HomeMy WebLinkAbout327239 07/10/18 CITY OF CARMEL, INDIANA VENDOR: 00350364
E, ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $*****2,233.39*
r ?�; CARMEL, INDIANA 46032 6612 E.75TH STREET CHECK NUMBER: 327239
;�roN SUITE 200 CHECK DATE: 07/10/18
INDIANAPOLIS IN 46250
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 100944 00-33153 576.38 OFFICER PHYSICALS
1110 4340701 100944 00-33154 1,657.01 OFFICER PHYSICALS
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 00350364 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PUBLIC SAFETY MEDICAL SERVICES IN SUM OF$ 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
$2,233.39
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
100944 00-33154 43-407.01 $1,657.01 1 hereby certify that the attached invoice(s),or 6/27/18 00-33154 officer physicals $1,657.01
1110 101 1110 101
100944 00-33153 43-407.01 $576.38 bill(s)is(are)true and correct and that the 6/27/18 00-33153 officer physicals $576.38
1110 101 materials or services itemized thereon for 1110 1 101
which charge is made were ordered and
received except
Thursday,June 28,2018
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
120
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Public Safety Medical - INVOICE
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N b ; Public Safety Medical Invoke Date: 06/27/2018
M6612 E.75th Street Invoice# 00.33153
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Indianapolis,IN 46250
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Pyoung@carmel.In.Gov (W)
Exclusively Serving Public Safety Professionals Since 1990.
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06119118 Frgg DMght D. QnMed Proaram
Res 'rator/Medical Review $19.21 $19.21
Health Risk Appraisal Medikee er 0.00 $0.00
Comprehensive Physical Exam $117.64 $117.64
Med O ini -Wellness $0.00 $0.00
Med O inion-Respirator $0.0D $0.00
Waist/Ho Ratio 62 $3.62
Body Fat Test-B A Bio-Elec ho Ana .81 16.81
Tread III-Submax 183.5 1
lar-Strencah Endurance'[wd $31.21Endurance'[ 121.21
ReAbilily Test 112.01 $12.01,
Chest X- - T Di ' 2
UrInalvels-Dipstick 2 $3.621
EKG W/Interp $24.01 $24.01
Audlomet 16.81 $16.81
PFT-Pulmonary Function Test S44.62 $44.62
Vision-Acuity 31.21 31.21
Vital signs-HT WT BP P R 90.00 0.00
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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 317-9642364.
Public Safety Medical - INVOICE ,
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Public Safety Medical Invoice Date: 0612712018
�%_p' ;z 6612 E.75th Street Invoice# 00-33154
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Indianapolis,IN 46250
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' Pyoung@carmel.ln.Gov (IIV)
Exclusively Serving Public Safety Professionals Since 1994.
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18 Se John Indiana PERF Exam 1218.4 218.
46
Med Op inion-Post Offer-PERF $0.00 $0.00
Chart Revl6w/Completion $97.22 $97.22
Respirator Clearance-SS $26.65 $26.66
Chest -Ra -PA/LAT Dl ftal 2.02 $72.02
Applicant Blood Pariel-PERF 137.82 $137.82
Venlouncture $3.623.62
uantifemn- load $60.01 $60.01
Drua Screen 9 +opiates&Oxygodone $48.02 $48.02
Vital Sin -HT WT BPP 0.00 0.0
Vision-Acuity 1.21 31.21
Vision- or Ishlh r
PFT- ulmon o Test $44.62
Audiome $16.81 $16.81
EKG W/Interp $24.01 $24.01
Urinalysis-Di tick 3.62 .62
Tonome Glaucoma Te 3.21 43.21
06/2268 Commodore D 'd A. ADD11cant Blood Panel-PERF $137.82 $137.82
Ve uncture $3.62 $3.62
Drua Screen +O iates&Oxycodone U8.02 448.02
Th Review- Hx P e Questionnaire 0
Indiana PERF Exam $218.46 218.
Med OrArilon-Post 011e -PERF-
Chart letio
Respirator Clearanoe-N_ $26.65 $26.6
Vital Si ns-HT WT BP P R $0.00 $0.00
Vlslon-Acuity 1.21 $31.21
Vision-Color Ishihara 1.21 1.21
PFT-PulmonaryFunction Test .62 .6
Audlomet 16.81 16.81
EKG Inte 24.0 24.01
is-D' 2
Tonometry(Glaucoma Test .21 .21
Chest X-Ray-P DI I 72. 72.0
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