i've seen a lot of confusion online on what exactly you need to do to summon grim gotchi1 on the tamagotchi uni.
...and i don't 100% know either. however, i have a few observations from trying to do it with my tama for the ambulance care icon, as well as some observations from other people who've summoned grim gotchi for their own tamas:
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only adult tamas can get the grim gotchi. babies, children, and teens seem to be unable to die and therefore cannot get grim gotchi
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leaving a sick tama for a long period of time doesn't seem to increase the chance to summon grim gotchi
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grim gotchi can only appear after a care mistake2. upon getting a care mistake, adult tamas have a 70% chance of returning to normal behavior, and a 30% chance of getting sick. if your tama gets sick, there's an additional, unknown chance of getting grim gotchi instead of a normal sickness
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if your tama gets a normal sickness after a care mistake, it's better to cure its sickness and try again. as previously mentioned, long periods of neglect don't seem to help
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i don't know if other forms of neglect (letting poop pile up or not bathing) have any effect on grim gotchi chances. further testing is required
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i don't know if the overall amount of care mistakes you have on your tama has any effect or not. mine had many care mistakes. further testing is required
1grim gotchi is the tamaverse version of the grim reaper, and appears on modern tamagotchi devices when your tama is about to die. it looks like a black ghost-like creature with yellow, squinted eyes and hangs around your tama. when it appears, your tama is a few minutes from death. grim gotchi is cured by pressing any button on your tamagotchi, which will call an ambulance to take your tama to the hospital and cure it. every time grim gotchi appears by your tama, the number of grim gotchi sprites will increase by 1 until there are 4 grim gotchis floating around your tama. once 4 grim gotchis appear by your tama, death is guaranteed and nothing will save it. uni players will often purposefully summon grim gotchi in order to get the ambulance care icon (however, you actually have to catch your tama before it dies! otherwise no care icon for you)
2a care mistake is only counted when your tama actively calls for you and you ignore it for 15 minutes. on the uni, your tama will only call when its hunger meter is empty, or its happiness meter is empty. (it also calls when it becomes sick, but i don't know if ignoring sickness counts as a care mistake)