316006 9/12/2017 9u "'",•� CITY OF CARMEL, INDIANA VENDOR: 00350364
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $****24,459.67*
+? r CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 316006
'M(ION g INDIANAPOLIS IN 46204 CHECK DATE: 09/12/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 100336 31119 304.03 FIRE DEPT PHYSICALS
1120 4340701 100336 31202 24,155.64 FIRE DEPT PHYSICALS
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Public Safety Medical - INVOICE
o Public Safety Medical Invoice Date: 08/10/2017
324 E. New York Street Invoice# 00-31119
E Suite 300 Terms:
X 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
08/01/17 Holden.Adam D HIV-4th Gen Rap'd Test(Blood) $25.93 --425:93
TSH-Thyroid Stim Hormone Blood 28.01 $28.01
Venipuncture $3.53 $3.53
Lipid Panel Blood 23.82 $23.82
CBC(Como Blood Count 20.29 20.2
CMP(Como Metabolic Panel 22.41 $22.41
PSA-Prostate Specific A Blood 0.99 $40.9
08/04/17 Benbow,Kip S. HIV-4th Gen Ra id Test Blood 25.93 $25.93
TSH-Thyroid Stim Hormone(Blood) 28.01
2
1
Venipuncture
CBC(Como Blood Count) $20.29
Lipid Panel $40.99 CMP(Como Metaboloc Panel) $22.41
PSA-Prostate Specific A0.99(Blood
0.99
Total Charges-> $329.96 boy o3
Total Payments&Balance Due-> $0.00
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
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
F- Denise Snyder, Budget&Accred Mgr
mDsnyder@carmel.In.Gov(B)
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee Description Amount Balance Due
08/14/17 Baskerville.Anthony A. OnMed Proaram $0.00 10.00
Respirator/Medical Review $18.74 $18.7
Health Risk Appraisal Motivation 0.00 $0.00
Comprehensive Physical Exam $114.77 $114.77
Body Fat Test-BIA Bi - I c Imp Analv) 16.40 $16.401
Treadmill-Submax $179.11 $179.11
Urinal sis-Dipstick $3.53 $3.53
EKG W Int
Audiometry $16.4
PFT-Pulmonary
Vii .4
Butts.Joseph A. ri
EKG W/Interp $23.42 $23.4
Audiometry 16.40 $16.401
PFT-Pulmonary Function Test S38.65 $38.65
Vi ion-Acuity $30.45 $30.45
Vit@1 -HT WT BP P R $0.00 $0.00
Bodyat Test-BIA Bio-Elec Imp Anal 16.40 $16.4
Treadmill-Submax $179.11 $179.11
Program $0.00
Respirator/Medical Review $18.74
Comprehensive 14.77
Edwards.Daniel E. QnMej Program $0.00 $0.0
Rtsoorator/Medical Review $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 16.4
Treadmill-Submax $179.11 $179.11
Urine-Bladder Cancer Screen $52.71 $52.71
Urinalysis-Dipstick $3.53 $3.53
EKG W1 Interp $23.42
Audiometry .4 16.4
F -Pulmonary Function Test 8.65 38.65
Vision-Acuity
Vital Sions-FIT WT BPPR
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� Indianapolis, IN 46204
IM
C Carmel Fire Department/CARMEFD
F- Denise Snyder, Budget&Accred Mgr
mDsnyder@carmel.In.Gov(B)
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee Description Amount Balance Due
R 1 .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 $16.4
Treadmill-Submax $179.11 $179.11
Urinalysis-Dipstick $3.53 $3.53
EKG W/Interp $23.42 $23.4
AmOometry $16.40 $16.4
Pulmonary Function
Vision-Acuity $30.45 $30.45
-VW Slans-HT WT BP
Finn.David S. OnMed Proaram $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
Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4
T a it -Submax $179.11 $179.11
_Ujinal sis-Dipstick $3.53 $3.53
EKG W/Intero $23.42 $23.42
Audiometry $1 .4 1 4
PFT-Pulmonary Function Test $38.65 $38.6
Vii -Acuity $30.45 $30.4
Vital WT BP P
Frye,Steven R. OnMed Proaram SO.00 S0,00
-Respiratodh4edical Review $18.74 $18.74
Health Risk Appraisal Motivation .00 $0.00
Comprehensive Physical Exam $114.77 $114.77
Body Fat Test-BIA Bio-Elec Imp Anal $16.4016.4
Treadmill-Submax 179.11 179.11
Urinalysis-Dipstick $3.53 $3.53
EKG W/Interp $23.42 $23.4
Audiometry .40 $16.4
PF -Pulmonary Function Test $38.65
Vision-Acuity 3 .45
Vital Sin -HT .0
Griffin.Timothy M. OnMed Pr
Respirator/Medical
Public Safety Medical - INVOICE
Public Safety Medical Invoice Date: 08/24/2017
324 E.New York Street Invoice# 00-31202
E Suite 300 Terms:
IX Indianapolis,IN 46204
o 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 Balance Due
Health Rilk 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
Urinalysis-Di stick $3.53 3.53
KG WI Interp $23.42 23.4
Audiometry 1 .4
PFT-Pulmonary Function Test $38.65 $38.65
Vision-Acuity $30.4530.4
Vital Swans-HT WT BP P
Mowery.Anthony W. QnMed.Proaram S0.00 $0.00
Resp'rator/Medical Revo $18.74 $18,
Health Risk 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-Dipstick $3.53 3.53
EKG W/Inte 23.42438.6
Audiometry16.40
PFT-Pulmonary Function Tet
Vision-Acuity .4
Vital Sians-HT WT BP P R
Niclev.Wes W. OnMed Proara $0.00 =QM
Review
Health Risk 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 $179.111
Urinalysis-Dipstick $3.53 3. 3
EK W/Inte 23.42 23.4
Audiometry $0.00
16.40 16.4
PFT-PulmonaryFunction Tet 38.65 38.6
Vision-Acuity30.45 3 .4
Vital S' ns-HT WT BP00
Scho ler.Dustind Program .00
ReSDirstor/Medical Reymew $18.74
Public Safety Medical - INVOICE
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
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
CompEphensive Physical Exam $114.77 $114.77
Body Fat Test-BIA Bio-Elec imp Anal16.40 $16.4
Treadmill Submax 179.11 $179.11
Urinalysis-Dipstick $3.53 $3.53
EKG W/Interp $23.42 $23.421
Audiometry $16.40 $16.4
PFT-Pulmonary Function Test $38.65 $38.6
Vision-Acuity 30.45 $30.4
Vital Shans-HT WTBPPR
Stroup.Scott A. OnMed Proaram $0.00 $0.00,
rIMedical Review
Health Risk Appraisal i
Comprehensive Physical Exam $114.77 $114.77
Bodyat 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 M6*4 $16.401
AudiometryPFT-Pulmona Fun ti n T st Vii -A i Vit l i n - T P P R rn i iew
Health Risk Appraisal(Motivation)
Comprehensive Physical Ex
Body Fat Test-BIA Bio-Elec Imp Anal $16.40 $16.4
Treadmill-Submax $179.11 $179.11
Urinalysis-Dipstick $3.53 $3.53
EN W/Interp $23.42 $23.42
Audiometry 16.40 $16.4.0
PFT-Pulmonary Function Test $38.65 $38.6
Vision-Acuity 4 30.4
Vital Signs-HT WT BPP .00 $0.00
1 OnMed Pro ram $0.00 $0.00
Respirator/MediolR v .74 $18.74
Health Risk Appraisal(Motivation) so-00 $0.00
Public Safety Medical - INVOICE
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
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
Comprehensive Physical 11 7
Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4
Treadmill-Submax 179.11 $179.11
Urinalysis-Dipstick $3.53 $3.5
EKG W1 Interp $23.42 $23.42
Audiometry 16.40 $16.4
PFT-Pulmonary Function Test $38.65
Vision i .4 .4
Vital Si ns-HT WT BP 0.00
DeCrastos.Richard A. OnMed r ram $0.00
Respirator/Medical Review $18.74 $18,
Health Risk AoDraisal(Motivation) $0.00 $0.0
Comorebensilve Physucal Exam $114.77 $114.7
7
Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4
Treadmill-Submax $179.11 $179.11
Urinalysis-Di stick $3.53 $3.53
EKG W/Interp $23.42 $23.42
Audiometry 16.40 $16.4
PFT-Pulmonary Function Test38.6
Vision-Acuity 4 30.4
Vital TWTBPPR $0.00 $0.00
Dorsch. E. OnMed Proaram $0.00 $0.0
Resoirator/Medical Review $18.74 $18.
Health Risk A
Comorehensive Physical Exam $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. 16.4
PFT-Pulmonary Function Test $38.65 $38.65
Vision-Acuity 30.45 $30.4
Vital Sions-HT WT 5P P R $0.00
Edwa[da-Steven L. OnMed Program0
espirator/Medacal Review $18.74 $18.
7
I
Public Safety Medical - INVOICE
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 1 CARMEFD
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(Boo-Elec Imp An I
Treadmill-Submax $179.11 $179.11
Urinalysis-Dipstick $3.53 $3.53
EKG W/Interp $23.42 $23.42
Audiometry 16.4 16.40
PFT-Pulmonary Function Test $38.65 $38.65
Vision-Acuity 30.45 $30.45
Vital -HT WT BP P R
Essex,Cory C. OnMed Proaram $0.00 $0.00
ResDiratorlMedical evi wA17�
AppraisalHealth R'sk (Motivation)
Comprehensive Phyalcal Exam
Imp Analy)
Treadmill-Submax 4$ ��. 1
Urine-Bladder Cancer Screen $52.71 $52.71
Win sis-Dipstick $3.53 $3.531
EKG W1 IntoInterp $23.42 $23.42
Audio met 16.40 $16.40
PFT-Pulmonary Function Test $38.65 $38.6
Vision-Amity 0.4 $30.46
Vital Sions-HT WT BP P R $0.00 $0.00
OnMed Proaram $0.00 $0,00
Review $18.74 $18.7
Health Risk Appraisal(Motivation)
Physical 1
Bodv 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 $38.6
Acuity 30.45 $30.45
Vital Signs-HT WT BP P R $0.00
Fisher, d Pro ram $0.00
Respirator/Medical Review $1 .74
:=Health Rik Appraisal
Public Safety Medical - INVOICE
Public Safety Medical Invoice Date: 08/24/2017
324 E. New York Street Invoice# 00-31202
E Suite 300 Terms:
p� Indianapolis,IN 46204
o Carmel Fire Department/CARMEFD
F- Denise Snyder,Budget$Accred Mgr
m Dsnyder@carmel.In.Gov(B)
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee Description Amount Balance Due
Body Fat Test-BIA(B*o-Elec Imp nl
Treadmill-Submax $179.11 $179.11
Urinalysis-Dipstick $3.53 $3.53
EK W/Interp $23.42 $23.42
Audiometry 16.40 $16.40
PFT-Pulmonary Function Test $38.65 $38.65
Vision cul 30.4
Vital Si ns-HT WT BP P R $0.00 $0.00
McNab.John D. OnMe Proaram .00
Resporator/Madacal Review $18.74 $18.
Health Risk Appraisal tivati n
Comprehensive Physical Exam $114.77 S114.7
Body Fat Test-BIA(B'o-Elec Imp I
Treadmill-Submax $179.11 $179.11
Urinalysis-Di stick S3.53 $3.53
EKG W1 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 Ions-HT WT BPP 0.00 .0
Urine-Bladder Cancer Screen $52.71 $52.71
Paddock,Ronald"Dean" .00
Resp*rator/Med*cal Review $18.74
Health Risk Anoraisal(Motivation)
Comprehensive Physical Exam
Body Fat Test-BIA Bio-Elec Imp Anal $16.40 $16.40
Treadmill-Submax $179.11 $179.11
Urinalysis-Dipstick $3.53 $3.53
EK W/Interp $23.42 $23.42
Audiometry $16.40 $16.40
PFT-Pulmonary Function Test $38.65 $38.65
Vii -Acuity 4 .45
Vital Sians-HT WT BP P R $0.00 $0.00
Price.Joseph P. I OnMed Program $0.00 $0.001
Rest)irator/Medical Review Q 74
Health Risk=# 2;omprehenseve Physical Exam $114.77
Appraisal
Public Safety Medical - INVOICE
H Public Safety Medical Invoice Date: 08/24/2017
w 324 E. New York Street Invoice# 00-31202
E Suite 300 Terms:
iY Indianapolis, IN 46204
C Carmel Fire Department/CARMEFD
F- Denise Snyder,Budget&Accred Mgr
mDsnyder@carmel.In.Gov(B)
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee Description Amount Balance Due
Body Eat Test-BIA(Bio-Elec Imp Analy) $16.40
Treadmill-Submax $179.11 $179.11
Urine-Bladder Cancer Screen $52.71
Urinalysis-Di stick $3.53 $3.53
EKG W/Interp $23.42 $23.421
Au iome 16.40 $16.4d
PFT-Pulmonary Function Test
Vision-Acuity $30.45 30.4
V' P P R $0.00 • 0
Gr
Respqrator/Med6cal Review S18.74 $1814
Health Risk Appraisal(Motivation) $0.00 Wag
Cgmorehonsive 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/Interp $23.42 $23.421
Audiometry 16.40 $16.4
PFT-Pulmonary Function Test $38.65
Vision-Acuity 30.45 $30.4
Vital Signs-HT WT BP P R $0.00
William n r
Respirator/Medical 4
in
Hemoccult $0.00 0.00
Comprehensive Physical Exam $114.77 114.77
Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4C
Treadmill-Submax $179.11 $179.11.
Urinalysis-DipsticK $3.53 3
EKG W/Interp $23.42 $23.42
Audiometry $16.40 1 .4
F -Pulmonary Function Tet $38.65 8.6
Vision-Acuity $30.45 4
Vital s T WT BPP R $0.00 $0.00
Public Safety Medical - INVOICE
too 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
Denise Snyder, Budget&Accred Mgr
mDsnyder@carmel.In.Gov(B)
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee Description Amount Balance Due
Health Risk AoDraisat(Motivation) 10.0 S0,00
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 $3.531
EKG W/Inte 23.42 23.42
Audiometry .40
PFT-PulmonaryFunction Test 8.65 $38.6
Vision_ 30.4
Respirator/Medical Review $ 8.74 $18.74
Health Risk Appraisal(Motivation) $0.00 $0.0
Hemoccult $0.00 $0.00
comprehensive Physical Exam $114.77 $114.7
Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4C
Treadmill-Submax $179.11 $179.111
Urine-Bladder Cancer Screen 2.71 52.71
Urinal si -Dipstick 3.53 3.53
EKG / to 2 2 .4
Audiometry $16.40 6
PFT-Pulmonary Function Test $38.65
Visign
Butts.Renee L. OnMed Proaram $0.00 $0.00
Res irator/Medical Review $18.74 18.7
Health Risk Appraisal Motivation 0.00 $0.00
Com rehensive Physical Exam $114.77 $114.771
Body Fat Test-BIA Bio-Elec Im Anal 16.40 $16.4d
Treadmill-Submax 179.11 179.11
Urinalysis-Dipstick 3.53 .53
EK I 4 23.4
Audiometry .4 1 .4
PFT-Pulmonary Function T t $38.65 md
vision-Acuity 45
Vital Suns-HT WT PP
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:
Indianapolis,IN 46204
o Carmel Fire Department/CARMEFD
12 Denise Snyder, Budget&Accred Mgr
m Dsnyder@carmel.In.Gov(B)
Exclusively Serving Public Safely Professionals Since 1990.
Date Employee Description Amount Balance Due
Resgiralqr/Medcal Review $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 Analy) $16.40 $16.40
Treadmill-Submax 17 .11 $179.11
Urinalysis-Dipstick $3,53 $3.53
EKG W/Interp $23.42 $23.42
$16.40 $16.40
F -Pulmonary Function Test $38.65 S38.65
Vision-Acuity .4
Vital Sions-HT WT BP PR
Heayner.Joel S. OnMed Proaram $0.00 $0.00
Resporator/Medical Review $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 Anal16.40 $16.40
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 Functi Test $38.65
Vision-Acuity
V't I i P R
Marvel.Thomas L. OnMed Program $0.00 $0.001
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.
Treadmill-Submax $179.11 $179.11
Urinal sis-Dipstick $3.53 $3,531
EK W/Interp $23.42 W38.6
Audiometry 1
PulmonaryFunction Test Vision- i
-HT WT BP P
McNair,Travis L. OnMed Prooram
I Respirator/Medical Review
Public Safety Medical - INVOICE
12 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
m Dsnyder@carmel.In.Gov(B)
Exclusively Serving Public Safety Professionals Since 9990.
Date Employee Description Amount Balance Due
Health Risk Appraisal(Motivation)
Comprehensive Physical Exam $114.77 114.77
Body Fat Test-BIA Bio-Elec Imp Anal16.40 $16.4
Treadmill-Submax 179.11 179.11
Urinalysis-Dipstick $3.53 $3.531
EK W/Interp $23.42 $23.42A
Audlometry $16,40 $16.40
PFT-Pulmonary Function Test $38.6538.
Vision-Acuity 0.4
Vital Soons-HT WT BPPR
So
00
RespiratorlMed*cal Review $1 74 118.74
AppraisalHealth Risk v
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
r' i is-Dipstick $3.53 $3.531
G W/Interp $23.42 $23.4d
Audiometry 16.401 .4
PFT-PulmonaryFunction Test 38.6
Vii -Acuity 30.45
Vital i P P R 0
$0.00
Rpsgirator/Medical Review $18.74 $18.74
Health Risk Appraisal
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 $23,4
ABiomet 16. 16.40
PFT-Pulmonary Function T 38.65
Vision-Acuity 30.4
Vital Sions-HTWTB .0
Phillips,Craig M. I OnMed Pr r m
Resoirator/medical Review $18.74 $18.7A
Public Safety Medical - INVOICE
o Public Safety Medical Invoice Date: 08/24/2017
324 E.New York Street Invoice# 00-37202
E Suite 300 Terms:
oC 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
Hemoccult
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 WI Inte 23.42 $23.42
Audlometry $16.401 .4
PFT-Pulmonary Function Test .$38.65 $38.6
Vii -Acuity $30.45 $30.4
Vit
Rutherford,Justwn 0. OnMed Proaram
Respi ator/Meducal Review S118.74 $18,
Hmfth Risk Appraisal(Motivation) $0.00 $0.0
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
Pulmonary Function Test
Vision-Acuity $30,45 $30.4
Vital Sin -HT 0.00
Smith,David M. OnMed Proaram $0.00
Respirator/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 $16.4
Treadmill-Submax 179.11 $179.11
Urinalysis-Dipstick $3.53 $3.53
EKG W1 Interp $23.42 $23.42
Audiometry $16.40 $16.4
PFT-Pulmonary Function Test
Vision--Acuity 4
PPR
Cummins.FrankC. I Onlyled Proaram 1199 $0.00
Public Safety Medical - INVOICE
Public Safety Medical Invoice Date: 0 8/2 412 01 7
324 E. New York Street Invoice# 00-31202
E Suite 300 Terms: r
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 1990.
Date Employee Description Amount Balance Due
Comorehens"ve Physical Exam $114.77 $114.7
Body Fat Test-BIA Bio-Elec Imp Anal $16.40 $16.
Treadmill-Submax $179.11
Urinalysis-Dipstick $3.53 $3.53
EKG W/Intero $23.42 $23.42
Audiometry 16.40 $16.40
PF -Pulmonary Function Test M.65 S38.
Vii -Acuity 30.45
Vital Si ns-HT WT BP P R $0.00
Freer.Keith T.
Resoqrator/Medical Review $18.74 $18.74
Health Risk AoDraisal v
Comorehensuve Physical Exam $114.77 $114.7
Bodv Fat Test-BIA Bio-Elec Imp Anal $16.40 $16.
Treadmill-Submax $179.11 $179.11
Urinalysis-Dipstick $3.53 $3.631
EKG W/Interp $23.42 23.4
Audiometry 16.40 $16.4d
PFT-Pulmonary Function Test8.6J38
Vision-Acuity .4
V' PPR
Greiner.Brandon
Resoarator/Medical Review
Health Risk Aooraisal(Motivation) $0.00
Comprehensive Physical Exam $114.77 $114.77
Bodv Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.401
Treadmill-Submax $179.11 $179.111
Urinalysis-Dipstick $3.53 $3.531
EKG W/Interp $23.42 3.4
Audiometry 16.401
6.4
PFT-PulmonaryFunction Test 38.65 38.6
Vision-Acuity.... 30.45 30.4
Vital Signs-HT WT BP R 0.00
Ray,Lucas M M d ram 0.0rn
e it for Medical Review 1 $18.74
Health Risk r '
Public Safety Medical - INVOICE
Public Safety Medical Invoice Date: 08/24/2017
324 E.New York Street Invoice# 00-31202
E Suite 300 Terms:
Indianapolis, IN 46204
G 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
Body Fat Test-BIA(Bio-Elec Imp Analy) $16.40 $16.4-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 3 $30.45
V' -HT WT BPPR $0.00 $0.00
Small Thomas D OnMed Program $0.00
Respirator/Medical R 7
Health Risk Appraisal
Comprehensive Physical Exam $114.77 $114.7
Body Fat t-BIA
Treadmill-Submax $179.11 $179.11
Urinalysis-Dipstick $3.53 .53
EKG W/Interp $23.42 $23.421
Audiametry $16.40 16.40
PFT-Pulmonary Function Test 38.65 38.6
Vision-Acuity $30.45 30.45
Vital Sions-HT WT BP P R
Sn�tLBrian E. OnMed ram
Respirator/Mediral Review $18.74 $18.74
Health Risk Appraisal(Motivation) S0,00 $0.00
Comprehensive Physical
Bodv Fat t-BI
Treadmill-Submax $179.11 $179.11
Urinalysis-Dipstick $3.53 $3.53,
EKG W/Interp $23.42 23.4
Audiometry 16.40 $16.4d
PFTPulmonary Function Test $38.65 $38.6
Vision-Acuity 30.45 $30.45
Vital Si ns-HT WT BP .00
Stindle,Kevin P OnMed Program $0.00 1 $0,00
ResviratoUlMedical $18.74
Healthr ' o ivation 0.00
Comprehensive Physical Exam $114.77 $114.77
Public Safety Medical - INVOICE
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 1 CARMEFD
f- Denise Snyder,Budget&Accred Mgr
mDsnyder@carmel.In.Gov(B)
Exclusively Serving Public Safety Professionals Since 9990.
Date Employee Description Amount Balance Due
Treadmill-Submax $179.11 $179.11
Urinalysis-Dipstick $3.53 $3.53
EKG W/Interp $23.42 $23.42
Audiornetry $16.40 $16.40
PFT-Pulmonary Function Test $38.65 $38.651
Vision-Acuity 30.45 0.4
Vital Si -HT WT BP
Jr.08/18117 Andres OnMed Pr r m $0.00
R s irator/Medi al Review 18.74 $18.
Health Risk Appraisal(Mofivatmon) $0.00 $0.001
Cornorehensive Physical 4 S114.77
Body Fat Test-BIA i _ 4
Treadmill-Submax $179.11 $179.11
Urinalysis-Dipstick $3.53 $3.53
EKG W/Interip $23.42 $23.42.
Audiornetry $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 .00
Butts.Andrew P. OnMed Pro-gram $0.00 0.00
Respirator/Medical Review $18.74 $18.74
Comprehensive Physical Exam $114.77 $114.77
Body Fat Test- A i - I .4
$179,11
Urinalysis-D'Dslick $3.53 $3.5
EKG W/Interp $23.42 $23.4
Audiornetry 16.40 $16.40
PFT-Pulmonary Function Test $38.65 $38.6
Vision-Acuity45 30.4
Vital Sions-HT WT BP P R $0.00 $0.00
Condra Kyle I-. OnMe Program $0.00 S0.001
Respirator/Medical Review $18.74 $187A
Health Risk Aporaisal(Motivation) 0.00
Comprehensive Physical 114.77 $114.77
I Body Fat Test- c Imp Analy) 1 .4
$179.1
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:
Indianapolis, IN 46204
C Carmel Fire Department 1 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
EKG W/Intero S23.42 $23.421
Audiometry 16.40 $16.40
PFT-Pulmonary Function Test $38.65 $38.6
VisionAcuity 0.45 $30.45
Vital Si ns-HT WT BP P R $0.00
.00
Daile Robert A. OnMed Program 0.00
Respirator/MedicalReview 18.74 18.7
Comprehensive Physical Exam 114.77 1
Body Fat Test-BIA Bi EI I 16.40
Treadmill- mx $179.11 $179.11
Urinalysis- tick
EKG WL Interp &23.42
Audoometry $16.40 $16.
PFT-Pulmonary Function Test $38.65 $38..
Vision-Acuity 30.45 $30.4d
Vital Signs-HT WT BP P R $0.00 so.001
Lanza Jr Theodore A. Urinalysis-Dipstick $3.53 $3.531
EKG W/Interp $23.42 23.4
Audiom t 16.4 16.4
PF -Pulmonary Function Test 5 38.
Vi 0.4
Vital PPR $0.00
B -BIA(Bio-Elec I $16.40
Treadmill-Submax $179.11 $179,11
OnMed PLQgram $0.00 $0.0
Res irator/Medical Review $18.74 $18.7
Health Risk Appraisal Motivation 0.00 $0.00
Com rehensive Physical Exam $114.77 $114.77
Malicoat Justin R. OnMed Program $0.00 $0.0Q
Respirator/Medical Review $18.74 $18.7
Health Risk Appraisal Motivation) $0.00
Comprehensive Physical Exam $114.77 $114.77
Body Fat Test-BIA Bi -EI c Imp Anal 16.40 $16.401
Treadmill-Submax $179.11
Urinalysis-Dipstick 3.5
EKG W1 Interp $23.42
Public Safety Medical - INVOICE
t°- Public Safety Medical Invoice Date: 08124/2017
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 1990.
Date Employee Description Amount Balance Due
PFT-Pulmonary Function Test
Vision-Acuity $30.45 $30.4
Vital Signs-HT WT BP P R $0.00 $0.00
Mitchell James C. OnMed Program $0.00 $0.00
Respirator/Medical Review $18.74 $18.74
Health Risk Appraisal Motivation 0.00 $0.00
om r hensive 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 k
EK 2
Audiomr,try
PFT-Pulmonary Function
Vision-Acuity 30.45 $30.4
Vital Signs-HT WT BP P R $0.00 $0.00
Mulford David A. OnMed Program $0.00 $0.00
Respirator/Medical Review $18.74 $18.74
Health Risk Appraisal Motivation 0.00 $0.00
Comprehensive Physical Exam $114.77114.77
Body Fat Test-BIA Bio-Elec Im Anal 16.40 $16..40
Treadmill-Submax $179.11 $179.11
Urinalysis-Dipstick $3.53 $3,531
EKG W/Intero $23.42S23.4j
Audiometry
PFT-Pulmonary Function
Vision-Acuity $30.45 $30.4
Vital Signs-HT WT BP P R $0.00 $0.00
Russel Grant W. OnMed Program $0.00 $0.00
R s irator/Medical Review $18.74 $18.741
Health Risk Appraisal Motivation 0.00 $0.001
Comprehensive Physical Exam $114.77 $114.77
Body Fat Test-BIA Bio-EI al 0 $16.4
Treadmill-Submax $179.11 $179.11
Urinalysis stick
KG / me 2
Public Safety Medical - INVOICE
I°- Public Safety Medical Invoice Date: 08/24/2017
324 E. New York Street Invoice# 00-31202
E Suite 300 Terms:
12 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
Vision-Acuity $30.45 $30,
Vital Si ns-HT WT BP P R $0.00 $0.00
Steurv.Kent C. OnMed Program $0.00 $0.00
Respirator/Medical Review $18.74 $18.7
Health Risk Appraisal Motivation 0.00 S0,001
Comprehensive Physical Exam $114.77 $114.77
Body Fat Test-BIA(Bio-Eler,Imo Anal 16.40 $16.
Treadmill-Submax $179.11 $179.11
Urinalysis-Di stick
EKG W/InteM $23.42 1 S23.421
Audiometry
PFT-Pulmonary Function Test $38.55 S38.65
Vision-Acuily $30.45 S30.
Vital Si ns-HT WT BP P R $0.00 $0.00
Thordarson Erik M. OnMed Program $0.00 $0.00
Respirator/Medical Review WSW9.11
18.7
Health Risk Appraisal Motivation 0.00
Com rehensive Physical Exam 114.77
B Fat Test-BIA i -Ele I Anal 16.40
Treadmill-Submax $179.11
Urinalysis- i tido $3.53
EKG W1 Intero $23.42 $23.42
Audiometry 1
PFT-Pulmonary Function Test
Vision-Acuity $30.45
Vital Signs-HT WT BP P R 0.000.00
Total Charges-> $24,155.64
Total Payments&Balance Due > $0.00 1 $24,155.64
Public Safety Medical - INVOICE
12 Public Safety Medical Invoice Date: 08/2412017
.. 324 E.New York Street Invoice# 00-31202
E Suite 300 Terms:
Indianapolis, IN 46204
o Carmel Fire Department 1 CARMEFD
Denise Snyder, Budget&Accred Mgr
mDsnyder@carmel.In.Gov(B)
Exclusively Serving Public Safety Professionals Since 9990.
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.