is.....
o Sympathy: Unfortunately, Regrettably, Fortunately,
o 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...
 o Advice: It is important to..., I recommend that you....., Please ensure
that....
o Chronology: Firstly, Secondly, Finally


Example 1
Case Notes Paragraphs Analysis
Diagnosis
 Ms. Harwood was • Topic sentence is
Right partial rotator cuff admitted to our hospital introduced with the phrase:
tear 
 on the 30th of October Ms. Harwood was admitted
Presented to Mater with a diagnosis of right to our hospital on....
hospital with pain and rotator cuff tear • Supporting sentences
weakness in the right following a fall while transform case notes into
shoulder, especially descending stairs. complete sentences
when lifting arm Therefore, surgery has
overhead.
 been suggested, • Signal words express cause
Descending stairs at however, she prefers and effect and express
home and slipped, non-surgical treatment. contrast
falling onto She has received o Therefore,
outstretched arm. 
 ibuprofen and cortisone
Xray and MRI showed a as prescribed and also
o However
partial rotator cuff tear.
 daily visits by a
Orthopaedic surgeon physiotherapist.
discussed surgery.
Patient prefers to try
non-surgical treatment.

Date of admission:
30-10-2008

Date of discharge:
01-11-2008



Treatment

Ibuprofen orally QID

Cortisone injections 

Daily physiotherapy
 Medical History
 In terms of her medical • Topic sentence is
Diabetes Mellitus Type 2 
 history, she suffers introduced with the phrase:
Metformin 500mg mane
 from type 2 diabetes In terms of medical

 mellitus for which she is history,
Nursing Care Needs 
 taking metformine • Supporting sentences
Needs blood glucose 500mg. However, transform case notes into
level monitoring 4 following her discharge, complete sentences
hourly
 she will need a regular
May be elevated monitoring on the blood • Signal words connect ideas
because of cortisone
 glucose level which may and express contrast
Needs assistance with become elevated due to o However,
shower and housework
 administration of
o due to
Orthopaedic review on cortisone during
19th November hospitalisation. She will o also
also require assistance o As well as this,
in showering and home
help. As well as this,
she needs to review her
condition with an
orthopaedic surgeon on
the 19th of November.

Social Background
 Ms. Harwood lives alone • There is no topic sentence,

Marital status: Widow. and has no children. but the main idea of social
No children. Lives alone 
 Her next of kin is her history is clear
Next of kin: Megan niece, Megan Mack who • Supporting sentences
Mack (Niece)
 lives in Sydney. expand the case notes into
Niece lives with Regrettably, she has no complete sentences, note
husband in Sydney who relatives or friends to the use of verbs, articles
works as software support her. and conjunctions (and)
engineer for Google
Australia. Sister died • Signal word shows
recently. No other empathy
relatives. o Regrettably,



Example 2
Case Notes Paragraphs Analysis
Birth History
 The patient was born • The topic sentence is begins
Normal vaginal birth at via vaginal birth at with the baby's birth.
term
 term with a birth • Supporting sentences
Birth weight: 3400gm 
 weight of 3400 grams. transform case notes into
Apgar score at 5min: 9
 During a heatwave at complete sentences
No antenatal or Christmas, the baby
postnatal complications
 became unsettled, due • Displays understanding of

 to lack of fluids. When the long case notes by
Feeding
 the mother became summarising the main idea.
Breast fed for first sick for a few days, her Explains conflicting views of
three weeks after birth. 
 mother-in-law visited mother and mother-in-law.

 to help out but has • Signal words express a time
Baby became unsettled advised her to change line, contrast and cause and
during heatwave at to formula feeds and to effect.
Christmas. Mother got put more powder in the
o During a heatwave
sick and had a fever for bottle to improve
a few days. Mother-in- weight gain. However, o When...
law came to visit and the mother believes o However,....
advised changing baby that breast milk is the
to formula feeds. best for her baby and o Therefore,....
Mother-in-law advised would like to breast
extra powder in feed full-time but is
formula feeds to worried that she
improve weight gain. doesn’t have enough
Mother-in-law says her breast milk for the
son (Ray Charles) also baby. Therefore, she
had feeding problems has been giving extra
and difficulty gaining formula feeds to the
weight as a baby.
 baby.


Mother says she is
worried she does not
have enough breast
milk and now gives
extra formula feeds as
well as breast feeding.
She wishes she could
breast feed properly as
she believes it would
be the best thing for
her son. He hasn’t
taken to the bottle.



 15/01/10
 At the 6 week check- • Topic sentence is introduced

 up, the baby’s weight with the phrase: At the 6
Subjective
 is 4200 grams and his week check up,
Mother and baby vital signs are in • Focuses on objective
attended for routine 6 normal limits. information and final
week check-up. Mother However, the baby is assessment.Omits less
says she is concerned suffering from mild relevant detail.
about constipation: constipation,
once every three days, dehydration and • Summarises objective
hard stool. Mother is lethargy. details concisely into "vital
asking about stool signs in normal limits"
softener or prune juice • Paraphrases adjectives into
for baby.
 nouns i.e lethargic=lethargy


Objective 

Reflexes normal

Lethargic

No abdominal
tenderness

Heart Rate: 174

Respirations: 56

Temperature: 37.1

Weight: 4200gms

3 wet nappies in last
24 hours. Urine dark. 



Assessment

Mild constipation and
dehydration

Plan 
 Could you please • Topic sentence is a request

Increase breast feeds. support and advise the of support
Refer to breast feeding mother regarding • Supporting sentences
support service. Check breastfeeding and expand case notes into
formula is correctly correct preparation of formal sentences
prepared. If continuing formula feeds if
formula feeds, advise required. In addition, • Signal words add cohesion
to supplement with advice on how to keep o In addition,
water (boiled and the baby cool in hot
cooled). Advise on weather is necessary.
o Please note,
keeping baby cool in Please note, the patient
hot weather. Return for is due for review on
review in 48 hours. 17/01/2010.