306883 01/06/17 ...s.,,,4 CITY OF CARMEL, INDIANA VENDOR: 00350364
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�q � ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $"""•«««896.64"
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 306883
w,«oN.,:� INDIANAPOLIS IN 46204 CHECK DATE: 01/06/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 00-29715 896.64 MEDICAL EXAM FEES
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Public Safety Medical - INVOICE
I° Public Safety Medical Invoice Date: 12/21/2016
._ 324 E. New York Street Invoice# 00-29715
0 Suite 300 Terms: ~�
W Indianapolis, IN 46204 4
C Carmel Police Department/CARMEPD
�- Attn: Pat Young
m 3 Civic Square
Carmel, IN 46032
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee Description Amount Balance Due
12/12/16 Sedberry,Jeffr T. HIV-4th Gen Rapid Test I $25.9
Venipuncture $3.53 $3.53
Lipid Panel Blood $23.82 $23.82
CBC(Comp Blood Count 20.29 $20.2
CMP(Como Metabolic Panel 22.41 $22.41
12/16/16 Keinslev,Matthew J. Respirator Clearance-SS $25.00 $25.0
Chart Review/Completion $91.20 $91.2
Indiana PERF Exam $204.93 $204.93
Veni uncture $3.39 $3.391
Applicant BI od Panel-PERF $129.29 $129.29
uantiferon-Tb Blood .30 $56.3
Drua Screen +Opiates&Oxycodone
T n m t (Glaucoma Test)
Urinal sis-Dipstick $3.39 $3.39
EKG W/Interp $22.52 $22.52
Audiometry 15.77 $15.77
PFT-Pulmonary Function Test $37.16 $37.1
Vision-Color Ishihara 29.28 $29.28
Vision-Acuity 29.28 1 29.2
Vital signs-HT WT BP P R $0.00 $0.00
Chest X-Ra -PA/LAT Qc ital 67.56 $67.56
Total Charges-> $896.64
Total Payments i3 Balance Due-> $0.001 $896.64
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.