-Send a fax or letter inquiry to the visa office, indicate date of meds exam and request for PR visa issuance.
-Inquire through (your) MP right away and ask them to inquire about tentative date for finalization and what's pending.
It's good that you've sent a GCMS request already. The notes should give you an idea about what's happened so far.
Too bad it takes a month to get the month-old notes.
thanks canvis for the great advise. I will try to send fax or letter, if they have fax # on visa office website. I hope they will followup. But I don't know how I can enquire through MP. Can I enquire through the MP elected in my riding?