25 July, 2009

The Director

Community Child Health Service

41 Jones Street

Ekibin

Dear Sir/Madam,

Re: Vamuya Obeki

23 May, 2005

I am pleased to refer Vamuya Obeki, a four year-old refugee from Sudan, who was diagnosed with
acute meningoencephalitis, for further shots of required vaccine and neurological assessment.

During confinement, They were aware that both children were given vaccination; however, there was
no record present upon questioning which serves no definite answer if the children were given
preventive shots against Mumps.

As regards the patient’s social background, Vamuya, alongside his family, moved to Australia last year
as refugees from Sudan. The family has limited facility of the language although the father takes some
english classes. Moreover, the family has no family doctor.

As the patient appears significant signs of recovery as evidenced by the absence of the disease. The
patient will be discharged on 25th July, 2009. Included in the patient’s discharge plan are medical
advice on needed vaccination and a neurological assessment. Her family’s social background warrants
the need to use basic english translation so to avoid any misunderstanding in a medical procedure.
Hence I am writing this letter to refer Vamuya for further assessment and appropriate management.

I would be grateful if you could heed to this request on behalf of the patient. Should you have further
querries, please do not hesitate to contact me at Children’s Emergency Department.

Sincerely Yours,

Grazielle Pagute
Nurse
Words: 102

13 September, 2009

The Director

Community Child Health Service

41 Vulture Street,West End

Brisbane 4101

Dear Sir/Madame,

Re: Ms Nicole Smith, 18 years old

I am pleased to refer Ms Smith, an eighteen year-old lady, who has recently given birth to her first
child through the Spirit Mother’s Hospital, for further advice and guidance on proper newborn care.

On the 9th of September, 2009, Ms. Smith arrived in the hospital at 7 in the evening with contractions
that lasted for 1:10 minutes. Her first stage of labour reached up to 16 hours which resulted to an
Emergency Caesarean Section. At exactly 1120 hours on the 10th September, 2009, a healthy baby boy
was born weighing 4.4 kilograms and an Apgar score of 6. Her last surgical operation was 3 years ago
which was an appendicectomy but other than that, she is generally in good health during her first
pregnancy with no antenatal complications.

As regards the patient’s social background, She is single and has no information of the child’s
biological father on his whereabouts. Moreover, She has no contact with her direct family because of
this the patient expressed feelings of isolation and insecurity which caused her to doubt her ability to
care as a mother. She is opting to offer the baby for adoption.

As the patient shows signs of minimal blood loss with a haemoglobin result prior to discharge of 90
g/L, the patient will be discharged on the 13th September, 2009. Included in the patient’s discharge
plan are the following: continuation of drug supplements, breastfeeding practice, and proper
newborn care. Her social background warrants that there is no one to guide her and provide
assistance in caring for her newborn. Hence, I am writing this letter to request for a home visit in
order to procide counsel and assistance for Nicole and her baby.

I would be grateful if you could heed to this request in behalf of the patient. Should you have further
querries, Please do not hesitate to contact me at the Spirit Mother’s Hospital.

Sincerely yours,

Grazielle Pagute

Nurse

Words:
 10 July, 2009

The Admitting Physician

Spirit Hospital Emergency Department

Dear Doctor,

Re: Betty Olsen, aged 73

I am pleased to refer Mrs. Olsen, a seventy-three year-old widow, who shows symptom of heart
attack, for immediate admission to hospital.

On 10th July, 2009 at 10:45 at night, Ms. Olsen was showing signs of distress, pallor, diaphoretic, and
expressing persistent chest pain with a blood pressure reading of 190/100 mmhg, despite given with
pain relief 45 minutes prior to this attack. In the previous days, She had been complaining of an
episodic pain from the shoulder to the abdomen accompanied by insomnia, which believed only to be
bouts of pain or indigestion and inability to sleep rather than signs of an impending attack.

Her medical history traces her with Hyperthyroidism, Hypertension, and Glaucoma for the past 12
years included in her medications were Karvea, Oroxine, Normison, and Timoptol Eye Drops
respectively. She also has Vitamins and Supplements that were non-prescribed by physician namely
Glucosamine and Vitamin C complex. It is also important to note that she has an allergic reaction to
penicillin.

Given the physical manifestations and medical condition of the patient, I believe immediate medical
attention is needed. Hence, I am writing this letter for the urgent admission of Mrs. Olsen.

Sincerely yours,

Grazielle Pagute
Nurse

1 August, 2009

The Director

Glen Haven Palliative Care Hospice

971 Arthur Street

Toowoomba
Dear SIr/Madame,

Re: Mrs Maeve Greevson

9 October, 1951

I am pleased to refer Ms Maeve Greerson, a fifty-seven year-old widow, who suffers from intestinal
cancer, for palliative care.

Four days prior to transfer, the patient grew increasingly weak that she can only tolerate liquids on
her diet and was often noted with episodes of confusion. However, she was not in any state of pain as
compared to her condition last 25th of July, 2009 wherein she was observed with occasional to sever
breakthrough pain in which pain medication was increased. During her admission, she was also
managed for nausea and dehydration, therefore an intravenous therapy was commenced in order to
replace lost fluids. It is also important to note that the patient can consume light low fiber diet at that
time.

Her medical history traces to laparotomy she underwent 5 months ago that confirmed her present
diagnosis which resulted to a partial bowel resection and colostomy procedure. A month after her
surgery, she had six weeks of radiation therapy to alleviate the symptoms and despite treatment, her
prognosis remains poor. Both family and patient decided for supportive care resulting for the
patient’s request for a social worker referral, in which her brother met on her behalf.

Considering the patient’s physical manifestations and medical condition at the decision she and her
family made, I believe your services are needed. Hence, I am writing this letter to refer Mrs Greerson
for further supportive care.

Sincerely yours,

Sarina Chai

Nurse
9 September, 2009

The Community Information Section of the Heart Foundation

Gregory Terrace
Brisbane

Dear Sir/Madame,

Re: Mr. Bill O’Riley, aged 53

I am pleased to refer Mr. Bill O’Riley, a 53-year-old male fencing contractor, who was diagnosed with
obstructive coronary artery disease, for advice on specific dietart protocols and basic healthy recipes.

On the 2nd of September, 2009, Mr. O’Riley was admitted and diagnosed with the said disease
mentioned above. Consequently, He underwant coronary artery bipass graft 2 days after. HIs
management includes daily post operative care, smoking cessation, alcohol reduction, low fat diet
restriction, and routing visit from the social worker. Furthermore, he was able to walk properly and
displayed signs of good wound healing.

His lifestyle history traces a sedentary habit which started from smoking 20 cigarettes daily to
excessive alcohol intake consuming two bottles of 300 ml beer per day. Apart from this, his usual diet
consists of unhealthy food/high fat containing food that contributed to his weight reaching 99
kilograms against his 170 centimeter height. It is also important to note his allergic reaction to nuts.
As the patient shows significant signs of recovery as evidenced by improved ambulation and wound
healing. The patient will be discharged on this day. Included in the patient’s discharge plan are:
modified diet plan, scheduled visit to dietician, and continued rehabilitation exercise. It is noteworthy
to know that he has an appointment with the dietitian, Dr. Avril Jensen on the 15 th of September,
2009 at 2PM. Considering the guidelines needed of the patient as verbalized during confinement, I
believe your service are needed.

I would be grateful if you could heed to this request on behalf of the patient. Should there be any
querries, please do not hesitate to contact me at the coronary care unit of St. Andrews Hospital
Brisbane

Sincerely yours,

Lee Wong

Registered Nurse

21 May, 2009

The Director

Blue Nursing Service

208 Sydney Street

West End

Dear Sir/Madame,

Re: Ms. Annette MacNamara, aged 73

I am pleased to refer Ms. Annette MacNamara, a seventy-three year old pensioner, who suffers from
a fracture, laceration and bruising following a fall from the stairs, for need of assistance on daily
activities and physical rehabilitation.

On the 20th of May, 2009, Ms MacNamara fell down the stairs while taking out the garbage which
rushed her to the hospital resulting a massive bruising on the right shoulder and lower back that was
addressed by surgical stitching. X-ray result revealed a fracture on the right wrist and laceration on
the left. Prescribed medications were given for pain, insomnia, and high blood pressure which were 2
tablets of Panadol, 1 tablet of Normison everynight, and 1 tablet of Karvea in the morning,
respectively.

As regards Ms. MacNamara’s social background, she recently moved to a small flat in the new
suburbs alone. Her niece visits her every two weeks and she rarely sees her neighbours since she is
new around the area.

As the Ms. MacNamara shows significant signs of recovery as evidenced by no complications and
increased wound healing. The patient will be discharged on the 22nd of May, 2009. Included in the
patient’s discharge plan are: Daily visit by the Nursing service staff to provide assistance with hygiene
and wound dressing, Organize Meal Plan and physiotherapy by the Social worker. It is also
noteworthy to know that she has a scheduled appointment on the 31 st of May, 2009 at 10:30 am for
stitches removal and further assessment of general condition at Out Patient Department
appointment. Hence, I am writing this letter to request for an assistance in the mentioned activities
above.

I would be grateful if you could heed to this request in behalf of the patient. Should you have any
queries, please do not hesitate to contact me at 07 3897 7642.

Sincerely yours,

Grace Jones

Nursing sister worker