I was able to complete step 1 today for my permanent residency renewal (there was no internet last week and therefore they couldn't receive any payments...). Paid my 4,500 for the medical exam, handed over 2 copies of my passport, cedula and residency (all on 1 paper), got a receipt and one of copies back with a stamp authorizing the medical exam. The guy in charge of the office was in and out while I was there talking to other foreigners and directly supervising everything. Hopefully he'll keep it up. Walked down the hall, took a right and entered what at first glance appeared to be an abandoned office but no, it was where they take the samples. No electricity connected there yet, not too impressive but hey, anything to save myself a trip to Santo Domingo. The guy taking the samples asked me some health questions, took a blood sample and asked me to step behind a divider for the urine sample. I was happy to see that he didn't see the need to supervise me doing that so even though the conditions were not the best, at least I was able to do my business away from prying eyes... From there he told me to go to Hospiten for the chest x-ray. Hospiten are still a bit in the air about the whole process but managed to get it worked out. NOTE: bring an extra copy of your documents when you go, they don't tell you that at Migracion or the sample taking place. I was lucky enough (or unlucky) to be well known there as a recurring patient so they made the copy for me but originally the supervisor's instructions were to send me away. 15 minutes later I was walking back out again and the x-ray will be given directly to Migracion, same as in SD. I was told to check back in to Migracion in 10-15 days to see if they've received the results and to proceed to step 2, depositing the documents.
Since I was off today I went ahead and got my picture taken at Digital Veron (plaza Genaro), these need to be deposited with the documents. Also went to Higuey to the Centro de Servicio al Ciudadano to get my papel de buena conducta. It's located on Cese Catherina which is the street that's parallel to the one where the Palacio de Justicia is, next one down if you're heading towards Punta Cana. It's the next door down from the Ministerio Publico and it's not really identified apart from their logo on the door. Copy of my cedula, 330 pesos receipt from Banco de Reservas and 20 minutes later I was walking out with my document. Oftentimes there's no system so don't be surprised if you have to make repeat trips to get it done. Other option is to pay someone from Higuey to get it done for you instead of taking multiple trips up.
Hope this can be of help to someone, I'll update when I complete the next step.