HomeMy WebLinkAbout320538 01/11/18 CITY OF CARMEL, INDIANA VENDOR: 365641
!@ i! ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $********75.92*
CARMEL, INDIANA 46032 ATT:HIM DEPARTMENT CHECK NUMBER: 320538
9'�+i�TON-�o•a 2001 W 86TH STREET CHECK DATE: 01/11/18
INDIANAPOLIS IN 46260
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4358200 75.92 SPECIAL INVESTIGATION
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 365641 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
ST VINCENT HOSPITAL IN SUM OF$ CITY OF CARMEL
ATT: HIM DEPARTMENT An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
2001 W 86TH STREET rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46260
Payee
$75.92
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Carmel Police Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
0 43-582.00 $75.92 1 hereby certify that the attached invoice(s),or 1/3/18 0 medical records $75.92
1110 101 1110 101
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday,January 8,2018
Jim Barlow
Chief
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
,20—
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Submit]
%FStNilncent I AICENSION
Patient Details:
Release of Information Invoice Patient Name: KEVIN RICHARDSON
MPI: 210226550
Bill To: Facility: St Vincent Hospital
Recipient Name: Judge of the Hamilton Superior Court 6
Address Lina!: 2nd Floor,Hamilton Judicial Center Request Type: AC-Certified Attorney
Address Line2: - Statement Date:
20 December 2017 8:50 AM
CRY: Noblesville State: IN Postal0p Code: 4606o Country:
DOCUMENT SUMMARY Number of Pages: 146 A member of
Document Type j:g ®L Documents Pages Number of Documents: 4
LAB REPORT @*�® 4 146 &SCENSION
HDA�TM
OEC 2 LC�� Payment Type:
Payment Date:
�-00"E Payment Amount: Cole Values
t,Iwi+�Y�10" We are called to:
Total Amount: $83.75 Service of the
Poor Generosity
Certification Fee: Of spirit,
Postage Fee: $B,77 especially for
Rush Fee: persons
° most in need.
Labor Fee:
Reverence
Supplies Fee: Respect and
Discount: $14.60 compassion for
Pre-Payment: the dignity and
diversity of life.
Amount Owing:. $75.92
Integrity
Please include a copy of this Inspiring trust
through personal
invoice with your payment. leadership.
Submit Wisdom
Integrating
excellence and
STV stewardship.
St Vincent Hospital CERTIFIED Requested Medical Records will be Creativity
HIM Department mailed upon receipt of payment Courageous
2001 W 86th Street innovation.
Indianapolis,IN 46260 Dedication
Phone 317-338-2216 Affirming the
Fax 317-338-9559 hope and joy
Tax ID 35-0869066 of our '
29D09-1710-MC-007999 ministry,
DOC
Document Filed
Staff Name: Stephanie 1767999 I l I
Staff Title: IIIIIIII�IIII�lllllflll�ll��l�� I
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