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307352 1/20/17
Q VENDOR: 00350364 CITY OF CARMEL, INDIANA PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: S"""2.712.88' ONE CIVIC SQUARE CHECK NUMBER: 307352 324 E NEW YORK ST SUITE 300CARMEL, INDIANA 46032 INDIANAPOLIS IN 46204 CHECK DATE: 01/20117 DESCRIPTION DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT 5T 88 OFFICER PHYSICALS 1110 4340701 100018 00-29765 202.83 MEDICAL EXAM FEES 1120 4340701 29620 913.66 MEDICAL EXAM FEES 1120 4340701 29672 580.51 MEDICAL EXAM FEES 1120 4340701 2976 2 � $ 0 0 k \ 1c, C 3 . ow ■ � > Z5q n \ # » z / # 0 0 _, k o O c K / .\ z z f 7 � # k '69 k ; 2 E > T al � r \ § -n > 0co m / A � A CL § 7 k § § * » m $ z q � C362 ( > - < 2 0 O $ R 2 m ƒ E ® ca > 0 \ 2 & I § 0 i % E + E 0 m m C a o m o = n_ ) d m 2 $ k Q � § § m CL 9 \ \ § k 3 k ƒ a / J n A / a E _ CD \ k a \ \ / w § 7 K ƒ N C. 73 ° g | \ / _ #\ 7 LI: k m R M \r m / \ \ � g # = D CDa ) \ C E ( j § \ k k c / EI ew q = C 0 & CA D / 3 - ( CD :r k o EE � 2 _ | �2 \ D \k � $ # CDf2 E & » � CD k / R. { j U I = % i n O ƒ % £ 7 % CD / q 2-1 C R 0 $ ID ] « § CD CL \ § / { CD ( k / � CD PD Z 7 K ? e 0 :rE 2 § � k u !u n 8' Z £S''E (Pools)Rued ! !l Z'OZ ZOluno poolg wok 09 'ZZ L4ZZ hued o!logelaW wok dWO Pe4O uew a!M 6'0 66'0 (Poole) y ogoaS alsad- dSd E6'SZ POO18lsal P! eU uaE)41t,-AIH a.nloun uanSE'SZ 8'EZ Z8'EZ (Pools)Iaued pI Z'OZ$ 6Z'OZ$ lunoo poolg woo 090 V*ZZ$ LtiZZIaued o!logelaW wok dWO •0 p!neQ uoalS 6'SZ$ E6'SZ$ (Poole)lsel P! eb uaE)4t,-AlH E Flu un Z ' Z I9 l u d MT Z'OZ 6Z'OZ lunoo poolg wok Ogo Lti'ZZ WZZ Iaued o!logelaW wok dWO J lee4owy jall!W 6'SZ E6'9Z PO018 lsal P! eb uaE)41t,-AIH ES'E ES'E aanloun !uan 8'EZ Z8'EZ Poo18 Iaued P! !I Z'OZ 6Z'OZ lunoo pool8 wok O80 Lti'ZZ LV'ZZ Iaued o!logelaW wok dWO -y o aaC) lleano-j 6'SZ £6'SZ po018 lsal P!(M:1 WE)41y-/UH ES'E$ ES'E$ 971350—59A 8'EZ$ Z8'£Z$ Poo18 Iaued p! !-1 GZ'OZ$ 6Z'OZ lunoolg w 9 WZZ L4' l ued !Ial 3 W wo dW M la!u 43 N IM !eas!ulwpy00LSL 00LS al!S jnoA-poolg 95=1 an •p 4low!l uaaUE) 6'0 66'0 PoolB V 39!39 S alelsad-VSd 6'SZ E6'9Z PoolB lsal P! ell uOO 414-AIH ES'E ES'E ainpun !uan 8'EZ Z8'EZ pool8 Iaued p! !-1 Z'OZ 6Z'OZ lunoo poolB wok 090 1,1773 LVZZ Iaued o!logelaW wok dWO 'd aue4S suIllOO £S'£ ES'£ ainloun !uan 8'EZ$ Z8'EZ$ Poo18 Iaued P! !j Z'OZ$ 6Z'OZ$ lunoo poolg wok 0130 Lti'ZZ L4' Z l ued !log l W w dW 'W APUOM wo4u 9 9L/OZ ana eoueleg lunowy uo!lduosad oeAoldw3 alep -066k eou,S sleuoissepid AjejeS jggnd 6uilveS AjeAisnlox3 Z£09V NI `IawJeO ejenbS oInIO£ W (Z9M Od) uaaJO Lull 10143 c ad3WI]VO/;uaw:pedea 03110d IOW-JeO s . ti0Z9V NI `sllodeue!pul M :Swjal 00£e4!nS 3 99L6Z-00 #9310AU1 48845)IJoA MGN '3 VZ£ -7 LOZ/9040 mea 8310AUI leo!peW A49jeS ollgnd o IIOZ 6 0 Of 03AI3338 33I0ANI Iec)IpaW AjejeS ollgnd 0££Z-b96-LL£le jadald eiggaa ;oe;uoo aseald `aolonul sly;6ulpJe6aJ suollsanb Aue aney nog lI -nog(anus of fl!un:loddo ayl aleloajdde Alleai6 aM 'L6L6LOZ-5£sl jagwnu uoyeol}l;uepl jaAoldw3 Iejapaj,mo -Noego;uawfed uo jagwnu aolonul 91Pm aseald 88'9 Lo`L$ 00'0$ I<-an4 eoue!eg V sluawAed!elol 88'9L0'L$ 1<-sa6ae40lelol 6'9Z £6'9Z PoolB isal p! e�!u90 4ly-AIH E9'E E9'£ ainloun !uan 8'EZ Z8'EZ P0018 !sued p! !-1 Z'OZ$ 6Z'OZ$ lunoo Poo18 wok Og0 Lb'ZZ$ L4'ZZ$ kiGued o!!ogelaW wok dWO '-1 a14sy swe!II!M 6'0 66'0t,$ 01g b 09POaS al i Jd-d d ana aoueleg lunowy uo!lduosea aaAoldwg ales '066 6 eouis sleuolssejo ld AjejeS o!lgnd FuiAieS Ajanisnlox3 Z£0917 NI `IOWJea ejenbS DInla£ W (Z9 LVE Od)uaaJ0 Wil}al43 -- dd3W21V3/;ualupedaa 83110d IawJea V0Z9b NI `sllodeuelpul :swjal 00£a}InS 3 99L6Z-00 #aolonul ;aaJ;S)IJoA MON '3 VZ£ 1602/90/60 :owa aolonul IeoIpayll/(;a}es ollgnd o 33I0ANI - leo!poW A;ojeS :)ilgnd 2 w -V < < 2 m O O #PIJ E : . § § _0 2 2 D m E o 0 ■ 2 2 n \ 0 0 k S ;a\ 0 1: m w 2 i K k q E O $ § o n 4 A n Q # @ m # £ _ @ � # q ® O Ln 2 \ 0 p ■ \ E to 2 / C 0 S X / � k $ E \ < 7 e # a n R � 5 R '69 > -n | } § E m (D e J i 2 E / § f � � K 2 % t E } ( E 2 Q m CD , 2 n c $ § 3 3 - � M. . ; f O E 2 \ f CL $ : J / C- ' - C n \ 8 » \ 0 E / E m 0 c & © 7 ƒ 7 k \ E CL § § , o e f $ § & --4E § i § § / | • - « oma � f 7 %« § § > k < R 7$ ° § m \ ƒ k / } C/)�� ) / E nk -n < � ° E _ C o E 7 }} k ) # n % 0 Z / E m k\� 3 < � / | a \ \ �kCD L C) D \0 Ko a = \ % \ \ § 0 { / c r O 9 / ƒ \ ] i \ \ C 0_ ac 2 } ¥ § 0 co0 m \ � k § # z CDCD 2. \ 2 CL _ D \ C § } . CD � � \ Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 01/06/2017 t 324 E. New York Street Invoice# 00-29764 E Suite 300 Terms: (� X 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 12/21/16 ButtI r.James N. Comprehensive Physical Exam $102.46 $102.4 Res irator/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 Bodv Fat Test-BIA Bio-Elec Imp Anal 14.64 $14. CMP(Comp Metabolic Panel 20.00 $20.0 CBC(Comp Blood Count 18.13 $18.1 Li id Panel Blood 21.26 $21.2d Venipuncture $3.14 $3.14 HIV-4th Gen Rapid Test Blood 24.56 $24.56 PSA-Pro t to Specific A (Blood) Chest X-Ray-PA/LAT(Digital) $6 .7 62.7 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.1 PFT-Pulmonary Function Test $34.50 $34.5 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Total Charges-> $580.51 Total Payments&Balance Due-> $0.001 $580.51 Please write invoice number on payment check. Our Federal Employer identification number is 35-2079797. We greatly appreciate the opportunity to serve you. If you have any questions regarding this invoice, please contact Debbie Pieper at 317-964-2330. z C.) -0 < < ( �\ 0 Q A % : O 2 § § © 7 z» M m r- 0 n 0 # 2 cr q 3$ > o q k z k / 0 O $ § ° ® % / d R § k 40 q ®O _ 0 Cl) C) -01 C > 0 ) R r _ # m cn \ t t -n > ƒ 3 co b / \ -jk § � � -00 ƒ ) a § © _ n L >_ q 3 ) ? 0 2 ° 7 7 z O R @ > -n • i 2 % \ E 0 | $ E . r _ a i z f #a R � §g @ kk . % E g 7 E 2 Q m e ? ; -no g 2 m ƒ - CL a - ; # f E f a CL { § J m \ 0 - CD I c :E3 § a & 2 � § / % 2 o « ® C _ \ i ( EF ' 8 • ; J 2 & § ) « 7 g | o [ ƒ - § Q \\ C)::z M \ \ = a kk k Cl) {� ) & . / -nz ® 0 \i G o o § k k $ \ 4 / 0 Z 9 an (D « § k / | \} 7 2 \f G \ - CA E ) #0- /0 qq £ > i § § \ E f / 2. j E m \ \ r 0 7 U) z « ] � 7 CD C G 7CD p $ § / % CL E k a = ( U) CDR § # « k 2 ■ CL > g \ 7 q § - $ < 9 $ § CD m 3 ® k Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 12/15/2016 324 E. New York Street Invoice# 00-29672 E Suite 300 Terms: '1 W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD I Denise Snyder, Budget&Accred Mgr 00 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due 12/05/16 Bondur nt Jeff S. 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(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 $14.64 EK W/Interp $20.91 $20.91 Urinalysis-Di sti k $3.14 $3.14 Nalle , Marcus E. 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 Bodv Fat Test-BIA Bio-Elec Imp Anal 14.64 $14. 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 $34.5 Audiometry 14.64 $14. EKG W/Int 1 $20.91 Urinalysis-Dipstick $3.14 $3.14 Total Charges-> $913.66 Total Payments&Balance Due->1 $0.00 $913.66 Public Safety Medical - INVOICE �°o Public Safety Medical Invoice Date: 12/15/2016 ._. 324 E. New York Street Invoice# 00-29672 E Suite 300 Terms: ce 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 I Balance Due 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. Public Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 12/08/2016 324 E. New York Street Invoice# 00-29620 E Suite 300 Terms: i f Ix Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD I— Denise Snyder, Budget&Accred Mgr 00 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due 11/28/16 St l ffr A Comprehensive Physical Exam $102.46 $102.46 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 Urinalysis-Dipstick $3.14 1.14.14 Total Charges-> $202.83 Total Payments&Balance Due-> $0.00 $202.83 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.