Sample: record-request response pack
Fictional case, written for this page. Client name: Sample Client 7. No real client, health plan or clinician. Sources are shown in brackets; in an exported document they move to an optional source index.
Drafted from your own notes: treatment plans, plan reviews, continued-care letters and record-request packs. Every sentence sourced to your documentation.
1. Sample and request details
Client: Sample Client 7. Request reference: RR-2026-0471. Date received: 02/10/2026. Records requested: treatment plan excerpt and progress notes from 01/06/2026 to 02/03/2026. Response due: 02/24/2026. Treating clinician: Sample Clinician.
Filled from the case file. No text is generated for this section.
2. Cover letter
The records listed in the index below cover the period 01/06/2026 to 02/03/2026 and were reviewed by the treating clinician before release. [S1 · 02/03] The client was seen weekly from 01/06/2026 to 02/03/2026, eight sessions in total. [S2 · 01/06]
The pack is signed off by the clinician before export.
3. Document index
| Document | Pages | Date range |
|---|---|---|
| Cover letter | 1 | 02/03/2026 |
| Treatment plan excerpt | 2 | 01/06/2026 |
| Progress notes, notes 1 to 8 | 9 | 01/06/2026 to 02/03/2026 |
The index is built from the case file. No document is added and no entry is reordered by the software.
4. Treatment plan excerpt
Presenting concerns: worry before work meetings and difficulty speaking up in them. [S1 · 01/06] The client reports disturbed sleep in the days before a meeting. [S2 · 01/13]
Goals, as you wrote them: To attend a full team meeting and raise one concern.
Code field: F41.1 (typed by the clinician). This line is a fictional example. ICD-10-CM and CPT codes appear only as fields the clinician types; the software does not select or suggest a code.
5. Progress notes index
01/06/2026, note 1, 55 minutes, code 90837, plan in force. [S1 · 01/06]
01/13/2026, note 2, 50 minutes, code 90837, plan in force. [S2 · 01/13]
01/20/2026, note 3, 53 minutes, code 90837, plan in force. [S3 · 01/20]
Each line is taken from the note header and the plan in force on that date.
6. Completeness check
The check lists what is missing or does not match in the notes.
| Check | Finding |
|---|---|
| Date on note 4 | Does not match the session record |
| Session length on note 6 | Missing |
| Countersignature on note 8 | Missing |
This check covers form only. It does not assess clinical content.
The check never says what to write. It lists what is missing or does not match, and the clinician decides what to do.
7. Review and signature
Written by you. This section is never drafted by the software.
Every document in the pack is reviewed, edited, approved and signed by the clinician before export. The software does not decide medical necessity and does not predict what a health plan will do.
We do not claim HIPAA compliance. The pilot takes no protected health information, so no Business Associate Agreement is needed. Before we accept real client data we will offer one. During the free pilot the service is hosted in Germany and takes de-identified or fictional data only; client identity is masked on your device and the server refuses recognizable identifiers.