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315615 8/30/2017 -"ASI f. CITY OF CARMEL, INDIANA VENDOR: 00350364 e PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $****22,169.22* ONE CIVIC SQUARE 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 315615 CARMEL, INDIANA 46032 INDIANAPOLIS IN 46204 CHECK DATE: 08/30/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCFIRE DEPT RIPTIONPHYSALS 1120 4340701 100336 31161 22,169.22 nz / $ « ° & m O O A S C D § G822 2 D m � o c ° m # 2 2A ? \ 0 Cl) R q C < k / / k O % g ¥ z % E e q Q Q# A @ m s # a) � q ® O co 0 ) » > o � r « / G / / 0 CD C) k X 3 © 5 & ® 2 � } z2 e ) > - O CD \ z w | � ¢ $ 2 7 / § / k g m (D ° ( § ƒ a - E « - ; R 2 � 7 � 3 / :3 CD% c + - ( k / k CD \ § CD N & CD % @ 2 ° \ / C co \ i \ \ co \ � / § E £ g § . - _ , y K 7, % m § } E k/ / j m \ \ � g E �$ & D \ 0 \ 0 t § K e C / G 82 z - g CD ° m ƒ \ k CL C o ) / _ D & 0 Z « ƒ §➢ E SF Ik CD k k } 0_< ei a a }_) CD \ / §0 a - > \ 7r CD o CL 2/ \ n / r O I ¥ Z CD & % C \ ( / / ) \ / g \ j n E } k / CL z § [ § _ & CD § _ > > J ; 9 - o CD CD \ k ° o Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/24/2017 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: IX Indianapolis,IN 46204 C Carmel Fire Department/CARMEFD H Denise Snyder, Budget&Accred Mgr m Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount Balance Due 08114/17 Baskerville.Anthony A. OnMed Prooram $0.00 $0.00 Respirator/Medical Review $18.74 $18.74 Health Risk Appraisal Motivation 0.00 $0.00 Comprehensive Physical Exam $114.77M$179.11 BodyFat Test-BIA Bio-Elec ImpAnal 16.40 Treadmill-Submax 179.11Urinal sis-Di stick 3EKG W/Inte 2 .42 Audiometry 16.4 $16.40 FT-Pulmonary Function Test Vision-Acuity .4 Vital Sion -HT WT Butts.Joseph A. Urinaly is-Dipstick EKG W/Interp $23.42 $23.42 Audiomet $16.40 $16.4 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity 0.45 30.4 Vital Signs-HT WT BP P R $0.00 $0.00 Bodv Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax 179.11 179.11 OnMed Pr ram $0.00 Respirator/Medical Review $18.74 $18.74 Comprehensive Phi 4. 7 $114.77 Edwards.Daniel E. OnMed Proaram $0.00 $0.0 Respirator/Medical Review 74 Health Risk Appraisal Motivation 0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urine-Bladder Cancer Screen $52.71 $52.71 Urinalysis-Dipstick $3.53 $3.53 EKG W/Intery $23.42 $23.421 Audiometry $16.40 16.4 P -Pulmonary Function Test $38.65 $38.6 Vision-AcWtv $30.45 S30.4 Vital Sians-HT WTBPPR $0.00 $0.00 Eischen.Kyle J. OnMed Proararn Public Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/24/2017 ._. 324 E.New York Street Invoice# 00-31202 E Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD H Denise Snyder,Budget&Accred Mgr m Dsnyder@carmei.In.Gov(B) Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due RuDiratQUIVIedical Reymew $18.74 $18.7 Health Risk Appraisal Motivation $0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.40 Treadmill-Submax $179.11 $179.111 Urinalysis-Dipstick $3.53 $3.531 EKG W/Interp $23.42 $23.421 Audiornetry $16.40 $16.401 PFT- I n Function Test $38.65 $38.65 V 0.4 Vital Sians-HT WT BPPR S0.00 $0.00 Finn.David S. OnMed Proaram S0.00 $0.00 Review Health Risk Appraisal Motivation $0.00 $0.00 Com rehensive Physical Exam $114.77 114.77 Bod Fat Test-BIA Bio-Elec Im Anal 16.40 16.4 Treadmill-Submax 179.11 179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.4 Audiometry 16.40 $16.4 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity 0.45 $30.4 Vital Sions-HT WT BP P Frve.Steven R. OnMed Proaram Resoirator/Medical $18.74 Health Risk Appraisal Motivation $0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Bodv Fat Test-BIA Bio-Elec Imp Anal $16.40 $16.4d Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 1 .40 $16.40 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity .4 Vital Sins-HT WT BPPR $0.00 $0.00 Tiffin Timothy ro ra $0.00 Respirator/Meducal Review $18.74 1 $18.74 Public Safety Medical - INVOICE II o Public Safety Medical Invoice Date: 08/24/2017 + 324 E.New York Street Invoice# 00-31202 E Suite 300 Terms: ce Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD t- Denise Snyder, Budget&Accred Mgr mDsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Health k Appraisal(Motivation) Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urinalysis-Di stick $3.53 j$23.4j EKG W/Inte 23.42Audiomet 16.40 PFT-Pulmona Function Test 38.65 Vision-Acuity 30.4 Vital Sions-HT WT BP P R Mowery,AnthonyW. OnMed Pro r m Respi tor/Medical Review Health r ' I i Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urinal sis-Di stick $3.53 $3.531 EKG W/Interp $23.42a Audiometry16.40 PFT-PulmonaryFunction Test $38.65 Vii -A i 30.45 Vital 0 Nicley.Wes W. OnMed Proaram $0.00 $0.001 Respirator/Medical Review $18.74 18.74 Health Risk Apr)raisal(Motivation) Com rehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal $16.40 $16.40 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 16.40 $16.40 PFT-Pulmonary Function Tet ...-.$38.65 $38.6 Vision-Acuity 30.45 $30.451 Vital Si ns-HT WT BP $0.00 $0.00 hooler.Dustin D. OnMed Proaram $0.00 $0.00 Respirator/Medical Review $18,74 $18.74 Health Risk Public Safety Medical - INVOICE w to- Public Safety Medical Invoice Date: 08/24/2017 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD I- Denise Snyder, Budget&Accred Mgr m Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal $16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.4 Audiometry 16.40 $16.4 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity $30.45 $30.45 Vital Sians-HT WT BP P R StroUD.Scott A. OnMed Proaram Respirator/Medical Review $18.74 Health Risk Appraisal M v i Comprehensive Physical Exam Body Fat Test-BIA Bio-Elec Imp Anal 16.40 16.4 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 16.40 $16.4 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity 30.45 $30.45 Vial Si n -HT WT BP P R $0.00 $0.00 Woodburn,Scott E. 0.00 $0.00 Review 18.74 $18.7 Health Risk Appraisal(Motivation) $0.00 $0.001 Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 16.40 $16.40 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity 4 30.4 Vital Si ns-HT WT BP P R $0.00 $0.00 08/15/17 Collins,Tony A. OnMed Program $0,00 $0.00 Resr)irator/Medical Review 18.74 Health Risk AoDraisal Public Safety Medical - INVOICE 0 H Public Safety Medical Invoice Date: 08/24/2017 ._ 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: pX Indianapolis,IN 46204 C Carmel Fire Department/CARMEFD H Denise Snyder, Budget&Accred Mgr mDsnyder@carmel.1n.Gov(B) Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount Balance Due Comprehensive Phyi 7 Body Fat Test-BIA Bio-Elec Imp Anal $16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 23.4 Audiometry16.40 16.4 PFT-PulmonaryFunction Test 38.65 38.6 Vision-Acuity30.45 0.4 Vital Si ns-HT WT BP 0.00 0.00 DeCrastos.Richard A. OnMe Prooram $0.00 $0.00 Resoi tor/Madical Review 7 18.7 Health Comorehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.4 Audiometry 16.40 $16.4 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity 30.45 $30.451 Vital Signs-HT WT BP P R0. 0.00 D h m E. 0.00 Respirator/Medical edical R vi w $18.74 1 .7 Health R*sk (Motivation) $0.00 Comprehensive Physical Exam114.7 Body Fat Test-BIA Bio-Elec Imp Anal $16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urinal sis-Di stick $3.53 $3.53 EKG WI Interp $23.42 $23.4 Audiometry16.40 16.4 PFT-Pulmonary Function Test $38.65 $38.65 Vision-Acuity 30.45 $30.4 Vital Signs-HT WT BP P R $0.00 $0.00 Edwarda,5teven L. OnMedPr r m $0.00 $0.00 Respirator/Medical Review $18.74 $18.74 (MotivationHealth Risk Appra*sal $0.00 . 0 comi2rehensive Physical Exam $114.77 1 $114.771 Public Safety Medical - INVOICE 1,o Public Safety Medical Invoice Date: 08/24/2017 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD H Denise Snyder,Budget&Accred Mgr m Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 4990. Date Employee Description Amount Balance Due Body Fat Test-BIA(Bio-Elec Imp Treadmill-Submax 179.11 179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 16.40 $16.4d PFT-Pulmonary Function Test $38.65 38.6 Vision-Acuity 30.45 30.4 Vital Si ns-HT WT BP P R $0.00 0.00 Essex,Cory C. OnMed Pr ram $0.00 $0.00 Respirator/Medical iew Health i k Appraisal(Motivation) Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA(Bio-Elec(Bio-ElImp Analvl Treadmill-Submax $179.11 $179.11 Urine-Bladder Cancer Screen $52.71 $52.71 Urinalysis-Dipstick $3.53 $3.531 EKG W/Interp $23.42 $23.4j Audiometry 16.40 $16.4d PFT-Pulmonary Function Test $38.65 $38.65 Vision-Acuity 30.45 $30.4 Vaal Sians-HT WT BP P R $0.00 $0.00 Fa in Timothy D. OnMed Prooram $0.00 $0.00 Respirator/Medical Review $18.7418.7 Health Risk Appraisal(Motivation) 0 PhysicalComo hens*ve Exam Body Fat Test-BIA Bio-Elec Imp Anal $16.40 Treadmill-Submax M23.4223.42 Urinal is-Dipstick EKG W/Inte Audiomet PFT-Pulmona Function Test Vision-Acuity .45 $30.451 Vital Signs-HT WT BP P R $0.00 $0.00 Fisher Gary L. OnMed Pro ram $0.00 $0.00 Respirator/Medical Review $18.74 $18.74 He th Risk Appraisal 0. rn-nrehensive Physical E am $114.77 $114.77' Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/24/2017 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD I- Denise Snyder, Budget&Accred Mgr mDsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Body Fat Test-BIA(Bio-Elec I An I Treadmill-Submax $179.11 $179.11 Urinalysis-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 30.4 Vital Signs-HT WT BP P R $0.00 $0.00 McNab John D. OnMed Pro ram $0.00 $0.00 Respirator/Medical Reviw $18.74 Health Risk I(Motivation Comprehensive h I Exam Body Fat Test-BIA I I Treadmill-Submax $179.11 $179.11 Urinalysis-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 Urine-Bladder Cancer Screen $52.71 52.71 Paddock,Ronald"Dean" OnMed Proaram $0.00 .00 Resoirator/Medical Review $18.74 $18.74 Health Risk Appraisal(Motivation) 0.00 Comorehensive Physical Exam $114.77 4.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.40 Treadmill-Submax $179.11 179.11 Urina 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 .4 30.45 Vital Signs-HT WT BP P R 0 $0.00 Price Joseph P. OnMed Proram $0.00 0.00 Resdrator/Medical Review 1 .74 Health i k Aporaisal iv Comorebeasiye Public Safety Medical - INVOICE f°- Public Safety Medical Invoice Date: 08/2412017 19 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: '� f W Indianapolis, IN 46204 c Carmel Fire Department/CARMEFD E- Denise Snyder,Budget&Accred Mgr m Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due $16.4 Treadmill-Submax $179.11 $179.11 Urine-Bladder Cancer Screen $52.71 $52.71 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42423.4Audiomet 16.40PFT-Pulmona Function Test 38. 5Vision-Acu' 30.45it i - TWT PPR .0r o A. r 0. Respi t $18.74 $18.74 Health Risk Appraisal(Motivation) $0.00 $0.00 Comprehensive Physical Exam $114.77 $114.7 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urine-Bladder Cancer Screen $52.71 $52.71 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 16.40 $16.40 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity 30.45 $30.4d Vital Si ns-HT WT BP P R $0.00 Workman,William J. OnMed Pr ram $0.00 Respirator/Medical Review 1 4 Health Risk Appraisal(Motivation) Hemoccult $0.00 $0.00 Com rehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax $179.11 179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp 23.4 Audiometry $16.4 16.4 PFT-Pulmonary Function Test $38.65 $38.6d Vii -Acuity $30,45 30.45 Vital Si ns-HT WTBPPR $0.00 0. 0 08116/17 Benae.Jonathanm $0.00 RespiratodMedical Review $18.74 1 Public Safety Medical - INVOICE H Public Safety Medical Invoice Date: 08/24/2017 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD F Denise Snyder, Budget&Accred Mgr m Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Health Risk I(Motivation) Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.531 EKG W/Interp $23.42 $23.42 Audiometry 16.40 16.4 PFT-Pulmonary Function Test .65 38.6 Vision-Acuity 30.4 Vital Sions-H T BPPR Buttler.James N. OnMedProaram Respirator/Medical Review Health Risk is I(Motivation) Hemoccult $0.000 .00 Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imo Anal 16.40 $16.40 Treadmill-Submax $179.11 $179.11 Urine-Bladder Cancer Screen $52.71 $52.71 Urinalysis-Di stick $3.53 $3.53 EKG W/Inte 23.42 $23.42 Audiometry 16.40 $16.401 PFT-Pulmonary Function Test $3 . 6 Vision-Acuity $30.45 $30.4 0 Butts. Res irator/Medical Review $18.74 $18.7 Health Risk Appraisal Motivation 0.00 $0.00 Com rehensive Physical Exam $114.77 $114.77 Bodv Fat Test-BIA Bio-Elec Imp Anal 16.40 16.40 Treadmill-Submax $179.11 $179.11 Urinal sis-Di stick $3.53 $3.53 EK W/Interp $23.4223.42 Audiometry 16.40 $16.40 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity $30.45 .4 Vital Sians-HT WT BP P R $0.00 $0.00 Deitsch.Marc W. OnMed Pro ram Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/24/2017 w 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD t- Denise Snyder, Budget&Accred Mgr m Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due s ' t dical Review Health Risk Appraisal Motivation $0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.40 Treadmill-Submax 179.11 $179.111 Urinal is-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 Vital Si - TWT BP P R Heavner.Joel S. OnMed Pro Resoirator/Medical Review $18.74 $18, Health Risk Appraisal Motivation $0.00 $0.00 Com rehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.40 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Inter 23.42 $23.42 Audiometry 16.40 $16.40 PFT-Pulmonary Function Test $38.65 $38.65d Vision-Acuity 30.45 30.4 Vital Sions-HT WT BP P R $0.00 0.00 Marvel,Thomas L. OnMed Prouram $0.00 Respirator/Medical Rey4ew $18.74 $18.74 Health Risk Appraisal Motivation $0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.40 Treadmill-Submax 179.11 $179.111 Urinalysis-Dipstick 3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 1 16.4 PFT-Pulmonary Function Test $38.65 $38.65 Vision-Acuity 30.4 Vital ns-HT WT BP P R $0.00 $0.00 McNair.Iravi L. I OnMed Proaram $0.00 $0.00 Respirator/medical v' Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/24/2017 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: tY Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD F- Denise Snyder, Budget&Accred Mgr m Dsnyder@carmel.in.Gov(B) Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Risk Appraisal iv $0.00 Comprehensive Physical Exam $114.77 $114.77 Bodv Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Inte 23.42 $23.42 Audiometry 16.40 $16.4 PFT-Pulmonary Function Test $38.65 38.6 Vision-Acuity 0.4 30.4 Vital i n -HT WTBPPR $0.00 $0.00 Medlen.Michael J. OnMed Proararn $0.00 Respirator/Medical Revi Health Risk Appraisal Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.40 Treadmill-Submax $179.11 $179.11 Urinalysis-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 Vital Sions-HT WT 13P P R $0.00 $0.00 Nallev.Marcus OnMed Proaram $0.00 $0.00 Respirator/Medical Review 4 Health Risk Appraisal(Motivation) Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.40 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.63 $3.53 EKG W/Intery $23.42 U38.6 Audiometry16.40 PFT-PulmonaryFunction T 38.65 Vision-Acuit 30.45 i I ins-HTWTB P 0.00 Rhillips,CraiaM. OnMed Program $0.00 1 0.00 Respirator/Medical $18.74 $18.74 Health Public Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/24/2017 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: 1 W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD H Denise Snyder, Budget&Accred Mgr m Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount Balance Due Hemoccult $0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal $16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 3.53 EKG W/Interp $23.42 23.42 Audiometry $16.40 1 .4 PFT-Pulmonary Function Test $38.65 8.6 Vision-Acuity .4 Vital Sions-HT WT BP P R Rutherford,Justin D. OnMed Proaram Respirator/Medical Review Health Risk 1(Motivation) Comprehensive Physical Exam $114.77 $114.771 Body Fat Test-BIA Bio-Elec Imp Anal $16.40 16.4 Treadmill-Submax 179.112179.11Urinal is-Di stick 3.533.53EKG W/Inte 23.4223.4Audiomet 16.4016.4 PFT-Pulmonary Function Test $38.65 $38.65 Vision-Acuity 0.45 $30.4 Vital Sions-HT WT BPP R $0.00 $0.00 Smith,David OnMed Proarem $0.00 Resp4rator/Medical Review $18.74 $18.7 Health Risk Appraisal(Motivation) 0 $0.00 Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 23.4 Audiometry 16.40 $16.4 PFT-Pulmonary Function Test Vision-Acui .4 .4 Vital Sians-HT WT BP P R 08/17/17 Cummins Frank C. OnMed Pr ram Respirator/Medical Review Health Risk Aggraisal(Motivation) $0.00 Tn no Public Safety Medical - INVOICE Foo Public Safety Medical Invoice Date: 08/24/2017 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: W Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD H Denise Snyder, Budget&Accred Mgr m Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount Balance Due Comprehensive h i Exam $114.77 $114.7 Body Fat Test-BIA Bio-Elec Imp Anal $16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Intern 23.42 $23.42 Audiometry 16.40 $16.4 PFT-Pulmonary Function Test $38.65 38.65 Vision-Acuity 30.45 $30.45 Vital Si ns-HT WT BP P R $0.00 $0.0 Fr ,er Keith T. OnMed Proaram $0.00 $0.00 Resoirator/MedicalReview 1 7 Health Risk t' Comorehensive Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill-Submax $179.11 179.11 Urinal sis-Di stick $3.53 $3.531 EKG W/Interp $23.42 $23.42 Audiometry 16.40 $16.4 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity 30.45 $30.4 Vital Sions-HT WT BP P R $0.00 $0.00 Greiner,Brandon J. OnMed .00 $0.001 Resporator/Medical Review $18.74 $18.7 Health Risk Appraisal on Comprehensove Physical Exam $114.77 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.40 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 16.40 $16.4 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity $30.45 30.4 Vital Si ns-HT WT BP P R $0.00 $0.00 Ray,Lucas M. OnMed Pro $0,00 $0.00 -Resairator/Medical Review18.74 18.74 Health Risk i . 0 Comprehensive7 Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/24/2017 J .. 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Fire Department I CARMEFD F- Denise Snyder, Budget&Accred Mgr m Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount Balance Due Body Fat Test-BIA -E ec Imp I $16.40 $16A Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 16.40 $16.40 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity 30.4 30.4 Vital Signs-HT WT BP P R $0.00 $0.00 Small.Thomas D OnMed Pr ram $0.00 Resoirator/Medical Review $18,74 Health Risk ftpraisal(Motivation Comorehensive Physical Exam 11 al Treadmill-Submax $179.11 $179.111 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 16.40 16.40 PFT-Pulmonary Function Test $38.65 $38. Vision-Acuity 0.4 30.4 Vital Si ns-HT WT BP P R $0.00 $0.00 _Srnith Brian E OnMed Pro ram $0.00 $0.00 Re i r/Medical Review 1 .74 Health Risk Aroraisall 'v $0,0 Comorehensive Physical Exam $114.77 $114.77 Bodv Fat $16.40 Treadmill-Submax $179.11 $179.11 Urinalysis-Di stick $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 $30.4 Vital Si ns-HT WT BP P R $0.00 $0.00 Stindle Kevin P. OnMed Pro ram $0.00 $0.00 Respirator/Medical Review $18.74 $18.74 Health Risk Appraisal Motivation $0.001 Comorehensive Physical Exam 1 1 7 Body Fat Test-BIA i - I clm Public Safety Medical - INVOICE H Public Safety Medical Invoice Date: 08/24/2017 ._ 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: Indianapolis, IN 46204 c Carmel Fire Department I CARMEFD F-- Denise Snyder, Budget&Accred Mgr m Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Treadmill- b x $179.11 $179.11 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 16.40 $16.40 PFT-Pulmonary Function Test 38.6538.6 30.4 Vision-Acuity 30.45 Vital Si ns-HT WT BP P R .00 0.00 08/18/17 Andres Jr Victor S. OnMed Pro ram4$118.74 0.00 Res it tor/Medical Review $18.74 Health Rik Aporaisal .00 Comprehensive i 114.77 Body F Treadmill-Submax $179.11 $179.11 Urinalysis-Di tick $3.53 $3.531 EKG W/Interp $23.42 $23.42 Audiometry 16.40 $16.4 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 Butts Andrew P. OnMed Pr ram $0.00 $0.001 Respirator/Medical Review $18.74 $18.74 Comprehensive Physical Exam $114.77 14.77 Body Fat Test- IA(Bio-Elec Imp Analvl $16.40 1 .4 11 EKG W1 Interp $23.42 $23.42 Audiometry 16.40 16.4 PFT-Pulmonary Function Test $38.65 $38.65 Vision-Acuity 30.45 30.4 Vital Si ns-HT WT BP P R $0.00 $0.00 Condra Kyle E. OnMed Program $0.00 $0.00 Respirator/Medical Review $18.74 $18.74 Health Risk Appraisal(Motivation) .00 $0.00 Comprehensive Physical $114,77 $114.77 Bodv Fat Test-BIA(Bio-ElecImp Anal 16.40 $16.4d Treadmill-Submax $179.11 $179.11 rin 1 i - Public Safety Medical - INVOICE y 0 Public Safety Medical Invoice Date: 08/24/2017 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: "} IX Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD I- Denise Snyder,Budget&Accred Mgr m Dsnyder@carmel.in.Gov(B) Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount Balance Due KG W/Interp $23.42 $23.4 Audiometry 16.40 $16.4 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity 30.45 $30.45 Vital Si ns-HT WT BP P R 0.00 .00 Daile Robert A. OnMed P ram 0.00 .00 Respirator/Medical Review 18.74 18.74 Comprehensive Physical Exam 114.77 14.77 1 Body Fat Test-BIA Bi -EI I 16.40 $16.401 Treadmill- bm x $179.11 Urinalysis-Diostick $3.53 S3.53 EKGW/Interp Audiometry PFT-Pulmonary Function Test $38.65 $38.65 Vision-Acuity 30.45 $30.45 Vaal Signs-HT WT BP P R $0.00 $0.00 Lenze Jr Theodore A. Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 16.40 $16,40 PFT- ulmonary Function Test $38.65 38. Vision-Acuity 30.4530.4 Vital i P R 0 Body Fat Test-BIA(Bio-Ele ImpAnal 16. 1 .4 11 OnMed Prooram Res irator/Medical Review $18.74 $18.7 Health Risk Appraisal Motivation 0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Malicoat Justin R. 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 Bodv Fat Test-BIA Bio-EI c Imp Anal 16.40 $16.40 Treadmill-Submax $179.11 $179.11 Urinalysis-Diostick $3.53 $3.53 K W Interp $23.42 .4 Audio m t $16.401 Public Safety Medical - INVOICE t°- Public Safety Medical Invoice Date: 08/24/2017 324 E. New York Street Invoice# 00-31202 Suite 300 Terms: W. Indianapolis,IN 46204 G Carmel Fire Department/CARMEFD I-- Denise Snyder, Budget&Accred Mgr m Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount Balance Due PFT-Pulmonary Function t $38.65 Vision-Acuity 30.45 $30.4 Vital Si ns-HT WT BP P R $0.00 $0.00 Mitchell James C. OnMed Program $0.00 $0.00 Respirator/Medical Review $18.74 18.7 Health Risk Appraisal Motivation 0.00 0.00 Comprehensive Physical Exam 114.77 114.77 BodyFat Test-BIA Bio-Elec ImpAnal 16.40 16. Treadmill-Submax 179.11 17 11 Urina -Dipstick $3.53 $3,531 EKG W/I $2142 2 Audiometry Pulmonary Function 5 Vision-Acuity 0.45 $30.4 Vital Signs-HT WT BP P R $0.00 $0.00 Mulford David A. OnMed Program 4$114.77 .00 0.00 Respirator/Medical Review .74 18.7 Health Risk Appraisal Motivation .00 0.00 Comprehensive Physical Exam 114.77Bod Fat Test-BIA Bio-Elec Im Anal .40 16.4 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick EKG W Interp $23.42 $23.42 Audiometry 1 PFT-Pulmonary Function Test Vision-Acuity $30.45 $30.45 Vital Signs-HT WT BP P R $0.00 $0.00 Russel Grant W. OnMed Program $0.00 $0.001 Respirator/Medical Review $18.74 $18.74 Health Risk A raisal Motivation 0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA(Bio-Elec Imp Analy) $16.40 $16.4 Treadmill-Submax $179.11 $179.11 Urinalysis-Dipstick $3.53 EKG W/Interp $23.42 Audiometry 16.4 PFT-Pulmonary Public Safety Medical - INVOICE w� Public Safety Medical Invoice Date: 08/24/2017 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: 0: Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD t- Denise Snyder, Budget&Accred Mgr m Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description Amount Balance Due Vision Vital Si ns-HT WT BP P R $0.00 $0.00 Steurv.Kent C. OnMed Program .00 $0.00 Respirator/Medical Review $18.74 $18.74 Health Risk Appraisal Motivation 0.00 $0.00 Com rehensive Physical Exam $114.77 $114.77 Body Fat Test-BIA Bio-Elec Im Anal $16.40 $16.4 Treadmill-Submax $179.11 $179.11 t is-Di sti Into t I n F i Test $38.65 Acuily Vital Si ns-HT WT BP P R $0.004$0.00 Thordarson Erik M. OnMed Pro ram $0.00 Respirator/Medical Review 18.74 Health Risk Appraisal Motivation 0.00 Comprehensive Physical Exam $114.77 $114.77 Bodv Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4 Treadmill- ubmax $179.11 $179.11 Udnalysis-Dipstick $3.53 $3.53 EKG W/Intero 23.42 $23.421 Audio etry $16.40 $16.401 PFT-Pulmonary Function Test $38.68.6 Vision-Acuity 30.45 4 Vital Si ns-HT WT BP P R $0.00 Total Charges-> $24,155.64 Total Payments&Balance Due-> $0.00 Ei64 Public Safety Medical - INVOICE ro Public Safety Medical Invoice Date: 08/24/2017 ;. 324 E. New York Street Invoice# 00-31202 E Suite 300 Terms: w Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD �- Denise Snyder, Budget&Accred Mgr m Dsnyder@carmel.In.Gov(B) 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 Michelle McClure at 317-964-2364.