HomeMy WebLinkAbout237027 09/10/14 �i CITY OF CARMEL, INDIANA VENDOR: 365641
" ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $"**""**268.54*
CARMEL, INDIANA 46032 HEALTH INFORMATION MANAGEMENT CHECK NUMBER: 237027
M,Irui�. 2001 W 86TH STREET CHECK DATE: 09/10/14
INDIANAPOLIS IN 46260
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4358200 59024 168.25 SPECIAL INVESTIGATION
1110 4358200 71902 59.54 SPECIAL INVESTIGATION
1110 4358200 72128 40.75 SPECIAL INVESTIGATION
I
St. Vincent Hospitals Invoice No
Indianapolis,Carmel & Fishers 72128
2001 W. 86th Street
Indianapolis, IN 46260 \\.
(317) 338-2216 Tax ID:35-0869066 7�
IS
Date: 08/27/2014
To: Carmel Police Department
3 Civil Square
Carmel, IN 46032
Attn: Sgt Nancy Zellers
Patient: Ryan A Jenkins
Request No Invoice No Medical Record No Date Received Date Sent
J175265 72128 0002348788 08/27/2014 08/27/2014 Pages/Time Charges
Photocopy 53 40.75
To ensure payment is posted
correctly please include copy of
our invoice and send Attn: Health
Information Management Department
Sales Tax 0.00
Total Billed $40.75
Document Date Amount Paid 0.00
Start End I Description Balance $40.75
08/20/2014 08/21/2014 Abstract
Indianapolis records
To ensure proper posting of payment, please send Attn: Health Information Management
St. Vincent Hospitals Invoice No
Indianapolis,Carmel & Fishers 71902
2001 W. 86th Street
Indianapolis, IN 46260
(317) 338-2216 Tax ID:35-0869066
Date: 08/15/2014
To: Carmel Police Dept lel-5135
3 Civic Square
Carmel, IN 46032
Attn: Sgt Nancy Zellers
Patient: Sandra Gronchow
Request No Invoice No Medical Record No Date Received Date Sent
G174573 71902 0000747782 08/14/2014 08/15/2014 Pages/Time Charges
Photocopy 106 54.00
To ensure payment is posted
correctly please include copy of I Postage I 5.54
our invoice and send Attn: Health
Information Management Department
Sales Tax 0.00
Total Billed $59.54
Amount Paid 0.00
Document Date
Start End Description Balance $59.54
08/06/2014 Abstract
To ensure proper posting of payment, please send Attn: Health Information Management
TOO'd rlds01
St.Vincent Hospitals Invoice No
Indianapolis,Carmel&Fishers 59024
2001 W. 86th Street
Indianapolis, IN 46260
(317 )338-2216 Tax ID:35-0869066
Date: 09/05/2014
To: Hamilton County Prosecutor's Office
Carmel Police Department
3 Civil Square
Carmel, IN 46032
Attn: Ashley Williams
Patient: Mario Chigo-Java
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Reques NCO ab,
-06d' •a . aateeRecel q �f:. ,mim4 aril :,. ':, w
C142787 59024 0002250777 1 02/20/2013 02/20/2013 Pages/Time Charges
Photocopy 483 148.25
To ensure payment is posted
correctly please include copy of
our invoice and send Attn: Health I Certified 20.00
Information Management Department
Sales Tax 0.00
Total Billed $168.25
Amount Paid 0.00
;'�` ',"•�DocukriQnt D�Bteaf:.,;�fd
Start End Description Balance $1� 6
11/17/2012 11/20/2012 Complete copy of medical record
To ensure proper posting of payment, please send Attn: Health Information Management
T00/T00'd Zd3Q NIH A IS 9V:9T VTOZ-90-dSS
VOUCHER NO. WARRANT NO.
ALLOWED 20
St. Vincent Hospital
IN SUM OF$
Health Information Management (PO BOX 409
2001 W. 86th Street
Indianapolis, IN 46260
$1-C& `-1
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1110 71902 43-582.00 $59.54:_
materials or services itemized thereon for
1110 72128 43-582.00 $40.75 which charge is made were ordered and
received except
Friday, September 05, 2014
Or,—�' a
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service,where performed,dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
OSI o2 �d1S (a$ �25
08/14/14 71902 Medical Records $59.54
08/27/14 72128 Medical Records $40.75
I hereby certify that the attached invoice(s),or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
, 20
Clerk-Treasurer