333989 01/04/19 ! CITY OF CARMEL, INDIANA VENDOR: 372939
• ONE CIVIC SQUARE ASCENSION ST VINCENT PUBLIC SAFEI%4ECK AMOUNT: $"""1,121.55*
s a°: CARMEL, INDIANA 46032 6612 E 75TH STREET CHECK NUMBER: 333989
SUITE 200 CHECK DATE: 01/04/19
INDIANAPOLIS IN 46250
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 2034332 1,121.55 MEDICAL EXAM FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 372939 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
ASCENSION ST VINCENT PUBLIC SAFETY IN SUM OF$ CITY OF CARMEL
6612 E 75TH STREET An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
SUITE 200 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46250
Payee
$1,121.55
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
20-34332 43-407.01 $1,121.55 1 hereby certify that the attached invoice(s),or 1/1/19 20-34332 officer physicals $1,121.55
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
Thursday,January 3,2019
&'--" E"w
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
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Ascension St. Vincent Public Safety Medical - INVOICE
o{' Ascension St.Vincent InvoiceDate; 12/21/2018 j
w a PO4lic Safety MedicalInvoice# 20-34332 �-
6612 E.75th Str.,eet,Suite 200 Terms:
ti i.>, Indianapolis IN 46.250 t :1
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I Carmel Police Department/CARMEPD
Pyoung@carmel'.In.Gov.(W)
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Exclusively Serving Public Safety Professionals Since 9990.
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Date, -; «,c : .< Employee :. .;;s,.c __.. ; _ ., :;; !.;_`Description •_ _ . ...
; ., Amount_ ,.'Balance;Due:
12/17/18 Prlcs john-D. OnMed 0:
Res irat-or/ Medical Review $19:21 $19:21
I Health RiskAppraisai`Medikee er: $0.00 0:00
Com rehensive Ph sical,aam $117:64. 117:64
Med.O ihion;=Wellness 6.00 0.00
Med Op inion:-Res irator 0:01.0 0.00
WaistlHi` Ratio 162 3:62
'body Fat Test-=BIA Bio-Elec Im -Anal 1681 116.81
Treadmilf=Submax 183.59 $ 183.59
Fiex1bh1i ..Test ,P$72gM'
.01 $12.01,
t = PA/LAT Di ita' 72.0r' si Di stick G' llnte 4.0Audiomef . $16.81
PFT Pulmona `Function Test $44.62 $44.62
Vision-Acuity3121 31.21
Vital`Si ns-HT WT BPP R 0.00 to.601
jL12M8L18 Bay,Christo'herA. OnMed'Proram 0.00 0.00
Res rator/Medical Review sla2i 19.21
Health Risk A raisalMed'ikee er 0.00 0.00
Comprehensive Ph slcal Exam .11.7.64 117.64
Med O 'inion_:-W II s P$1183.59
.00 0.00
Med O ini 'e `ator .00 0.00
Waisd Ratio 3.6
BodyFat Test-BIA Bio-Ele ImpAn l :81 16.81
Treadmill-:S ubmax $183.59
Muscular Strength Endurance Test 31:21 $31.21
Flex ibili Test $12:01I $12.01
Chest X-Ray-PA/LAT"Di ital 72.02 72.02
Urinal sis-Di stick 3.62 $3.62
EKG'W/Interp $24.oi $24.01
Audiometry 16.81 $16.81
PFT-Pulmonary Function Test $44.62 44.62
'Vision-Acuity $31.21 1 31:21
Vital Signs-HT WT BP P R $0.00 0.00