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HomeMy WebLinkAbout318356 11/07/2017 0>^ CITY OF CARMEL, INDIANA VENDOR: 00350364 CHECK AMOUNT: $....13,972.55*
® ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
_� CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 318356
,� INDIANAPOLIS IN 46204 CHECK DATE: 11/07/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 100336 31240 13,972.55 FIRE DEPT PHYSICALS
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Public Safety Medical - INVOICE
Io Public Safety Medical Invoice Date: 08/31/2017 +
.. 324 E. New York Street Invoice# 00-31240
E Suite 300 Terms:
W Indianapolis, IN 46204
o Carmel Fire Department/CARMEFD
1- Denise Snyder, Budget&Accred Mgr
mDsnyder@carmel.In.Gov(B)
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee Description Amount Balance Due
08/21/17 Bondurant.Jeff 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 $16.4d
Treadmill-Submax 179.11179.11
Urinalysis-Dipstick 3.53 .5
EKG W/Into 23.42 23.4
Audiometry 16.40 1 .4
PFT- ulmonary Function
Vision-Acuity 3 .4 4
Vital Signs-HT WT BP
DeLona.Michael T. OnMed Program $0.00
Respirator/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
Urinalysis-Di stilt $3.53 $3.53
EKG W/Inte 23.42 $23.42
Audiometry 16.4
Pulmonary Function Tet $38.65 $38.6
Vision-Acuity $30.45 $30.45
Vital Signs-HT WT BP
Fmst.Bruce S. OnMedr
Respirator/Medical Review $18.74 $18.7
Health Risk Appraisal Motivation .00 $0.00
Comprehensive Physical Exam $114.77 $114.771
Bodv Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4
Treadmill-Submax $179.11 $179.11
Urinalysis-Di stilt $3.53 $3.53
EKG W Inte 23.42 $23.42
Audiornetry $16.40 $16.4
PFT-Pulmonary i Test $38.65
Vision .4
Public Safety Medical - INVOICE
o Public Safety Medical Invoice Date: 08/31/2017
324 E. New York Street Invoice# 00-31240
E Suite 300 Terms:
W Indianapolis, IN 46204
C Carmel Fire Department 1 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
ator/Medical Review $18.74 $18.7
Health Risk Appraisal Motivation 0.00 $0.00
Hemoccult 0.00 0.00
Com rehensive Physical Exam 114.77 114.77
Body Fat Test-BIA Bio-Elec ImpAnal 16.40 16.
Treadmill-Submax 179.11 179.11
Urine-Bladder Cancer Screen 52.71 52.71
Urinalysis-Di stick $3.53 3.53
G /Inte S23.42
Audiometry 6.40
Function $38.65
Vision-Acuity $30.45 S30.4d
P
Hughes,Chad L. OnMed Program $0.00 $0.00
Respirator/Medical Review $18.74 $18.7
Health Risk Appraisal Motivation 0.00 $0.00
Hemoccult $0.00 .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
EKG W/Inten) 42 $23.42
Audiometry 16.40 116.40
PFT-Pulmonary Function
Vision-Acuity .4
Vital Signs-HT WT BP P R $0.00 $0.00
Reecer,Jason L. OnMed Program $0.00 $0.00
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
Body Fat Test-BIA(Bio-Elec Imp Analy) $16.40 $16.40
Treadmill-Submax 17 179.11
Urinalysis-Dipstick 3.5
EK W/Interp $23.42 $23.42
Audiometry40
FT-Pulmonary
Public Safety Medical - INVOICE
�°o Public Safety Medical Invoice Date: 08/31/2017 J
324 E. New York Street Invoice# 00-31240
E Suite 300 Terms:
W Indianapolis, IN 46204
C Carmel Fire Department I CARMEFD
H Denise Snyder, Budget&Accred Mgr
m Dsnyder@carmel.In.Gov(B)
Exclusively Serving Public Safety Professionals Since 1990.
Date Employ ee Description Amount Balance Due
Vision
Vital Signs-HT WT BP P R 0.00 0.00
Sutton Sean B. OnMed Program 0.00 .00
Res irator/Medical Review 18.74 18.74
Health Risk Appraisal Motivation 0.00 0.00
Hemoccult 0.00 0.00
Comprehensive Ph sical Exam 114.77 114.77
Body Fat Test-BIA Bio-Elec ImpAn I 16.40 16.4
Treadmill-Su max $179,11 179.11
EKG W1 Interp $23.42 $23.4j
Test
Vision-Acuity "$30.45 $30.45Vital Si ns-HT WT BP P R W ant Andrew D. OnMed Pro ram
Res irator/Medical Review $18.74 $18.74
Health Risk Appraisal Motivation 0.00 $0.00
Com rehensive Physical Exam S114.77 $114.77
Body Fat Test-BIA Bio-Elec Im Anal $16.40 16.4
Treadmill- 17 . 1 $179.11
Urinalysis-Dipstick $3.53 $3.53
EKG W/Interp $23.42 23.4
Aud*ometry $16.40 $16,
PFT-Pulmonary Function
Vision-Acuity 30.45 $30.4
Vital Signs-HT WT BP P R $0.00 .00
08/22/17 Anderson Kent W. 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 An 16.40 $16.40
Treadmill-Submax $179.11 $179.11,
Urinalysis-Di tick $3,53
EKG W InterIntero $23.42
Audio etry $16,40
PET-Pulmonary Function Test $38.65 $38-6
Public Safety Medical - INVOICE
t°- Public Safety Medical Invoice Date: 08/31/2017
324 E. New York Street Invoice# 00-31240
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 Balance Due
Vision-Acuity $30.45 4
Vital Si ns-HT WT BP P R $0.00 $0.00
Brant Kenneth E. 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
Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.4
Treadmill-Submax $179.11 $179.11
Urinal sis-Di tick $3.53
EKG ! $23.42 $23.421
Audiometry 40 $16.40
PFT-Pulmonary Function
Vision Acuity $30.45 $30.4
Vital Si ns-HT WT BP P R $0.00 $0.00
Cromlich Mark A. OnMed Program $0.00 $0.00
Respirator/Medical Review $18.74 $18.741
Health Risk Appraisal Motivation .00 $0.00
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
EKG W/Interp 2 $23.4
Audiorrietry $16.40 $16.4
PFT-Pulmona!y Function Test $38.65 $38.6
Vision-Acuity 30.45 $30.4
Vital Si ns-HT WT BP P R $0.00 $0.00
Ellison Christopher M. OnMed Pr ram $0.00 $0.00
Respirator/Medical Review $18.74 $18.7
Health Risk Appraisal Motivation 0.00 $0.00
Hemoccult $0.00 $0.00
Comprehensive Physical Exam $114.77 $114.77
Body Fat Test-BI B' - lec Imp Anal 16.40 $16.4
Treadmill-Submax $179.11
Urine-Bladder Cancer Screen
Urinalysis-Dipstick 1 $3.53 $3.53
Public Safety Medical - INVOICE
t°- Public Safety Medical Invoice Date: 08/31/2017
�. 324 E. New York Street Invoice# 00-31240
E Suite 300 Terms:
12 Indianapolis, IN 46204
C Carmel Fire Department/CARMEFD
I-- Denise Snyder, Budget&Accred Mgr
m Dsnyder@carmei.In.Gov(B)
Exclusively Serving Public Safety Professionals Since 1990.
Date Employ ee Description Amount Balance Due
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
Harrin ton Adam C. OnMed Program $0.00 $0.001
Respirator/Medical Review $18.74 $18.741
Health Risk Appraisal Motivation 0.00 $0.00
Hemoccult $0.00 $0.00
ComDrehensive Physical Exam $114.77 114.77
Body Fat Test-BIA lac Imp Anal 16.4
Treadmill-Submax $179.11 $179.11
Urinal is-Dipstick $3,53, $3.531
EKG W/Intero $23.42 4
Audiometry $16.40 LA
PFT-PulmonaryFunction Test 38.65
Vision-Acuity30.45
Vital Signs-HT WT BP P R 0.00
Keaton AnthonyR. OnMed Program 0.00
Respirator/Medical Review $18.74 $18.74
Health Risk Appraisal Motivation) $0.00 $0.00
Com rehen iv i am $114.77 $114.77
Body Fat T c Imp Anal
Treadmill Submax $179.11 $179.11
Urine-Bladder Cancer Screen $52.71 $52.71
Urinalysis-Diostock $3.53 $3.53
EKG W/Interp $23.42 $23.4
Audiometry 16.40 $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
Maners Jeremy B. OnMed Pr ram $0.00 $0.00
Respirator/Medical Review $18.74 $18.7
Health Risk Atmraisal(Motivation) 0.00 $0.00
Comprehensive Physical Exam $114.77 $114.77
t Test-BIA(Bio-Elec Imp Analy) $16.40 $16.
Treadmill- x $179-11 $179.11
Public Safety Medical - INVOICE
Public Safety Medical Invoice Date: 08/31/2017
324 E. New York Street Invoice# 00-31240
E Suite 300 Terms:
I: Indianapolis, IN 46204
o Carmel Fire Department/CARMEFD
H Denise Snyder,Budget&Accred Mgr
mDsnyder@carmel.In.Gov(B)
Exclusively Serving Public Safety Professionals Since 9990.
Date Employee Description Amount Balance Due
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
Marcum Bradley D. OnMed Pro ram $0.00 $0.00
Res irator/Medical Review $18.74 $18.74
Health Risk Aopraisal Motivation .00 $0.00
COMDrehensive Physical Exam $114.771
Body Fat Test- I (Bio-Elec Imp Anal iA$368..461
Treadmill- x
AudiometryUrinalysis-D*ostwck $3.53
EKG W/Intem
$16.40
PFT-PulmonaryFunction Test 38.65
Vision-Acuity 30.45 $30.4d
Vital Si ns-HT WT BP P R $0.00 $0.00
Os me Scott K. OnMed Pro ram $0.00 $0.00
Resvirator/Medical Review 18.74 $18.7
Health Risk Aopraisal Motivation) $0.00 $0,00
Hemoccult
Comorehensave Physical Exam $114.77
Body Fat Test-BIA i -Elec Imp An I
Treadmill-Submax $179.11 $179.11
EKG W/Interp $23.42 $23.4
Audiometry 16.40 $16.401
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
Plumer,Charles J. OnMed Program $0.00 $0.00
Res irator/Medical Review $18.74 $18.74
Health Risk Aopraisal(Motivation) 0.00 $0.001
Comorehensive Physical Exam $114.77 $114.77
Body Fat Test-BIA B' - .4
Treadmill- $179.11 $179wll
I -Di
Public Safety Medical - INVOICE
Public Safety Medical Invoice Date: 08/31/2017
324 E. New York Street Invoice# 00-31240
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
Interp S23421
Audiomet 16.40 16.4
05
PFT-Pulmona Function Test 38.65 38.6
Vision-Acui 30.45 30.4
Vital Si ns-HT WT BP P R $0.00 0.00
Reeves Neil P. OnMed Pr ram $0.00 $0.001
Respirator/Medical Review $18.74R179
Health Risk isal Motivation 0.00
Com rehensive Physical Exam 4.77
Body Fat Test-BIA Bio-EI Imp
Treadmill-S max
Quantiferon-T
Venbuncture $3.53 $3.53
Urinalysis-Dipstick $3.53 $3.53
EKG W/Interp $23.42 $23.42
Audiometry 16.40 $16.40
PFT-Pulmonary Function Test $38.65 $38.6d
Vision-Acuity 30.454$1314.77
Vital ins-HT WT BP P R 0.00
Youn Kevin M. nM Pro ram 0.0
r t is I Review .74
Health Risk Appraisal(Motivation)
ComDrehensive Physical Exam
Body Fat Test-BIA io-Elec Imp Analy) S16-40 $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 $38.65
Vision-Acuity 30.45 $30.4
Vital Si ns-HT WT BP P R $0.00 $0.00
08/23/17 Allen,Brad A. OnMed Proram $0.00 $0.00
Res irator/Medical Review 18.74 $18.74
Health Risk r i 1 0 0.
Comprehensive P 114.77
Body FtT t-BIA(B*o-Elec Imp Analy) $16.401 .4
Treadmill-Submax $179.11
Public Safety Medical - INVOICE
N
0 Public Safety Medical Invoice Date: 08/31/2017 J
324 E. New York Street Invoice# 00-31240
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
Diostick $3.53 $3.531
EKG W/Into 23.42 23.4
Audiometry 16.40 16.4
PFT-Pulmona Function Test 38.65 38.6
Vision-Acuity 30.45 30.4
Vital Signs-HT WT BP P R 0.00 .00
Anderson D.Co OnMed Program 0.00
Respirator/Medical Review 18.74 18.7
Health RiskI Motivation .00
Comprehensive $114.77
B F tT cl n
Treadmill-Submax $179.11 $179.11
i -
EKG W/Interp $23.42 $23.42
Audiometry 16.40 $16.40
PFT-Pulmonary Function Test $38.65 $38.65
Vision-Acuity 30.45 $30.4d
Vital Si ns-HT WT BP P R $0.00 $0.00
Gu el Mark E. OnMed Program $0.00 $0.00
Respirator/Medical Review $18.74 $18.74
Health Risk Aooraisal tion 0.00
CQmp-re-hensive Ph 114.77
Body Fat Test- - I c Imp Anal $16.40
Tr ill-Submax $179.11 $179.11
Urinalysis
EKG W/Interp $23.42 $23.4
Audiornetry $16A0 16.4
PFT-Pulmonary Function Test $38.65 $313.6
Vision-Acuity 30.45 $30.4
Vital Signs-HT WT BP P R 0.000.00
Haboush Davi G. OnMe Program 0. .00
Resoirator/Medical Review $18.74 $18.74
Health Rik Appraisal Motivation $0.00 $0.00
Comorehensive Physical Exam $114.77 $114.77
Body Fat Test-BIA (Bio-El Iy) $16.40 $16.4
Treadmill- x $179.11 $179.11
Public Safety Medical - INVOICE
0 Public Safety Medical Invoice Date: 08/31/2017
324 E. New York Street Invoice# 00-31240
Suite 300 Terms: "}
re 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
EKG W/Inte 23.42 23.42
Audiomet 16.40 16.4
PFT-Pulmonary Function Test 38.65 38.6
Vision-Acuity30.45 30.4
Vital Signs-HT WT BP P R 0.00 0.00
Heinlein,Rob rt A. OnMed Pr ram 0.00 $0.00
Respirator/Medical Review $18.74 18.74
Health Risk A ai al ti .0
h iv Physical S114.77 $114.77
Test-BIA Bi I $16.40
Treadmill- x $179.11 $179.11
EKG W/Interp $23.42 $23.42
Audiornetry $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 $0.001
KnottBruce A. OnMed Pr ram $0.00 $0.00
Res irator/Medical Review $18.74 $18.74
Health Riskraisal Motivation 0.00
Comprehensive h sical Exam $114.77 $114.77
Body Fat Test-BIA Bi -EI .4
Treadmill-Submax $179.11 $179.111
Urinalysis-Di f
EKG W/Interp $23.42 $23.42
Audiomet 16.40 16.4
PFT-PulmonaryFunction Test 38.65 38.65
Vision-Acuity30.45 30.4
Vital Signs-HT WT BP P R 0.00 0.00
Reppert,Ian T. OnMed Pro ram $0.00 $0.00
Resvirator/Medical Review 1 . 4
Health Risk r i I(Motivation) 0.
Com r h n i Physical 114.77
B I Bi - lec Imo Anal $16.40
Treadmill 1
Public Safety Medical - INVOICE
to Public Safety Medical Invoice Date: 08/31/2017 J
324 E. New York Street Invoice# 00-31240
E Suite 300 Terms:
w Indianapolis, IN 46204
•..
C Carmel Fire Department I 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
EKG W1 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 $0.00
Walker Christopher E. OnMed Pr ram $0.00 .00
Re 'rator/Medical Review $18.74 $18.741
Health Risk A raisal(Motivation) .0 0.00
Hemoccult $0.00
Comprehensive Physical E 114.77
Body Fat Test- IA(Bio-Elec Imp Analyl $16.40
Treadmill-Submax S179.11 $179-11
Urinalysis-Dmostick $3.53 $3.531
EKG W/Interp $23.42 23.4
Audiornetry $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
08/24/17 Gehlbach Marc A. OnMed Pro ram $0.00 $0.00
Respirator/Medical Review $18.74 $18.74
Health Rik Appraisal Motivation 0.00
CornDrehenseve Physical Exam $114.77 $114.77
Body Fat Test-BIA(Bio-Elec Imp16.40
Treadmill-Submax $179.11 $179.11
Urine-Bladder Cancer Sgreen $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 $38.651
Vision-Acuity 30.45 $30.4
Vital Signs-HT WT BP P R $0.00 $0.00
Voskuhl Mark J. OnMed Pro ram $0.00 $0.00
Res irator/Medical Review 1 . 4 $18.74
Health Risk Appraisal(Motivation) $0.00 $0.00
ComDrehensive Physical Exam7 114.77
Body Fat T Anal S15,4d
Public Safety Medical - INVOICE
Public Safety Medical Invoice Date: 08/31/2017
324 E. New York Street Invoice# 00-31240
E Suite 300 Terms:
� 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 Balance Due
alysms-Dipstick $3.53 $3.53
EKG W/Inte $23.42 23.42
Audiometry16.40 16.4
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
08/25/17 B tyles rbte H. OnMed Pro ram $0.00 $0.00
Res irator/Medical Review $18.74 $18.74
Health Risk Aooraisal(Motivation) $0.00 $0.00
Como sive Physical Exam $114.77 $114,77
Body Fat Test-BIA Bi -Et $16.
Treadmill-Submax $179.11 $179.11
EKG W/Interp $23.42 23.42
Audiometry 16.4016.40
Vision-Acuity30.45 30.45
Vital Si ns•HT WT BP P R 0.00 .00
Total Charges-> $13,972.55
Total Payments&Balance Due-> $0.001 $13,972.55
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.