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Home My WebLink About302999 09/12/16 CITY OF CARMEL, INDIANA VENDOR: 00350364 G ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $****41,241.79* CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 302999 9�,,roN INDIANAPOLIS IN 46204 CHECK DATE: 09/12/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 24831 00-28987 26,992.97 DEPARTMENT PHYSICALS 1120 4340701 24831 00-29033 14,248.82 DEPARTMENT PHYSICALS VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) PUBLIC SAFETY MEDICAL SERVICES ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 324 E NEW YORK ST SUITE 300 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service INDIANAPOLIS, IN 46204 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $14,248.82 Payee Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 24831 29033 43-407.01 $14,248.82 1 hereby certify that the attached invoice(s),or 9/2/16 29033 $14,248.82 1120 101 1120 101 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 Friday, September 02,2016 David Haboush Fire Chief 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Public.Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/31/2016 22 324 E. New York Street Invoice# 00-29033 E Suite 300 Terms: W Indianapolis, IN 46204m o Carmel Fire Department/CARMEFD I Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount -' Balance Due 08/22/16 Ca shave Jeffrev A. Comi3rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 BodV Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14. EKG W Intero $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Collins,Tony A. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.7 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Hemoccult $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.7 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.1 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Condra Kyle E. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.1 PFT-Pulmonary Function est $34.50 $34.50 Public, Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/31/2016 :!:!: 324 E. New York Street Invoice# 00-29033 E Suite 300 Terms: D Indianapolis, IN 46204 M o Carmel Fire Department/CARMEFD 10 Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel,IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Dorsch James E. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Hemoccult $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audlometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Fa in Timothy D. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax M$27.18 159.90 Bod Fat Test-BIA Bio-Elec Im Anal 14.6 Chest X-Ray-PA/LAT Di ital 62.7 Vital Si ns-HT WT BP P R 0.00 Vision-Acuity $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Fisher Gary L. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.7 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Bodv Fat Test-BIA Bio-Elec Imo Anal 14.64 $14. Chest X-Ray-PAILAT(Digital) $62.73 $62.73 Public, Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/31/2016 r 324 E. New York Street Invoice# 00-29033 Suite 300 Terms: r-" Indianapolis, IN 46204 1 c Carmel Fire Department/CARMEFD I- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-PulmonarV Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Intem $20.91 $20.91 Urinal sis-Di stick $3.14 $3.14 Jenkins John W. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14. EKG W/InteM $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Paddock Ronald"Dean" Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 0.00 Health Risk A raisal Motivation 0.00 $0.00 Hemoccult $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Bodv Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Intem $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Starr Greaory A. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.7 OnMed Pro ram $0.00 $0.00 Health Risk A i al Motivation 0 $0.00 Public. Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/31/2016 324 E. New York Street - Invoice# 00-29033 �E Suite 300 Terms: W Indianapolis, IN 46204 ,a. C Carmel Fire Department/CARMEFD F- Denise Snyder, Budget$Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount Balance Due Hemoccult $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14. EKG W/Inte 20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Voskuhl Mark J. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.7 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation $0.00 1 $0.00 Hemoccult $0.00 $0.00 Treadmill-Submax $159.90 $159.90 BodyFat Test-BIA Bio-Elec ImpAnal 14.64 14. Chest X-Ray-PA/LAT(Digital) 62.73 62.73 Vital Si ns-HT WT BP P R 0.00 0.00 Vision-Acuity27.18 27.18 PFT-PulmonaryFunction Test 34.50 34.50 Audiometry14.64 14.6 EKG W/Inte 20.91 20.91 Urinalysis-Di stick 3.14 3.14 Workman William J. Comprehensive Physical Exam 102.46 102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 0.00 Treadmill-Submax 159.90 159.90 Bod Fat Test-BIA Bio-Elec Imp Anal 14.64 $14. Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Inte 20.91 $20.91 Urinal is-Diostick $3.14 $3.14 Public. Safety Medical - INVOICE Public Safety Medical Invoice Date: 08/31/2016 324 E. New York Street Invoice# 00-29033 E Suite 300 Terms: w Indianapolis, IN 46204 c Carmel Fire Department/CARMEFD H Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description` Amount Balance Due Youna.Andrew S. Com rehensive Ph sical- $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14. Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 34.50 Audiometry 14.64 $14.6 EKG W/Inte 20.91 $20.91 Urinal sis-Di stick $3.14 $3.14 08/23/16 Anderson,Kent W. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W Inte 20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Heavner,Joel S. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT Di ital 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 27.18 PFT-Pulmonary Function Test $34.50 34.50 Audiometry 14.64 $14.641 Public. Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/31/2016 324 E. New York Street Invoice# 00-29033 �E' Suite 300 Terms: W Indianapolis, IN 46204 a Carmel Fire.Department/CARMEFD F- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date EmployeeEResDiWrator/Medical >Descdptiori Amount Balance Due' e 20.91 20.91 Dipstick $3.14 $3.14 Malicoat Justin R. Comprehensive Physical Exam $102.46 $102.46 Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 CMP(Comp Metabolic Panel 20.00 $20.00 CBC(Comp Blood Count 18.13 $18.13 Lipid Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 HIV-4th Gen Rapid Test Blood 24.56 $24.56 uantiferon-Tb Done In Error 0.00 $0.00 TSH-Th roid.Stim Hormone Error 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-AcuitV $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Chest X-Ray-PA/LAT Di ital 62.73 $62.73 Mitchell James C. Comprehensive Physical Exam $102.46 $102.46 Res irator Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 1 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Mulford David A. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 Public. Safety Medical - INVOICE t° Public Safety Medical Invoice Date: 08/31/2016 '. 324 E. New York Street Invoice# 00-29033 E Suite 300 Terms: Indianapolis, IN 46204 . r C Carmel Fire Department/CARMEFD I Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Hemoccult $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Inte 20.91 $20.91 Urinal sis-Di stick $3.14 $3.14 Chest X-Ray-PA/LAT Di ital 62.73 $62.73 Payne,Thomas C. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 BodV Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/In en) 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Russel Grant W. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.1 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EK W Into 20:91 $20.91 Public. Safety Medical - INVOICE �°o Public Safety Medical Invoice Date: 08/31/2016 324 E. New York Street Invoice# 00-29033 E Suite 300 Terms: W Indianapolis, IN 46204 x ti. o Carmel Fire Department/CARMEFD I-- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Urinalysis-Di stick $3.14 $3.14 Steury,Kent C. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Aooraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Intern 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Young,Kevin M. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.7 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax 159.90 159.90 BodyFat Test-BIA Bio-Elec ImpAnal 14.64 14.6 Vital Signs-HT WT BP P R 0.00 0.00 Vision-Acuity27.18 27.18 PFT-PulmonaryFunction Test 34.50 $34.50 Audiometry 14.64 $14.64 EKG W Inte 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 08/24/16 Drake Carl D. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.731 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Hemoccult $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.7 Vital Si ns-HT WT BP P R $0.00 0.00 Vision-Acuity $27.18 27.1 Public Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/31/2016 324 E. New York Street � Suite 300 Invoice# 00-29033 Terms: r W Indianapolis, IN 46204 r o, Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date ''' Employee Description Amount Balance Due? PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 3.14 Edwards Steven L. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Hemoccult $0.00 $0.00 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imo Anal 14.64 $14.64 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14. EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Frenzel Eric C. Comprehensive Physical Exam $102.46 $102.461 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 Treadmill-Submax 159.90 $159.90 Body Fat Test-BIA Bio-Elec Imn Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Holubik Steven W. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.7 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BI Bio-Elec Im Ana 14.64 $14.64 Public Safety Medical - INVOICE I-o Public Safety Medical Invoice Date: 08/31/2016 �.' 324 E. New York Street Invoice# 00-29033 Suite 300 Terms: a Indianapolis, IN 46204 r c Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-PulmonarV Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Kinney,Jared N. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Anpraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Bodv Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.1 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Love Joseph(Bradley) Com rehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Annraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 BodV Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Reynolds,Shawn J. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Aggraisal Motivation 0.00 $0.00 Public. Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/31/2016 324 E. New York Street Invoice# 00-29033 E Suite 300 Terms: W Indianapolis, IN 46204 .;i C Carmel Fire Department/CARMEFD I- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-PulmonarV Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.141 Smith Brian E. Com rehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Anoraisal Motivation 0.00 $0.00 Treadmill-Submax =Analv) $14.64 $159.90 Bod Fat Test-BIA Bio-Elec Imp $14.6Chest X-Ra -PA/LAT Di ital 62.7Vital Si ns-HT WT BP P R 0.00 Vision-Acui 27A PFT-PulmonarV Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinal sis-Di stick $3.14 $3.14 Utzia.Chad M. Com rehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Chest X-Ray-PA/LAT(Digital) $62.73 $62.7 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Wilson Carlos A. I Com rehensive Physical Exam $102.46 $102.46 Resoirator/Medical Review $16.73 $16.73 13011c. Safety Medical - INVOICE r—° Public Safety Medical Invoice Date: 08/31/2016 T ' & 324 E. New York Street Invoice# 00-29033 E Suite 300 Terms: W Indianapolis, IN 46204 G Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr 00 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount Balance Due OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Bodv Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Intern 20.91 20.91 Urinalysis-Di stick $3.14 3.14 Total Charges Total Payments&Balance Due-> `$0.00 $14,248.82 Please write invoice number on payment check. Our Federal Employer identification number is 35-2079797. We greatly appreciate the opportunity to serve you. If you have any questions regarding this invoice, please contact Debbie Pieper at 317-964-2330. VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) PUBLIC SAFETY MEDICAL SERVICES ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 324 E NEW YORK ST SUITE 300 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service INDIANAPOLIS, IN 46204 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $26,992.97 Payee Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 24831 28987 43-407.01 $26,992.97 1 hereby certify that the attached invoice(s),or 9/1/16 28987 $26,992.97 1120 101 1120 101 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 Friday, September 02,2016 David Haboush Fire Chief 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- Cost 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Public Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: W Indianapolis, IN 46204 Iiµ c Carmel Fire Department/CARMEFD ► Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due 08/15/16 Cromlich Mark A. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W1 In err) 20.91 $20.91 Urinal sis-Di stick $3.14 $3.14 DeCrastos,Richard A. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.901 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.1 PFT-Pulmonary Function Test $34.50 34.50 Audiometry 14.64 $14.64 EKG W Inte 20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Freer Keith T. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.731 Vital Si ns-HT WT BP P R $0.00 0.00 Vision-A ui27.18 27.18 PFT-Pulmonary Function Test $34.50 34.50 Audio et 14.64 14.6 Public Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due EKG W/Interp $20.91 $20.91 Urinal sis-Di stick $3.14 $3.14 Frye,Steven R. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Gehlbach Marc A. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Bodv Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Haboush David G. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.901 Body Fat Test-BIA Bio-Elec Im Anal 14.64 14.6 Chest X-Ray-PA/LAT Di ital 62.73 62.73 Vital Si ns-HT WT BP P R $0.00 0.00 Vision-A ui27.1 27.1 Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: W Indianapolis, IN 46204 .w, C Carmel Fire Department/CARMEFD II- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Hoover AnthonyB. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imo Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Lux Michael T. Comprehensive Ph sical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.731 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Hemoccult $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Bodv Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-PulmonarV Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 20.91 Urinalysis-Dipstick $3.14 $3.14 Marsh Michael A. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Apwaisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BI Bi -E ec Imo Anal 14 Public Safety Medical - INVOICE �0 Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: w Indianapolis, IN 46204 E` c Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount ..Balance Due Chest X-Ray-PA/LAT Di ital 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 McNab John D. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Aippraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) $62.73 1 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 AudiometrV $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Price Joseph P. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Aooraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ra -PA/LAT(Digital) $62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Intem $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Reeves Neil P. Comprehensive Physical Exam $102.4602.46 Respirator/Medical Review 16.73 16.73 OnMed Pro ram 0.00 0.00 ealth Risk raisal Motivation 0.00 $0.00 Pubfic Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: w Indianapolis, IN 46204 �M •e i G Carmel Fire Department/CARMEFD I Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount. Balance Due Treadmill-Submax 159.90 159.90 Bod Fat Test-BIA Bio-Elec Im Anal $14.64 $14.6 Chest X-Ra -PA/LAT Digital $62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuitv $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.141 Ryan,Christopher D. Com rehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 16.73 OnMed Program $0.00 0.00 Health Risk Anoraisal Motivation 0.00 0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 34.50 Audlometry $14.64 $14.64 EKG W/Inte 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Stindle Kevin P. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.001 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Inte 20.91 $20.91 Urinalysis-Dipstick 3.14 3.14 Utzi Todd T. Com rehensive Physical Exam 102.46 102.46 Res irator Medica Review 16 3 $16.731 Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 m Suite 300 Terms: m W Indianapolis, IN 46204 r 4: c Carmel Fire Department/CARMEFD F- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 BodV Fat Test-BIA Bio-Elec Imp Anal 14.64 $14. Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Intem $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Webb Greaory A. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Bodv Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 lLig Vital Signs-HT WT BP P R $0.00 $0.001 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 08/16/16 Baskerville Steven P. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 14. EKG W/Inte 20.91 20.91 Urinalysis-Di stick $3.14 3.14 Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 m Suite 300 Terms: F- ,- W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD I Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Brant Kenneth E. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Bodv Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/tAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W Intem $20.91 $20.91 Urinal sis-Di stick $3.14 $3.14 Frost Bruce S. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/IAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Inte 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Hutchison Brian P. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/IAT(Digital) 62.73 62.73 Vital Si ns-HT WT BP P R 0.00 0.00 Vision-Acuity27.18 27.1 PFT-PulmonaryFunction Test 34.50 34.50 Audiometry14.64 $14.64 Public Safety Medical - INVOICE to Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: IY Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD F Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount Balance Due EKG W Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Lenze Jr. Theodore A. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Maners Jeremy B. Comprehensive Ph sical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.7 OnMed Program $0.00 $0.00. Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Martin David D. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.7 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Hemoccult $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec IMQ Anal 14.64 $14.6 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 Public Safety Medical - INVOICE too Public Safety Medical Invoice Date: 08/25/2016 r 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due PFT-Pulmonary Function Test $34.50 $34.50 Audiornetry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Chest X-Ra -PA/LAT(Digital) 62.73 $62.73 Martin Richard A. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Hemoccult $0.00 0.00 Treadmill-Submax 159.90 159.90 BodyFat Test-BIA Bio-Elec Im Anal 14.64 14.6 Chest X-Ray-PA/LAT(Digital 62.73 62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acui $27.18 $27.18 PFT-Pulmona Function Test $34.50 $34.50 AudiornetrV $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Peterson Vernon(Al)A. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Aooraisal Motivation 0.00 $0.00 r dmill-Submax 159.90 159.90 Fat Test-BIA Bio-Elec Im Anal 14.64 14. st X-Ra -PA/LAT Di ital $62.73 $62.73 l Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 1 $27.18 PFT-Pulmonary Function Test $34.50 34.50 Audiornetry $14.64 $14. EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Small Thomas D. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 m Suite 300 Terms: w Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X- ay-PA/LAT(Digital) $62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-PulmonarV Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Thordarson Erik M. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Anoraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuitv $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 08/17/16 Baskerville AnthonyA. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Aporaisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 1 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-AcuitV $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry W20.91 14.6 EKG W/Inte 20.91 Urinal sis-Di stick 3.14 Bene Jonathan R. Com rehensive Ph sical Exam 102.46 Res irator/Medical Review 16.7OnMed Pro ra 0.00 Public Safety Medical - INVOICE t°- Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 Suite 300 Terms: IX Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD F- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount Balance Due Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Chest X-Ra -PA/LAT(Digital) 62.73 $62.73 Venipuncture $0.00 $0.00 R epeatC Com Blood Count 0.00 0.00 -HT WT BP P R 0.00 0.00 ui 27.18 27.1ona Function Test 34.50 34.50 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinal sis-Di stick $3.14 $3.14 Del-ona.Michael T. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Bodv Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/InterD $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Edwards,Daniel E. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Hemoccult $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14. Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.6 14.6 Public safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: W Indianapolis, IN 46204 c Carmel Fire Department/CARMEFD H Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Gu el Mark E. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Hemoccult $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Kelsheimer,TroV W. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 McNair Travis L. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14. Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Public safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/25/2016 . 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: w Indianapolis, IN 46204 c Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiornetry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 3.14 Mowery,AnthonyW. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax 159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 AudiornetrV $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Nalley,Marcus E. No Show Fee $40.00 $40.00 Reecer,Jason L. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 Hemoccult $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digi al $62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiornetry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.141 Robinson Mark G. Com rehensive Physical Exam $102.46 102.46 Res irator/Medical Review $16.73 16.73 OnMed Program $0.00 0.00 Health Risk A raisal Motivation 0.0 0.00 Public Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 E Suite 300Terms: 1z Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD F- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Treadmill-Submax $159.90 $159.90 Bodv Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-AcuitV $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Stroup,Scott A. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ra -PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.1 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Viehe Richard E. Com rehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Chest X-Ray-PA/LAT(Digital) 62.73 62.73 Walker Christopher E. Com rehensive Physical Exam $102.46 $102.46 Res irator Medical Review $16.73 $16.73 Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/25/2016 ~_. 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: w Indianapolis, IN 46204 G Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Inte 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Woodburn Scott E. Comixehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 14.64 EKG W/Interp $20.91 $20.91 Urinal sis-Di stick $3.14 $3.14 08/18/16 Baskerville Steven M. Com rehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 14.64 EKG W/Inte 20.91 $20.91 Urinal sis-Di stick 3.14 $3.14 Chest -Ra -PAILAT(Digital) 62.73 62.73 Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/25/2016 r 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: w Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD I- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount =Balance Due Benbow.Kiv S. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 BodV Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Intero $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Brisco Michael D. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 0.00 Health Risk Appraisal Motivation 0.00 0.00 Hemoccult 0.00 0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Ellison Christopher M. Com rehensive Ph sical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT Di ital 62.73 62.73 Vital Signs-HT WT BP P R 0.00 0.00 Vision-Acuity27.18 27.18 PFT-PulmonaryFunctionest 34. 0 34.50 Public Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount Balance Due Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Essex Cory C. Comprehensive Ph sical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 1 $20.91 Urinalysis-Dipstick $3.14 $3.14 Heinlein Robert A. Comprehensive Ph sisal Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.731 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Keaton AnthonyR. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.7 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Chest X-Ray-PA/LAT(Digital) 62.73 62.73 Treadmill-Submax 159.90159.90 BodyFat Test-BIA Bio-Elec Im Anal 14.64 14.6 Vital Signs-HT WT BP 0.00 .00 Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: M Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 McNeely, Michael W. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.7 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14. Chest X-Ray-PA/LAT Di ital 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 1 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.141 Mead David L. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Aporaisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 1 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinal sis-Di stick $3.14 $3.14 Chest X-Ray-PA/LAT Di ital 62.73 $62.73 Ray,Lucas M. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Im Anal $14.64 $14.64 Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/25/2016 " 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuitv $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 AudiometrV $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 VanVoorst Robert J. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Hemoccult $0.00 $0.00 Chest X-Ray-PA/LAT Di ital 62.73 $62.73 Treadmill-Submax $159.90 1 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.1 PFT-PulmonarV Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 08/19/16 Contino David M. Comixehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Intem $20.91 $20.911 Urinal sis-Di stick $3.14 3.14 Cox Jordan R. Com rehensive Physical Exam $102.46 102.46 Res irator Medical Review 16.73 16.73 Onme P o am 0.00 0.00 Public Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: lX Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD F- Denise Snyder, Budget&Accred Mgr M 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Health Risk A raisal Motivation 0.00 0.00 Treadmill-Submax $159.90 $159.90 Body Feat -BIA Bio-Elec ImpAnal $14.64 $14.6 Chest X-Ra -PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.001 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Inte 20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Crane Barry L. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Mason Bryan L. Com rehensive Physical Exam $102.46 $102.46 Res irator Medical Review $16.73 $16.731 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Intern $20.91 20.91 Urinal sis-Di stick $3.14 3.14 Reese Aaron P. I Comorehensive Physical Exam 102.46 102.46 Public Safety Medical - INVOICE a 0 Public Safety Medical Invoice Date: 08/25/2016 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: w Indianapolis, IN 46204 = S C Carmel Fire Department/CARMEFD H Denise Snyder, Budget&Accred Mgr = 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiornetry $14.64 $14. EKG W/Intern 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Rutherford Justin Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review. $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec lrnQ Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.7 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiornetry $14.64 $14.64 EKG W/Inte 20.91 $20.91 Urinal sis-Di stick $3.14 $3.14 Thomas,Nathan C. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.001 Vision-Acuity 27.18420.9 7.18 PFT-PulmonaryFunction Test 34.50 .50 Audiomet 14.644.6 EK W Intern $20,91 Public Safe#y Medical - INVOICE d o Public Safety Medical Invoice Date: 08/25/2016 r 324 E. New York Street Invoice# 00-28987 E Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD I Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Urinalysis-Di stick $3.14 $3.141 Total Charges-> $26,992.97 Total Payments&Balance Due-> $0.001 $26,992.97 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 regarding this invoice, please contact Debbie Pieper at 317-964-2330.