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313114 06/28/17 9a; CITY OF CARMEL, INDIANA VENDOR: 00350364 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $*****2,531.83` ?° CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 313114 MITON INDIANAPOLIS IN 46204 CHECK DATE: 06/28/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 100018 00-30789 2,531.83 OFFICER PHYSICALS nu -U < k » qT O b k � « § O $ / § j * / R c > # 2 7 q k > o m ' O E « m E z ƒ $k q E O g w 2 w i /q O A « M P. tn. © # -n # q ® 9 0 / C: > \ -0 6 M � / Cl) / � 3 / 3 §2 & \ k o < # � k > m » 2 2 C # K k $ 0O E $ / | } B z g ■ « a ■ a L — 2 > { f ( CD k ƒ ? § @ g § F 7 § K E � m , { 7 i \ \ / m « g k 2 ƒ § k §f C E 2 k CD CL ƒ k 0 CDN J E 0 g n E f Z % $ 7 E 3' 2 C? § \ 0 \ 2 E N m & g \ / > KI _ CD cr CL CT\ 5'; M. k \ a = cr � ) \ & ( / 8 -n < 0 Go � \o j § 2 \ 2 ; o # D 2 0 Z > / i i ° \ B \< % _0 O �± ( \ ( - �) & 0 D \ \ ; q > \ 5CD 0 R 0 / 2j E / \ D G / ƒ ■ f 2 \ ] / % ƒ ; $ c Q CD CD } ƒ ) 0 / M -n f \ ] § k # 2 a ƒ [ { \ ( N 2 -CD 5 7 < C4 Public Safety Medical - INVOICE F Public Safety Medical Invoice Date: 06/15/2017 324 E. New York Street Invoice# 00-30789 m Suite 300 Terms: tY Indianapolis, IN 46204 o Carmel Police Department/CARMEPD t` Pat Young mPyoung@carmel.In.Gov Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due 06/08/17 Dietz,Aaron n Pr r Respirator/Medical Review $18.74 $18.74 Health Risk Appraisal Motivation 0.00 $0.00 Hemoccult 0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Waist/Hi Ratio $3.53 $3.53 Bodv Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax $179.11 $179.11 Muscular Stren th Endurance Test 30.45 30.4 Flexibility Tet 11.72 11.72 Urinal i -Dipstick $3.53 $3.53 EK Interp Audiometry $16.40 $16.40 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity 30.45 $30.4 Vital Signs-HT WT BP P R $0.00 $0.00 Frost Dwi ht D. OnMed Pro ram $0.00 $0.00 Respirator/Medical Review $18.74 $18.74 Health Risk ADDraisal Motivation 0.00 $0.00 Hemoccult $0.00 $0.00 Com rehensive Physical Exam $114.77 $114.77 Waist/Hip Ratio $3.53 $3.53 Body Fat Test-BIA Bi -Elec Imp Anal 16.40 $16.40 ffEKG - m x $179.11 $179.11 tr h T t .4 Test $11.72 $11.7s-Di stick 3.53 3.53 Interp $23.42 $23.42 Audiometry 16.40 $16.4 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity 30.45 $30.45 Vital Signs-HT WT BP P R $0.00 $0.00 Gauthier.Edward B. HIV-4th Gen Rapid Test Blood 25.93 $25.93 Venipuncture $3.53 $3.53 LiDid Panel(Blood) 23. 2 2 .82 (CompCBC I Public Safety Medical - INVOICE H Public Safety Medical Invoice Date: 06/15/2017 0.0 324 E. New York Street Invoice# 00-30789 E Suite 300 IX Indianapolis, IN 46204 Terms: o Carmel Police Department/CARMEPD 12 Pat Young mPyoung@carmel.In.Gov Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due nM Program Respirator/Medical al Review $18.74 $18.74 Risk Appraisal Motivation 0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Waist/Hi Ratio $3.53 $3.531 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax $179.11 $179.11 Muscular Strength Endurance Test $30.45 $30.4 Flexibility Test $11.72 $11.72 Urinalysis-Dipstick 3.53 $3.53 EKG W Interp $23.42 $23.42 Audiometry $16.40 1 .4 FT-Pulmonary Function T Vision-Acuity $30.45 $30.4 Vital Si ns-HT WT BP P R $0.00 $0.00 Govin John K. OnMed Program $0.00 $0.00 Respirator/Medical Review $18.74 $18.74 Health Risk Appraisal Motivation 0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Waist/Hi Ratio $3.53 $3.53 Bodv Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax $179.11 $179.11 Muscular tren th Endurance Tet $30.45 $30.4 Flexibility Test $11.72 $11.721 Urinalysis Dipstick EKG W/Interp $23.42 $23.42 Audiometry 16.40 $16.40 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity 30.45 $30.4 Vital Signs-HT WT BP P R $0.00 $0.00 Smith Troy D. OnMed Program $0.00 $0.00 Res irator/Medical Review $18.74 $18.74 Health Risk Appraisal Motivation 0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Waist/Hip Ratio 3.53 3.53 Public Safety Medical - INVOICE t` Public Safety Medical Invoice Date: 06/15/2017 324 E. New York Street Invoice# 00-30789 E Suite 300 Terms: W Indianapolis, IN 46204 o Carmel Police Department/CARMEPD H Pat Young m Pyoung@carmel.In.Gov Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Muscular Strenath Endurance Test $30.45 $30.4 Flexibility Test $11.72 $11.72 Urinal sis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 16.40 16.40 PFT-Pulmonary Function Test $38.65 $38.65 Vision-Acuity 30.45 $30.45 Vital Signs-HT WT BP P R 0.00 $0.00 Total Charges->1 $2,531.83 Total Payments&Balance Due->1 $0.00 $2,531.83 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.