HomeMy WebLinkAbout321215 01/25/2018 CITY OF CARMEL, INDIANA VENDOR: 00350364
4
'.� d =!• ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $**'*12,943.92*
a� CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 321215
INDIANAPOLIS IN 46204 CHECK DATE: 01/26/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 R4340701 100018 00-32121 2,682.25 OFFICER PHYSICALS
1110 4340701 100944 00-32121 156.56 OFFICER PHYSICALS
1120 4340701 32120 91.64 MEDICAL EXAM FEES
1120 4340701 332067 10,013.47 MEDICAL EXAM FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 00350364
PUBLIC SAFETY MEDICAL SERVICES IN SUM OF$ CITY OF CARMEL
324 E NEW YORK ST SUITE 300 An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46204
Payee
$2,682.25
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
EPT INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
100018 00-32121 43-407.01 $2,682.25 1 hereby certify that the attached invoice(s),or 1/19/18 00-32121 officer physicals $2,682.25
1110 %) .idJc .-• 101 1110 101
—— bill(s)is(are)true and correct and that the
materials or services itemized thereon for
e
which charge is made were ordered and
received except
L ren-
M �
Tuesday,January 23,2018
Jim Barlow
Chief
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
,20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts city Form No.201(Rev.1995)
Vendor# 00350364 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PUBLIC SAFETY MEDICAL SERVICES IN SUM OF$ CITY OF CARMEL
324 E NEW YORK ST SUITE 300 An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46204
Payee
$156.56
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police. Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
�D INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
100944 00-32121 43-407.01 $156.56 1 hereby certify that the attached invoice(s),or 1/19/18 00-32121 officer physicals $156.56
1110 101 1110 101
bill(s)is(are)true and correct and that the
�Z— P�/�C v�f12�✓� materials or services itemized thereon for
which charge is made were ordered and
f received except
\ v v
Tuesday,January 23,2018
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
Public Safety Medical - INVOICE
o { Public Safety Medical Invoice Date: 01/18/2018 +
! 324 E. New York Street Invoice# 00-32121
1► E Suite 300 Terms:
r Indianapolis, IN 46204
c j Carmel Police Department/CARMEPD
( m i Pyoung@carmel.In.Gov (W)
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee Description Amount Balance Due
01/08/18 B rlow James C. Administrative Fee Blood-Your Site 174.00 $174.00
Driver Charles E. HIV-4th Gen Rapid Test Blood $26.58 $26.58
Venipuncture $3.62 $3.62
Lipid Panel Blood 24.42 $24.42
CBC(Comp Blood Count 20.80 $20.80
CMP(Comp Metabolic Panel 22.97 22.97
PSA-Prostate Specific A Blood 42.01 42.01
Keinsle Matthew J. HIV-4th Gen Rapid Test Blood 26.58 26.58
Venipuncture 3.62 3.62
PHIV-
anel Blood 24.42 24.42
om Blood Count 20.80 20.80
om Metabolic Panel 22.97 22.97
Loveall Gre o A. th Gen Ra id Tes Blood 26.58 26.5ncture $3.62 $3.62
Lipid Panel Blood 24.42 $24.42
CBC(Comp Blood Count 20.80 $20.80
CMP(Comp Metabolic Panel 22.97 $22.97
Moore Scott L. HIV-4th Gen Rapid Test Blood 26.58 $26.58
Venipuncture $3.62 $3.621
Lipid Panel Blood 24.42 $24.42
CBC(Comp Blood Count 20.80 $20.80
CMP(Comp Metabolic Panel 22.97 $22.97
PSA-Prostate S ecific A Blood 42.01 $42.01
Strona.David C. HIV-4th Gen Ra id Test Blood 26.58 $26.58
Veni uncture q$24.42
.62 $3.62
Lipid Panel Blood $24.42
CBC Com Blood Count 0.80 20.80
CMP Com Metabolic Panel 2.97 22.9PSA-Prostate S ecific A Blood 2.01 $42.01
01/09/18 Collins Shane P. HIV-4th Gen Rapid Test Blood 26.58 $26.58
Venipuncture $3.62 $3.62
Lipid Panel Blood 24.42 $24.42
CBC(Comp Blood Count 20.80 $20.80
CMP Com Metabolic Panel 22.97 $22.9
PSA-Prostate Specific A Blood 42.01 42.01
Chest X-Ray-PA/LAT Di ital 72.02 $72.02
CollinsJr.Willie h D'
Public Safety Medical - INVOICE
o Public Safety Medical Invoice Date: 01/18/2018
324 E. New York Street
Invoice# 00-32121
j Suite 300 Terms: -`
Indianapolis, IN 46204
o Carmel Police Department/CARMEPD
� F
m ' Pyoung@carmel.in.Gov (W)
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee Description Amount.' -Balance Due
HIV-4th Gen Ra id Test Blood 26.58 $26.58
Venipuncture $3.62 $3.62
Li id Panel Blood 24.42 $24.42
CBC(Comp Blood Count 20.80 $20.80
CMP(Comp Metabolic Panel 22.97 $22.97
PSA-Prostate Specific A Blood 42.01 $42.01
Fisher Charles B. Chest X-Ray-PA/LAT(Digital) 72.02 $72.02
HIV-4th Gen Rapid Test Blood 26.58 $26.58
Veni uncture $3.62 $3.62
Li id Panel Blood 24.42 $24.42
CBC Com Blood Count 20.80 $20.80
CMP(Comp Metabolic Panel 22.97 $22.97
Hill Nathaniel W. Chest X-Ray-PA/LAT Di ital 72.02 $72.02
HIV-4th Gen Rapid Test Blood $26.58 $26.58
Venipuncture $3.62 $3.62
Lipid Panel Blood 24.42 24.42
CBC(Comp Blood Count 20.80 $20.80
CMP(Comp Metabolic Panel 22.97 $22.971
Theis Adam G. Chest X-Ray-PA/LAT(Digital) 72.02 $72.02
HIV-4th Gen Rapid Test Blood 26.58 $26.58
Veni uncture $3.62 $3.62
Lipid Panel Blood 24.42 $24.42
CBC(Comp Blood Count 20.80 $20.80
CMP Com Metabolic Panel 22.97 $22.97
Valentine Patrick L. Chest X-Ray-PA/LAT(Digital) $72.02 $72.02
HIV-4th Gen Rapid Test Blood $26.58 $26.58
Venipuncture $3.62 $3.62
Li id Panel Blood 24.42 $24.42
CBC(Comp Blood Count 20.80 $20.80
CMP(Comp Metabolic Panel 22.97 $22.97
01/10/18 Robbins Todd E. Chest X-Ray-PA/LAT(Digital) 72.02 $72.02
Venipuncture $3.62 $3.62
Livid Panel Blood 24.42 $24.42
CBC Com Blood Count 20.80 $20.801
CMP(Como Metabolic Panel 22.97 $22.97
PSA-Prostate S ecific A Blood 42.01 $42.01
Troyer. do M CheatL (Digit 72 nq 2
Public Safety Medical - INVOICE
o ' Public Safety Medical Invoice Date: 01/18/2018 +
i 324 E. New York Street Invoice# 00-32121
E: Suite 300 Terms:
m �
Indianapolis, IN 46204
Carmel Police Department/CARMEPD
l.1 i
@ t Pyoung@carmel.In.Gov (W)
Exclusively Serving Public Safety Professionals Since 9990.
Date Employee Description Amount Balance Due
HIV-4th Gen Ra id Test Blood 26.58 $26.58
Venipuncture $3.62 $3.62
Lipid Panel Blood 24.42 $24.42
CBC(Comp Blood Count 20.80 $20.80
CMP(Como Metabolic Panel 22.97 $22.97
PSA-Prostate Specific A Blood 42.01 $42.01
White II Robert E. HIV-4th Gen Rapid Test Blood 26.58 $26.58
Venipuncture $3.62 $3.62
Li id Panel Blood 24.42 $24.42
CBC(Comp Blood Count 20.80 $20.80
CMP Com Metabolic Panel 22.97 $22.9
PSA-Prostate S ecific A Blood 42.0 $42.01
Chest X-Ray-PA/LAT Di ital 72.02 $72.02
Wiegman,Chad R. Venipuncture $3.62 $3.62
Lipid Panel Blood 24.42 1 $24.42
CBC(Comp Blood Count 20.80 $20.80
CMP(Comp Metabolic Panel 22.97 $22.97
PSA-Prostate Specific A Blood 42.01 $42.01
Chest X-Ray-PA/LAT(Digital) 72.02 $72.02
Williams Ashlev L. Chest X-Ray-PA/LAT(Digital) 72.02 $72.02
Venipuncture $3.62 $3.62
Li id Panel Blood 24.42 $24.42
CBC(Como Blood Count 20.80 $20.80
CMP(Comp Metabolic Panel 22.97 $22.9A
Total Char es->` $2,838.81_
Total Payments&Balance Due-> .$6.00 $2,838.81
�s' to
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
Vendor# 00350364 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PUBLIC SAFETY MEDICAL SERVICES IN SUM OF$ CITY OF CARMEL
324 E NEW YORK ST SUITE 300 An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46204
Payee
$10,105.11
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire 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
32120 43-407.01 $91.64 1 hereby certify that the attached invoice(s),or 1122/18 32120 $91.64
1120 101 1120 101
332067 43-407.01 $10,013.47 bill(s)is(are)true and correct and that the 1/22/18 332067 $10,013.47
1120 1 1 101 1 materials or services itemized thereon for 1120 1 101
which charge is made were ordered and
received except
Monday,January 22,2018
David Haboush
Fire 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
120—
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Public Safety Medical - INVOICE
i°- Public Safety Medical Invoice Date: 01/11/2018
324 E. New York Street Invoice# 00-32067
E Suite 300 Terms:
Indianapolis, IN 46204
.6
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
01/d2118. Taylor.Mark J. s ira or Clearance- $26.65 $26.6
Chart Review/Completion $97.22 $97.22
Indiana PERF Exam $218.46 $218.46
PSY-Applicant Psych Eval $407.22 $407.22
Drug Screen 9 +Opiates&Oxycodone $48.02 $48.02
Venipuncture $3.62 $3.62
Applicant Blood Panel-PERF $137.82 $137.82
uantiferon-Tb Blood 60.01 $60.01
Tonometry Glaucoma Test 43.21 $43.21
Urinal sis-Dipstick 3.62 $3.62
EKG W/Interp $24.01 $24.01
Audiometry 16. 1 $16.81
PFT- m n Function T s 3 .62 $39.62
Vision-Color Ishihara $31.21 1 $31.21
Vision-Acuity 31.21 $31.21
Vital Signs-HT WT BP P R $0.00 $0.00
Chest X-Ray-PA/LAT(Digital) 72.02 $72.02
01/03/18 Murphy.Johnny J. Res irator Clearance-SS $26.65 $26.65
Chart Review/Completion $97.22 $97.22
Indiana PERF Exam $218.46 $218.46
PSY-Apiplicant Psych Eval $407.22 $407.22
Drua Screen 9 +O iates&Oxycodone $48.02 $48.02
Tonometry Glaucoma Test 43.21 $43.21
Urinalysis-Di i k $3.62 $3.62
EKG W/Interp $24.01 $24.01
Audiometry $16.81 $16.81
PFT-Pulmonary Function Test $39.62 $39.62
Vision-Color Ishihara 31.21 $31.21
Vision-Acuity 31.21 $31.21
Vital Sims-HT WT BP P R $0.00 $0.00
Venipuncture $3.62 $3.62
Aimlicant Blood Panel-PERF $137.82 $1137.821
uantiferon-Tb Blood 60.01 $60.01
Chest X-Ray-PA/LAT(Digital) 71.67 $71.67
01/04/18 Crane Jordan L. Res irator Clearance-SS $26.65 $26.65
Chart Review/Comoletion $97.22 $97.22
Public Safety Medical - INVOICE
o Public Safety Medical Invoice Date: 01/11/2018
H 324 E. New York Street
Invoice# 00-32067
E Suite 300 Terms:
Indianapolis,IN 46204
o Carmel Fire Department/CARMEFD
�- Denise Snyder, Budget&Accred Mgr
m Dsnyder@carmel.ln.Gov(B)
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee Description Amount Balance Due
PS -6pplicant Psych Eval $407.22 $407.22
Drug Screen 9 +Opiates&Oxycodone $48.02 $48.02
Venipuncture $3.62 $3.62
Applicant Blood Panel-PERF $137.82 $137.82
Quantiferon-Tb Blood 60.01 $60.01
Tonomet Glaucoma Test 3.21 $43.21
Urinalysis-Dipstick $3.62 $3.62
EKG W/Interp $24.01 $24.01
Audiornetry $16.81 116.81
PFT-Pulmonary Function Test $39.62 $39.62
Vision-Color Ishihara 31.21 $31.21
Vision-Ai 121 $31.21
Vital Sis-HT WTBPPR $O.OQ $0.00
Chest X-Ray-PA/LAT(Digital) .$72.02 $72.02
Knox Justin Respirator Clearance-SS $26.65 $26.65
Chart Review/Completion $97.22 $97.22
Indiana PERF Exam 218.46 $218.46
PSY-Applicant Psych Eva[ $407.22 $407.22
Drug Screen 9 +O iates&Oxycodone $48.02 $48.02
Veni uncture $3.62 $3.62
Applicant Blood Panel-PERF $137.82 $137.82
uantiferon-Tb Blood 60.01 $60.01
Tonomet Glaucoma Test 3.21 $43.21
Urinalvsis-Di s i k $3.62 $3.62
EKG /In 24. 1 $24.01
Audiornetry $16.81 $16.81
PFT-Pulmonary Function Test $39.62 $39.62
Vision-Color Ishihara 31.21 $31.21
Vision-Acuity 31.21 $31.21
Vital Signs-HT WT BP P R $0.00 $0.00
Robinson Brock G. Respirator Clearance-SS $26.65 $26.65
Chart Review/Com letion $97.22 $97.22
Indiana PERF Exam $218.46 $218.46
PSY-A licant Psych Eval $407.22 $407.22
Drua Screen 9 +O iates&Oxycodone $48.02 $48.02
Ve i u ure $3,62 . 2
Public Safety Medical - INVOICE
o Public Safety Medical Invoice Date: 01/11/2018
324 E. New York Street
Invoice# 00-32067
B Suite 300 Terms:
Indianapolis, IN 46204 P
.4
C Carmel Fire Department/CARMEFD
II- Denise Snyder, Budget&Accred Mgr
m Dsnyder@carmel.In.Gov(B)
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee Description Amount Balance Due
B 1
Tonomet Glaucoma Test $43.21 $43.21
Urinalysis-Dipstick $3.62 $3.62
EKG W/Interp $24.01 $24.01
Audiometry 16.81 $16.81
PFT-Pulmonary Function Test $39.62 $39.62
Vision-Color Ishihara 31.21 $31.21
Vision-Acuity 31.21 $31.21
Vital Si ns-HT WT BP P R $0.00 $0.00
Chest X-Ray-PA/LAT(Digital) 72.02 $72.02
Schne Brent A. Res irator Clearance-SS $26.65 $26.65
Chart Review/Comoletion $97.22 $97.22
Indiana PERF Exam $218.46 $218.4
PSY-Applicant Psych Eval $407.22 $407.22
Drug Screen 9 +Opiates&Oxycodone $48.02 $48.02
Tonometry Glaucoma Test 43.21 3.21
Urinalysis-Dipstick $3.62 $3.62
EKG W/Interp $24.01 $24.011
Audiometry 16.81 $16.81
PFT-Pulmonary Function Test $39.62 $39.62
Vision-Color Ishihara 31.21 $31.21
Vision-Acuity 31.21 $31.21
Vital Si ns-HT WT BP P R $0.00, $0.00
Venipun ure $3.62 $3.62
Awlicant Blood Panel-PE F $137.82 $137.82
Quantiferon-Tb Blood $60.01 $60.01
Chest X-Ra -PA/LAT(Digital) 72.02 $72.02
Zellers Andrew L. Respirator Clearance-SS $26.65 $26.65
Chart Review/Completion $97.22 $97.22
Indiana PERF Exam $218.46 $218.46
PSY-Applicant Psych Eval $407.22 $407.22
Drug Screen 9 +Opiates&Oxycodone $48.02 $48.02
Veni uncture $3.62 $3.62
A licant Blood Panel-PERF 137.82 137.82
uantiferon-Tb Blood 60.01 60.01
Tonometry(Glaucoma Test) 4 .21
Public Safety Medical - INVOICE
o Public Safety Medical Invoice Date: 01/11/2018
324 E. New York Street Invoice# 00-32067
E Suite 300 Terms:
X Indianapolis, IN 46204
c Carmel Fire Department/CARMEFD
10 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 /Intea2 $24.01 $24.01
Audiornetry $16.81 $16.81
PFT-Pulmonary Function Test $39.62 $39.62
Vision-Color Ishihara 31.21 $31.21
Vision-Acuity 31.21 $31.211
Vital Signs-HT WT BP P R $0.00 $0.00
Chest X-Ray-PA/LAT(Digital) 72.02 $72.02
01/05/18 Southerland Josh D. Respirator Clearance-SS $26.65 $26.65
Chart Review/Completion $97.22 $97.22
Indiana PERF Exam $218.46 $218.46
PSY-A licant Psych Eval $407.22 S407.22
Drug en +Opiates&QUcodone $48.02 $48.02
Venbuncture $3,62 $3.62
Applicant Blood Panel-PERF $137.82 $137.82
Quantiferon-Tb Blood 60.01 $60.01
Tonomet Glaucoma Test 43.21 $43.21
Urinalysis-Dipstick $3.62 $3.62
EKG W/Interp $24.01 $24.01
Audiornetry $16.81 $16.81
PFT-Pulmonary Function Test $39.62 $39.621
Vision-Color Ishihara 31.21 $31.21
Vision-Acuity 31.21 $31.21
Vital Signs-HT WT BP P R $0.00 $0.00
Chest -Ra -PA/LAT(Digital) $72.02 $72.02
Total Charges-> $10,013.47
Total Payments&Balance Due-> $0.001 $10,013.47
Public Safety Medical - INVOICE
o Public Safety Medical Invoice Date: 01/18/2018
324 E. New York Street Invoice# 00-32120
'E Suite 300 Terms:
W Indianapolis, IN 46204
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
aylor. Mark I Med Odnion-Post Offer-PERF $0.00 $0.00
01/09/18 Murphy,Johnny J. Med Opinion-Post Offer-PERF $0.00 $0.00
01/10/18 chnepp,Brent A. Repeat GGT Blood 52.71 $52.71
Repeat Hepatic-LFT's Blood 35.31 35.31
venipuncture $3.62 $3.621
Total Charges-> $91.64
Total Payments&Balance Due=> $0.00 $91.64
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.