Get my records
A billing statement is not the clinical record. Ask for the relevant record set and original information in a usable format, keep it unchanged, and make a separate note of anything that appears absent. Access rights are broad, but legal exceptions and state rules can matter.
Record sets
Not every item exists in every case. The point is to avoid receiving only a short summary when the underlying record contains more.
Blank template—complete outside Ulekai
Send this through the provider’s official records process. Ulekai does not collect, transmit, or store the completed request.
To: [Records department or practice] I request a copy of the complete [dental / medical / facility] record for the period [date range]. Please include [relevant categories from the checklist], including original image files in a usable electronic format when available. Please provide the records in [electronic / paper] format. If any requested item will not be provided, please identify it and give the reason in writing. Please provide advance written notice of any fee. Requester information and authorization: [Complete only through the provider's official process]
When the record arrives
Missing information can be important, but absence from your copy does not automatically prove that it never existed.
List what was requested, received, unreadable, duplicated, or missing.
Keep files and metadata unchanged. Store working copies separately.
Match the note, orders, results, images, itemized bill, and explanation of benefits.
Ask in writing about missing categories, factual errors, and dated addenda.
Records systems often preserve the original entry and add an amendment, addendum, or statement of disagreement. A disagreement about judgment is different from a factual error. Ask the record holder to explain its process and use applicable HHS or state guidance.