As you approach the new hospital, it's hard to believe that just 18 weeks ago this site was little more than bare earth.
The first thing that becomes obvious is the sheer size of the main building.
Level one will eventually house the new emergency department, community and allied health services, maternity services and the first in-hospital Tresillian residential unit ever built in an Australian regional hospital.
Operating theatres, day procedure units for services like infusions, and administrative offices will take up residence on level two.
And on the north-facing ground floor will be a loading area for hospital support services.
The bones are well and truly there now.
And hospital staff and members of community advisory groups gathered on Monday to sign messages on a support beam which has already been fitted into the main building - a secret tribute to the hospital's future from those involved in its genesis.
Sherrie Cowie, Project Director for NSW Health Infrastructure:
But most impressively, Hansen Yuncken Project Manager Josh Crilley said his team has already finished sheeting up the two in-patient wards.
Tiles are ready to be mounted to the exterior walls, and services are already starting to be connected and installed inside.
Each room in both the 28-bed acute unit (general medical ward) and the smaller 14-bed subacute unit (designed for rehabilitation, and palliative and geriatric care) features a large window which will look out onto specially curated gardens. The Health Infrastructure team is currently liaising with botanical gardens staff to work on its landscaping designs.
What has been emphasised in the design process is the flexibility of rooms to transform as different needs arise. One handy feature will be drop-down cots for family members to make use of during 'end of life' care.
Looking towards the highway from the in-patient units, you can also get a sense now of the 'hospital street' - a covered atrium area which will house the main entrance, cafe and pharmacy. Visually connecting the street and the in-patient wards will be a large garden courtyard.
Construction is well on track to be finished by the latter half of next year. From there, there'll be an operational commissioning phase with staff orientation, before services are shifted across from the existing hospital and the new Macksville and District Hospital is officially open to its public.