Scott Christman - Department of Health Care Access and 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Facility Information. Fill in the Facility #, HCAI Project #, Facility Name, Street Address, Phone, Fax, City, County, and Zip code as required.
3. In Section B, specify the Interval/Milestone and Reference Number. Ensure you select the correct month and year for the report date.
4. For Section C, detail the Observed Elements of Construction. Clearly list all work completed during this reporting interval or milestone.
5. In Section D, provide a Compliance Statement declaring that all work performed meets approved standards. Include any necessary corrections in the comments section.
6. Complete Section F by entering your Print Name, Registration #, Firm Name, Address, City, State, and Signature. Select your role from the provided options.

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