310069 04/10/17 9 CITY OF CARMEL, INDIANA VENDOR: 00350364
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $.....**832.69*
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 310069
INDIANAPOLIS IN 46204 CHECK DATE: 04/10/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 00-30218 832.69 MEDICAL EXAM FEES
4 4
CD 0
o
�
M'o 0
% 0 7g-
(P
;,.k
4
0
Om (P
N
M(p
;.A
o �5
(p
C—)
o
0
ID,
CD
t0 3COD 15
CD
17&1
zo 0
o
oo t4
%6
CDo
o
?A Sr
C_D 54
0
om°
(p
ZL
0
(11
CD fa
o
%;
N. tg,
Sr
ID,
4g
CD
Sv
C,D
OD
Public Safety Medical - INVOICE
H Public Safety Medical Invoice Date: 03/23/2017
:L- 324 E.New York Street Invoice# 00-30218
E Suite 300
12 Indianapolis,IN 46204 Terms:
o Carmel Police Department/CARMEPD
12 Pyoung@carmel.In.Gov
m '
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee Description Amount Balance Due
03115/17 Roaowski,Joseoh H. Respirator Clearance-SS S26.00 St.9A 0
Chart Review/Completion 94.85 $94.8
Indiana PERF Exam 213.13 213.13
D Screen 9 +Opiates&Oxycodone .85 46.8
TonometryGlaucoma Test 42.16 42.1
Urinalysis-Dipstick 3.53 3.53
EKG W/Inter 23.42 23.4
Audiometry 1 .4 16.4
PFT-Pulmonary Function .85
Vision Colorlhi 4
Vision-Acuity S30-45 $30.4
Venlouncture S153 1 $353
Applicant Blood Panel-PERF $134.46 $134.46
Quantiferon-Tb Blood 58.55 58.5
Chest X-Ray-PA/LAT(Digital) 70.26 70.2
Total Charges-> $832.69
Total Payments&Balance Due-> so-0011 $832.69
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.