334143 01/04/19 CITY OF CARMEL, INDIANA VENDOR: 00350364
® ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: S*****7,972.31
CARMEL, INDIANA 46032 6612 E.75TH STREET CHECK NUMBER: 334143 TON SUITE 200 CHECK DATE: 01/04/19
INDIANAPOLIS IN 46250
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 20-34290 450.30 MEDICAL EXAM FEES
1120 4340701 20-34331 7,522.01 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 OFCARMEL
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
$7,972.31
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
20-34290 43-407.01 $450.30 1 hereby certify that the attached invoice(s),or 12/18/18 20-34290 Haus Physical-2018 $450.30
1120 101 Prior Year 1120 101
20-34331 43-407.01 $7,522.01 bill(s)is(are)true and correct and that the 12/21/18 20-34331 Recruit Physicals $7,522.01
1120 1 101 1 Prior Year materials or services itemized thereon for 1120 101
which charge is made were ordered and
received except
Thursday, January 3,2019
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
20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Ascension St. Vincent Public Safety Medical - INVOICE
t°- Ascension St.,Vincent Invoice Date: 12/18/2018
Public Safety Medical Invoice# 20-34290
E. 6612 E.75th Street,Suite.200 Terms:
.Indianapolis IN 46250
o Carmel Fire Department_ 1 CARMEFD
F- Denise.Snyder, Budget B.Accred Mgr
;m Dsnyder@carmel.in.Gov(B)
Exclusively Serving Public Safety Professionals Since 9990.
Date Employee Description Amount Balance Due
12LV/18 u J shua S. e e ivo Physiggi .0 1 0
Respirator/Medical Review $19.11: $19.11
OnMed Program $0.00 $0.00
Health Risk Appraisal Medikee er 0.00 $0.00_
Med 0 inion-Wellness $0.00 $0.00
.Med O inion-Respirator $0.00 $0.00
Med O inion-Hazmat $0.00 $0.00
Treadmill-Submax $182.69 $182.69
Bodv Fat Test-BIA Bio-Elec Imo Anal 16.73 $16.73
Vital Si ns-HT WT BP P R $0.00 $0.00
Vision-Acuity $31.06 $31.06
PFT-Pulmonary cron Test $39.42 $39.42
Audiometry $16.73 $16.73
EKG W/Interp $23.89 $23.89
Urinalysis-Dipstick $3.60
Total Charges->1 $450.30
Total Payments&Balance Due->1 $0.00-1 $450.30
Please-make-check payable to"Ascension St.Vincent Public_Safety-Medical"and write invoice number on payment
check. Our Federaf Employer identification number is 46-1227327.
We greatly appreciate the opportunity to serve you. If you have any questions regarding this invoice, please contact
Michelle McClure at 317-964-2364.
Ascension St. Vincent Public Safety Medical - INVOICE
o. Ascension St.Vincent Invoice Date: 12121/2018 g
�. Public Safety.Medical Invoice# 20.34331
E 6612 E.75th Street,Suite 200
Terms:
IY Indianapolis IN 46250
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
12/18/18 Bo d Carl A ed Opinion-Pgst Offer-PERF $0.00 $0.00
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
-Drun Screen 9 +Opiates&Oxycodone 48:02 $48.02
Venipuncture $3.62 $3.62
Applicant Blood Panel-PERF $137.82 $137.82
uantifer n-Tb Blood 60.01 $60.01
Chest -Ra -PAILAT Digital $72.02 $72.02
Tonometry(Glaucoma Test) $43.21 $43.21
Urinalysis-Dipstick 3.62 $3.62
EKG Intern $24.01
Audiometry $16.81 $16.81
PFT-Pulmonary Function Test $44.62 $44.62
Vision-Color Ishihara $31.21 $31.21
Vision-Acuity 31.21 $31.21
Vital Signs-HT WT BP P.R $0.00 $0.00
Christopher,David J. Med Opinion-Post Offer-PERF $0.00 0.00
Respirator Clearance-SS 26.65 $26.651
Chart Review/Completion $97.22 $97.22
Indiana PERF Exam $218.46 $218.46
PSY-Applicant Psych Eva 407.22 $407.22
DM Screen 9 +Opiates&Oxygodone $48.02 $48.0
Venipuncture $3.62 $3.62
Applicant Blood Panel-PERF $137.82 $137.82
Quantiferon-Tb Blood $60.01 $50.01
Chest X-Ray-PA/LAT Di ital 72.02 72.02
TonometryGlaucoma Test 43.21 $43.21
Urinal sis-Di stick $3.62 $3.62
EKG W/Inte4$24.01 24.01
Audiomet 81 16.81
PFT-Pulmona Function Test .62 44.62
Vision-Color Ishihara .21 31.21
Vision-Acui .21 $31.211
Vital Signs-HT WT BP P 0.00 0 00
E-Qqert.Kevin T. Med Opinion-Post Offer-PERF 0.00 Tn.
Ascension St. Vincent Public Safety Medical - INVOICE
o. Ascension St.Vincent Invoice Date: 12/21/2018 '
Public Safety Medical Invoice# 20-34331
�E 6612 E.75th Street,-Suite 200 Terms: "7 .
j2 Indianapolis IN 46250
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
Respirgtor Qlearance-SS $26.65 $26.6
Chart Review/Completion $97.22 $97.2
Indiana PERF Exam $218.46 $218.46
PSY-A plicant Psych Eval $407.22 $407.22
Druq Screen 9 +Opiates&Oxycodone $48.02 $48.02
Tonometry Glaucoma Test 43.21 $43.21
Urinalysis-Dipstick $3.62
EKG'W/Intero $24.01 $24.01
Audiometry 16.81 $16.81
PFT-Pulmonacy Function Test $44.62 $44.62
Vision-Color Ishihara 31.21 $31.21
Vision-Acuity $31.21 $31.21
Vital Si ns-HT WT BPP R $0.00 $0.00
Veni Duncture $3.62 $3.62
Applicant-Blood Panel-PERF $137.82 $137.82
Quantiferon-Tb Blood 60.01 $60.01
Gillespie,David C. Med O inion-Post Offer-PERF $0.00 0.00
Respirator Clearance-SS $26.65 $26.65
Chart Review/Completion $97.22 $97.22
Indiana PERF Exam M37.82
218.46
PSY-Applicant Psych Eval 07.22
DrugScreen 9 +O ' es&Oxycodone 48.02
Veni n r 3.62
Applicant Blood Panel-PERF 7. 2
ua t'ero - Blood $60.01
Chest X-Ray-PA/LAT(Digital) $72.02 $72.02
Tonometry Glaucoma Test $43.21 $43.21
Urinal sis-Di stick $3.62 $3.52
EKG W/Interp $24.01 $24.01
Audiomet 16.81 $16.81
PFT-Pulmonary Function Test 944.62 44.62
Vision-Color I hih 31.21 $31.21
Vision-Acuity 31.21 $31.21
Vital Signs-HT WT BP P R $0.00 0.00
12/19/18 Locke Garrett V. Med Opinion-Post Offer-PERF $0.00 O.DO
Resr)irator Clearance-SS $26,65 26 65
Chart Review/Completion $97.229 .22
Ascension St. Vincent Public Safety Medical - INVOICE
o Ascension St.Vincent Invoice Date: 12/21/2018
.~_. Public Safety Medical Invoice# 20-34331
E 6612 E.75th Street-,Suite 200 Terms:
Indianapolis IN 46250
o 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
India a 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
Aoolicant Blood Panel-PERF $137.82 137.82
Quantiferon-Tb Blood 60.01 $60.01
Chest X-Ray-PA/LAT(Digital) 72.02 $72.02
Tonometry Glaucoma Test 43.21 $43.21
Urinalysis-Dipstick $3.62 $3.62
G Interp $24.01 $24.01
Audiometry $16.81 $16.81
Pulmonary Function Test %4.62 $44.62
'o --Color Ishi ara 3 31.21
Vision-Acuity $31.21 $31.21
Vital Signs-HT WT BP P R $0.00 $0.00
Poeller,Kyle T. Med Opinion-Post Offer-PERF $0.00 $0.00
Res irator Clearance-SS $26.65 $26.65
Chart Review/Com letion $97.22 $97.22
Indiana PERF Exam $218.46 $218.46
PSY-Applicant Psych Eval $407.22 $407.22
Tonometry Glaucoma est 43.21 $43.21
Urinalysis-Di stick $3.62 $3.62
EKG W/Intero $24.01 $24.01
Audiometry $16 8 8
F -Pulmonary ction Test $44.62 $44.62
Vision-Color Ishihara $31.21 $31.21
Vision-Acuity 31.21 1 $31.21
Vital Signs-HT WT BP P R $0.00 $0.00
Venipuncture $3.62 $3.62
ADDlicant Blood Panel-PERF $137.82 $137.82
Quantiferon-Tb Blood 60.01 $60.01
Chest X-Ray-PA/LAT(Digital) 71.67 $71.6
Druo Screen 9 +O fates&Oxycodone $48.02 48.02
Total Charges->1 $7,522.01
Total Payments&Balance Due->1 $0.001 $7,522.01