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Home My WebLink About243310 3 /18/2015 (9, CITY OF CARMEL, INDIANA VENDOR: 00350364 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $•****6,466.99* CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 243310 INDIANAPOLIS IN 46204 CHECK DATE: 03/18/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4341999 25150 6,466.99' OTHER PROFESSIONAL FE Public Safety Medical - INVOICE 01 Public Safety Medical Invoice Date: 03/Q4/2015 , 324 E. New York Street Invoice# 00-25150 E , Suite 300 Terms: W Indianapolis, IN 46204 t c Carmel Fire Department/CARMEFD Attn:Asst Chief David Haboush 2 Civic Square m Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount Balance Due' 02/24/15 Anderson Kent W. Chart Review Com letion 89185 $89.85 Indiana PERF Exam $201190 1 $201.90 Drug Screen 9 +Opiates&Oxycodone $4438 $44.38 Tonomet Glaucoma Test 39194 $39.94 Urinalysis-Dipstick 3133 $3.33 EKG W/Interp $22.18 $22.18 Audiomet E$28184 15.54 PFT-PulmonaryFunction Test 36.61 Vision-Color Ishihara 28.84 Vision-Acuit 28.8Vital Si ns-HT WT BP P R $0.00 Armlicant Blood Panel-PERF $127138 $127.38 Tb Skin Test $7177 $7.77 Venipuncture $3.33 1 $3.33 Chest X-Ra -PA/LAT(Digital) $6656 $66.56 PSY-Ap licant Ps ch Eva[ 376136 $376.36 Bene Jonathan R. Chart Review/Completion 89185 $89.85 Indiana PERF Exam 201190 $201.901 Drug Screen 9 +Opiates&Oxycodone 44138 $44.38 Tonomet Glaucoma Test 39194 $39.94 Urinalysis-Dipstick $3133 $3.33 - - -- - - - _ EKG WFInter 22118 $22.18 - --- Audiomet 15154 $15.54 PFT-Pulmonary Function Test 36161 $36.61 Vision-Color Ishihara 28184 $28.84 Vision-Acuit $28184 $28.84 Vital Signs-HT WT BP P R 0100 $0.00 Applicant Blood Panel-PERF $127138 $127.38 Tb Skin Test 7177 $7.77 Venipuncture 3133 $3.33 Chest X-Ray-PA/LAT(Digital) 66.56 $66.56 PSY-Applicant Psych Eva[ 376136 $376.36 Mueller William C. Chart Review/Com letion $86.85 $89.85 Indiana PERF Exam $2011.90 $201.90 Drug Screen 9 +Opiates&Oxycodone $4.38 $44.38 Andicant Blood Panel-PERF $127.38 $127,38 Tb Review-PSM Given0 Public, Safety Medical - INVOICE o Public Safety Medical Invoice Date: 03104/2015 ~' 324 E. New York Street Invoice# 00-25150 Suite 300 Terms: Indianapolis, IN 46204 c Carmel Fire Department/CARMEFD F- Attn:Asst Chief David Haboush m 2 Civic Square Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date: EmployeeDescription Amou t Balance Due Veni uncture $3.33 $3.33 Chest X-Ray-PA/LAT(Digital) $66.56 $66.56 Tonomet Glaucoma Test $34.94 $39.94 Urinal sis-Dipstick 31.33 $3.33 EKG W/Inte 22.18 $22.18 Audiornetry $16.54 $15.54 PFT-Pulmonary Function Test $3d.61 $36.61 Vision-Color Ishihara 28.84 $28.84 Vision-Acuity 28.84 $28.84 Vital Si ns-HT WT BP P R / $01.00 $0.00 PSY-Apolicant Psych Eval a 376.36 $376.36 Phillips,Michael J. Chart Review/Completion $8d.85 $89.85 Indiana PERF Exam $2011.90 $201.90 Drug Screen 9 +Opiates&Ox codone $44.38 $44.38 Applicant Blood Panel-PERF $1271.38 $127.38 Tb Review-PSM Given $0'.00 0.00 .Venipuncture $3.33 $3.33 Tonomet Glaucoma Test 39.9439.94 Urinalysis-Dipstick 3.33 3.33 EKG W/Inte 22.18 22.18 Audiornetry $16.54 $15.54 PFT-Pulmonary Function Test $3d.61 $36.61 Vision-Color Ishihara 28.84 $28.84 Vision-Acuity 28.84 $28.84 Vital Signs-HT WT BP P R $6.00 $0.00 PSY-Applicant Psych Eval $376.36 $376.36 Russel Grant W. Chart Review/Completion $86.85 $89.85 Indiana PERF Exam $2011.90 $201.90 Drug Screen 9 +Opiates&Oxycodone $44.38 $44.38 Tonomet Glaucoma Test 39.94 $39.94 Urinal sis-Dipstick $3.33 $3.331 EKG W/Inte 22.18 $22.18 Audiornetry $19.54 $15.54 PFT-Pulmonary Function Test $39.61 $36.61 Vision-Color Ishihara $28.84 $28.84 Vision-Acuity 28.84 $28.84 Vital Si s-HT WT RP P R 00 Public,Safety Medical - INVOICE o Public Safety Medical Invoice Date: 03 04/2015 w 324 E. New York Street Invoice# 00-25150 E. Suite 300 Terms: Indianapolis, IN 46204 Carmel Fire Department/CARMEFD �- Attn:Asst Chief David Haboush ov` 2 Civic Square Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employe Description : Amount, Balahce:Due Armficant Blood Panel-PERF $127313 $127.38 Tb Review-PSM Given $0.00 $0.00 Venipuncture $3(i3 $3.33 Chest X-Ray-PA/LAT(Digital) 6656 $66.56 PSY-AmAicant Psych Eval 376.36 $376.36 Rutherford Justin Chart Review/Completion $89.185 $89.85 Indiana PERF Exam $201.'90 $201.90 Drug Screen 9 +Opiates&Ox codone $44.38 $44.38 Tonomet Glaucoma Test $39.194 $39.94 Urinalysis-Di stick $3.33 $3.33 EKG W/Inte $22J18 $22.18 Audiometry $15.154 $15.54 PFT-Pulmonary Function Test $36.'61 $36.61 Vision-Color Ishihara $28.84 $28.84 Vision-Acuity $28.84 $28.84 Vital Sign -HT WT BP P R $0.00 $0.00 Applicant Blood Panel-PERF $127.38 $127.38 Tb Skin Test $7.. 7 $7.77 Venipuncture $3.b3 $3.33 Chest X-Ray-PA/LAT(Digital) $66.56 $66.56 _ PSY-Avolicant Psych Eval 376.36 $376.36 ....•Total Charges-> $6;466.99 Totaf Payments&Balance Dde-> $0.00 $6,466:99 Please write invoice number on payment check. Our Federal Employer identification number is 35-2079797. We greatly appreciate the opportunity to serve you. If you have any questions regardi g this invoice, please contact Debbie Pieper at 317-964-2330. 1 VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF$ 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $6,466.99 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 25150 43-419.99 $6,466.99 1 hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except i MAR 1 6 2015 Fire Chief 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)) 25150 $6,466.99 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