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316268 9/26/2017
��'''� CITY OF CARMEL, INDIANA VENDOR: 00350364 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $*"*****541.87' 4 ?�; CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 316268 v INDIANAPOLIS IN 46204 CHECK DATE: 09/26/17 -M�roH c� DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 100336 31302 541.87 FIRE DEPT PHYSICALS nz / -0 < < S o q O O_ .C,N) O co i § § 2 z 2 > m o 0 Jcr) ® > $ / % I 00 > o { OE « m S 2 k k q E O / / § n 0 2 f k ■ # @ -n 7 q ® c_ 0 2 2 c 6 -i / 2 \ k � � 0 _0C) < m f © > m T. ® 2 � § z 2 E - O < _ (P CD 0 0 | \ d k $ ) i 2 LT - z r, z k & 4 / / k § i g ƒ 0 m @ ° ] e ƒ ( E f O ® 2 I \ ƒ CL ( \ CL CD - ± \ ƒ 3 ! \ G \ k / \ o k k ° FL , I / % 7 E \E CL < , \ 0) ; ( ® & CD a � / , f - f = � J K E , & j m § E E CL \ \ \ CY m E 3 PLm \ D \ � ) § / � / � 2 a G2 z - ƒCD / q ƒ \ L C o ) / _ (D3 C) Z n A 3 § / k k k } | 0_ e� ® }f CD D §_\ > co �E 2 § w m / - M \ $ 0 \ j E \ r O CD E + . Z CD ) \ E$ C 0 CA § m / / \OL M \ CL / § CD / ) } § / § & _ 2 ƒ / \ » \ 0 2 -4 § . Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 09/08/2017 r 324 E. New York Street Invoice# 00-31302 E Suite 300 Terms: tY 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 08/28117 Payne,Thomas 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 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 Vision-Acuity .45 $30.45 Vital Sians-HT WT BP P R T I Venwpuncture $3.53 $3.53 Livid Panel Blood 23.82 $23.82 CBC(Comp Blood Count 20.29 20.2 CMP(Comp Metabolic Panel 22.41 22.41 PSA-Prostate S ecific A Blood 0.99 0.9 Total Charges->1 $541.87 Total Payments&Balance Due->1 $0.00 1 $541.87 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.