189960 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
('s
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $9,271.82
INDIANAPOLIS IN 46204 CHECK NUMBER: 189960
CHECK DATE: 9/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4340700 00 -13514 195.00 MEDICAL FEES
1110 4340701 0013515 535.50 MEDICAL EXAM FEES
1110 4340701 0013563 5,097.26 MEDICAL EXAM FEES
1110 4340701 0013602 3,379.06 MEDICAL EXAM FEES
1081 4340700 13562 65.00 MEDICAL FEES
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
d
tY Indianapolis, IN 46204
G Carmel Police Department I CARMEPD
t 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/2512010
Invoice 00 -13515
Date Employee Description Amount Balance Due
08/16/10 Gauthier Edward B. CMP $15.30 $15.30
CBC WIDiff And Plat $12.24 $12.24
Lipid Panel $15.30 $15.3 0
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold 51.00 $51.0 0
HB SAb Quantitative Titer $35.70 $35.70
Harris Sarah E. CMP $15.30 $15.3 0
CBC WIDiff And Plat $12.24 $12.24
Li id Bane! $15.30 $15.30
Venimncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
Tb Review Hx Positive Questionnaire $0.00 $0.00
Hedrick Brad A. CMP $15.30 $15.30
CBC WIDiff And Plat $12.24 $12,24
Lipid Panel $15.30 $15.3 0
Veni uncture Fee $3.06 $3.06
HIV 1 2 113.26 $13.26
Quantiferon Tb Gold $51.00 $51.0 0
Lon q. Scott D. Lipid Panel $15.30 $15.301
Veniipuncture Fee $3.06 S3.06
HIV 1 &2 $13.26 $13.26
Q uant fer n Tb Gold 151 151,0
CMP $15.30 $15.30
CBC WIDiff And Plat $12.24 $12.24
Mabie. Michael L. CMP $15,30 $15.30
CBC WIDiff And Plat $12.24 $12,24
Lipid Panel 15.30 $15.3 0
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 51.00
Total Cha ges $535.5o
Total Payments Balance Due $0.00 $535.50
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
I
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
aY Indianapolis, IN 46204
i
Carmel Police Department 1 CARMEPD
Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 0910312010
m invoice 00 -13563
Date Employee Description Amount Balance Due
08/23/10 Dewald Gregory S. CMP $15.30 $15.30
CBC W /Diff And Plat $12.24 $12.24
Lipid Panel $15,30 $15.3 0
Veni uncture Fee $3.06 $3.0 6
Quantiferon Tb Gold $51.00 $51.0a
08/25/10 Moore Lindsay A. Indiana Police /Fire PERF $178.50 $178.5 0
Chart Review /Com letion $52.00 $52.00
Applicant Health Screen PERF $120.16 $120.16
Drug Screen 7 GC /MS W /MR0 $71.40 $71.4 0
Chest PA/LAT $61.20 $61.20
Tb Skin T 7.14
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
Color Vision Ishihara 26.52 $26.52
PFT W/Interip $33.66 $33.66
Audiometry 14.28 $14.28
ECG W/ Interp $20.40 $20.4 0
Urinalysis Dipstick $3.06 $3.06
Tonometry $36.72 $36.72
08/26/10 Govin John K. Indiana Police /Eire PERF $178.50 $178.50
Chart Review /Com letion $52.00 $52.00
Apiplicant Health Screen PERF $120.16 $120.16
Drug Screen 7 GC /MS W MRO $71.40 $71.4
Chest PA/LAT $61.20 $61.20
Tb Skin Test $7.14 $7.14
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
Color Vision Ishihara 26.52 $26.52
PFT W/Interp $33.66 $33.66
Audiometry 14.28 $14.28
ECG W1 Inter 20.40 $20.40
Urinalysis Di stick $3.06 $3.06
Tonometr $36-72 36.72
08127/10 Amos Chad B. Com rehensive Physical 92.82 $92.82
OnMed Pr r m
Health Risk Appraisal Motivation $16.32 $16.32
Respirator/Medical Review $16.32 $16.32
Treadmill (PFE) $156.00 $156.00
BIA Bio -Elec Im ed Anal $14.28 $14.28
Waist/Hi Ratio $3.06 3.06
Flexibility Check $10.20 $10.20
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus 26.52 $26.52
PFT W/interp $33.66 $33.66
Audiometr 14.28 $14.28
ECG W/ Interp $20,40 $20.40
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
o Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 09103/2010
m Invoice 00 -13563
Date Employee Description Amount Balance Due
Urinalysis Di stick $3.06 $3.06
Tonomet 36.72 $36.72
Broadnax Matthew L. Com rehensive Physical $92. $92.82
nM d Pr ram $0.00 so.00l
Health Risk Appraisal Motivation $16.32 $16.32
Respirator/Medical Review $16.32 $16.32
Treadmill (PFE) $156.00 $156.00
BIA Bio -Elec Im ed Anal $14.28 $14.28
Waist/Hi Ratio $3.06 3.06
Flexibility Check $10.20 $10.20
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
PFT W/Intern $33.66 $33.66
Audiometry 14.28 $14.28
ECG WI Inter 20.40 $20.4 0
Unnalys D' ti k $3.06 $3.06
Tonometr $36.72 $36.72
Collins Larry J. Comprehensive Physical $92.82 $92.82
QnMed Pro ram 0.00 $0.00
Health Risk Appraisal Motivation 16.32 $16.32
Res irator /Medical Review $16.32 $16.32
Treadmill (PFE) 156.00 156.00
BIA Bio -Elec Im ed Anal 14.28 1428
Waist/Hi Ratio 3.06 3.06
Flexibility Check 10.20 10.20
Vital Signs HT WT BP P R 7.14 $7.14
Vision Titmus $26.52 26.52
PFT W11 nt r
Audiometry $14.28 $14.28
ECG W/ Interp $20.40 $20.40
Urinalysis Dipstick $3.06 $3.06
Tonornetry $36.72 $36.72
Gauthier Edward B. No -Show Fee $40.00 40.00
Ha maker William E. Tonometr 36.72 $36.72
Comprehensive Physical $92.82 $92.82
QnMed Program $0.00 $0.00
Health Risk A raisal Motivation 16.32 $16.32
Res iratorlMedical Review $16.32 $16.32
Tre dmill PFE 156.00 $156.00
1 2
Waist/Hi Ratio $3.06 $3.06
Flexibility Check $10.20 510.20
Vital Si ns HT WT BP P R $7.14 $7.14
Vision Titmus 26.52 $26.52
PFT W/Interp $33.66 $33,66
Audiometry 1428 1428
ECG W1 Interp $20.40 S20.40
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
X Indianapolis, IN 46204
G Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 09103!2010
m Invoice 00 -13563
Date Employee Description Amount Balance Due
Urinalysis Dipstick $3.06 $3.06
Hedrick Brad A. Comprehensive Physical $92.82 $92.82
OnMed Program $0.00 $0.00
Health Risk Appraisal Motivation 16.32 $16.32
Respirator/Medical Review 16.32 16.32
Treadmill (PFE) $156.00 $156.0 0
BIA Bic -Elec Im ed Anal 14.28 $14.28
Waist/Hip-Ratio $3.06 $3.06
Flexibility Check $10.20 $10.2 0
Vital Si ns HT WT BP P R $7.14 $7.14
Vision Titm
PFT W/Interp $33.66 $33.66
Audiometry 14.28 $14.28
ECG W/ Interp $20.40 $20.4 0
Urinalysis Dipstick $3.06 3.06
Tonometry $36.72 $36.72
Long, Scott D. Comprehensive Physical $92.82 $92.82
OnMed Program 0.00 $0.00
Health Risk Appraisal Motivation 16.32 $16.32
Res irator /Medical Review $16.32 S16.321
Treadmill (PFE) $156.00 $156.0 0
BIA Bio -Elec Im ed Anal 14.28 $14.28
W i Hi do $3.06 $3.0
Flexibilitv Check $10.20 $10.20
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus 26.52 26.52
PFT Wllnter 33.66 $33.66
Audiometry 14.28 $14.28
ECG W/ Interp $20.40 20.40
Urinalysis Dipstick $3.06 $3,06
Matthews. Daniel M. Comprehensive Physical $92.82 $92.821
OnMed Program 0.00 $0,00
Health Risk Appraisal Motivation 16.32 $16.32
Respirator/Medical Review $16.32 $16,32
Treadmill PF 156. 1
BIA Bio -Elec Im ed Anal $14.28 $14.28
Waist/Hi Ratio $3.06 $3.06
FlexibilitV Check $10.20 $10.2 0
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
PFT W/interp $33.66 33.66
Audiometry 14.28 $14.28
ECG W/ Interp $20.40 S20.40
Urinalysis Dipstick 3.06 $3.06
CMP $15.30 $15.30
CBC W /Dill And Plat $12.24 $12.24
INVOICE
F- Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
C Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 09/03/2010
°a Invoice 00 -13563
Date Employee Description Amount Balance Due
Lipid Panel $15.30 $15.30
Veni uncture Fee $3.06 $3.06
HIV 1 &2 $13.26 13.26
f r n Tb Gold 1
White. Kari E. Comprehensive Physical $92.82 $92.82
OnMed Program $0.00 $0.00
Health Risk Appraisal (Motivation) 16.32 $16.32
Respirator/Medical Review $16.32 $16.32
Treadmill (PFE) $156.00 $156.00
BIA Bio -Elec Im ed Anal 14.28 $14.28
Waist/Hi Ratio $3.06 $3.06
Flexibility Check 10.20 10.20
Vital Signs HT WT BP P R 7.14 7.14
Vision Titmus 26.52 26.52
PFT W /inter 33.66 33.66
A imtr
ECG W/ Inter $20.40 $20.40
Urinalysis Dipstick $3.06 $3.06
Tonomet 36.72 36.72
Total Charges $5,097.26
Total Payments Balance Due $0.00 $5,097.26
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
INVOICE
F Public Safety Medical Services
324 E. New York Street
E Suite 300
tx Indianapolis, IN 46204
C Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 09109/2010
m Invoice 00 -13602
Date Employee Description Amount Balance Due
08/30/10 Bowman Gary A. CMP $15.30 $15.30
CBC W /Diff And Plat $12.24 $12.24
Li id Panel $15.30 $15.3 0
Veni uncture Fee $3.06 3.06
HIV 1 2 $13.26 $13.261
Quantiferon Tb Gold $51.00 $51.00
Locke Robert E. CMP $15.30 $15.3 0
CBC W /Dirt And Plat $12.24 $12.24
Lipid Panel $15.30 $15.30
Veni uncture Fee $3.06 $3.06
HIV 1 $13.2
Quantiferon Tb Gold $51.00 $51.00
09/03/10 Bowman.GarvA, Comprehensive Physical $92.82 $92.82
OnMed Program $0.00 $0.00
Respirator/Medical Review $16.32 $16.32
Health Risk Appraisal Motivation 16.32 $16.32
Treadmill (PFE) $156.00 $156.0 0
Flexibility Check $10.20 $10.20
Waist/Hi Ratio $3.06 3.06
BIA Bio -Elec Im ed Anal 14.28 $14,28
Vital Si ns HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
FT 6 $33.6
Audiornetry $14.28 1 $14.28
ECG W/ Interp $20.40 $20.40
Urinalysis Dipstick $3.06 $3.06
Tonometry $36.72 $36.72
Gerdt. Andrew P. Comprehensive Physical $92.82 $92.82
OnMed Pro ram $0.00 $0.00
Respirator/Medical Review $16.32 $16.32
Health Risk Appraisal Motivation 16.32 16.32
Treadmill (PFE 156.00 $156.00
Flexibility Check $10.20 $10.2 0
Waist/Hi Ratio $3.06 $3.06
BIA Bio -Elec Im e al y) $14.28 $1
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
PFT W/Interp $33.66 $33.66
Audiornetry $14.28 $14.28
ECG W/ Interp $20.40 $20.40
Urinalysis Dipstick $3.06 $3.06
TonornetrV $36.72 $36,72
Harris Robert P. Comprehensive Physical $92.82 $92,82
OnMed Program $0.00 $0.00
Res irator /Medics€ Review 16.2 16.32
Health Risk Armraisal Motivation 16.32 $16.32
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
o: Indianapolis, IN 46204
o Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 09/0912010
m Invoice 00 -13602
Date Employee Description Amount Balance Due
Treadmill (PFE) $156.00 $156.00
Flexibility Check $10.20 $10.2 0
Waist/Hi Ratio $3.06 $3.06
A t I y) $14.28 $14-2
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
PFT W/Interp $33.66 33.66
Audiometry 14.28 $14.28
ECG W/ Interp $20.40 $20.4 0
Urinalysis Dipstick $3.06 $3.0 6
Tonornetry 136.72 $36.72
Harris. Sarah E. Respirator/Medical Review $16.32 $16.32
Health Risk Apipraisal Motivation 16.32 $16.32
Treadmill (PFE 1156.D0 $156.00
Flexibility Check $10.20 $10.20
Waist/ Ratio $3.06 $3.
BIA Bio -Elec Im ed Anal $14.28 $14.28
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
PFT W/Interp $33.66 $33.66
Audiometry 14.28 14.28
ECG W/ Interp $20.40 20.40
Urinal sis Dipstick $3.06 $3.06
Tonometry $36.72 $36.72
Com rehensive Physical $92.82 $92.82
OnMed Program $0,00 $0.00
Herron James C. No -Show Fee Arrived Too Late 40.00 40.00
Locke, Robert Comprehensive Physical 2 2
OnMed Program $0.00 $0.00
Respirator/Medical Review $16.32 $16.32
Health Risk Appraisal Motivation 16.32 16.32
Treadmill (PFE $156.00 156-00
Flexibility Check $10.20 $10.20
Waist/Hi Ratio $3.06 $3.0 6
BIA Bio -Elec Im ed Anal 14.28 $14.28
Vital Signs HT WT BP P R $7.14 $7.1 4
Vision Titmus $26.52 $26.52
PFT W/Interp $33.66 $33.66
Audiomet 14.28 $14.28
G to 4 2
Urinalysis Dipstick $3.06 $3.06
Tonornetry $36.72 1 $36.72
Lovitt. Richard A. WaisUft Ratio 3.06 $3.06
BIA Bio -Elec Im ed Anal 14.28 $14.28
Vital Signs HT WT BP P R $7.14 17.14
Vision Titmus 26.52 $26.52
PFT W/Interp $33.66 $33.66
INVOICE
t o Public Safety Medical Services
324 E. New York Street
E Suite 300
m
tY Indianapolis, IN 46204
o Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 09109/2010
m Invoice 00 -13602
Date Employee Description Amount Baiance Due
Audiometry $14.28 $14.28
ECG W/ Interp $20.40 $20.40
Urinalysis Dipstick $3.06 $3.06
Tonometa $36.72 $36.72
Comprehensive Physical $92.82 $92.821
OnMed Program so.00 $0.00
Res iratorlMedical Review 16.32 $16.32
Health Risk Agorwsal Motivation 16.32 $16.32
Treadmill (PFE) $156.00 $156.00
Flexibilitv Check $10.20 $10.20
Mabie, Michael L. Comprehensive Physical
OnMed Program $0.00 $0.00
Respirator/Medical Review $16.32 $16.32
Health Risk Appraisal Motivation $16.32 $16.32
Treadmill (PFE $156.00 $156.00
Flexibility Check $10.20 $10.20
Waist/Hi Ratio $3.06 $3.06
BIA Bio -Elec Im ed Anal 14.28 $14.28
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus 26.52 26.52
PFT W/Interp $33.66 $33.66
Audiometry 14.28 $14.28
G W1 Interp 4.4 0.
Urinalysis Dipstick $3.06 $106
Total Charges $3,379.06
Total Payments Balance Due $0.001 $3,379.06
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
I
I
i
Pregcribed by State Board of Accounts City Form No. 201 (I ev. 1995)
ACCOUNTS PAYABLE VOUCHER
s; CITY OF CARMEL
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.
Payee
Publ Safety Medical Services Purchase Order No.
324 E New York St #300
Terms
Indpls, IN 46204
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
9/3/10 0013563 payment for officer physicals 5,097.26
8/25/10 0013515 payment for officer physicals
9/9/10 0013602 payment for officer physicals 3,379.061
Total 9,011.82
1 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
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services IN SUM OF
324 E New York St #300
Indpls, IN 46204
9,011.
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
D INVOICE NO. ACCT# /TITLE AMOUNT I hereby certify that the attached invoice(s), or
1110 0013563 407 -01 5,097 .26 bill(s) is (are) true and correct and that the
1110 0013515 407 -01 535.50 materials or services itemized thereon for
1110 0013602 407 -01 3,379.06 which charge is made were ordered and
received except
Sept 8, 2010
r'
A
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
X Indianapolis, IN 46204
O Carmel Clay Parks Recreation CARMELPARK
1411E 116th Street Terms
Carmel, IN 46032 Invoice Date 0812512010
Invoice 00 -13514
Date Employee Description Amount Balance Due
08116/10 Morical Ma (Cindy) J. Hepatitis B Vaccination #2 $6500 $65.00
Inmection Fee $0.00 $0.00
08118/10 Bromm, Catherine Hepatitis B Vaccination #1 $65.00 $65.0 0
In'ection Fee 0.00 $0,00
Turner Joy D. He atitis B Vaccination #1 165.00 65.00
Infection Fee 0.00 0.00
Total Charges $195.00
Total Payments Balance Due °$0100 $195.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
Purchase /J
Description 11�f (�fi t I' t' S rM
P.O. L– P or F M
G.L.# y7 -100 oo c /3 OGN AUG 2 1010
Budget
Line Descr H a 4 e S
Purchase bate r 3Cl /Q ��e .....................1e
Approval Date
I
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
x Indianapolis, IN 46204
C Carmel Clay Parks Recreation CARMELPARK
1411E 116th Street Terms
Carmel, IN 46032 Invoice Date 0910312010
m Invoice 00 -13562
Date Employee Description Amount Balance Due
08/23/30 Armbruster Dawn M. Hepatitis B Vaccination #1 $65.00 $65.00
Injection Fee $0.00 $0.00
Total Charges $65.00
Total Payments Balance Due $0.00 $65.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
Purchaft SO 0,
1�A
Description
P.O.0 _PorF
G.L. D UYo
Budget
Line De r
Purchtas a� #e
Appro>r� Date
i
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
Payee
Purchase Order No.
00350364 Public Safety Medical Services Terms
324 E. New York Street, Ste 300
Indianapolis, IN 46204
I
i
Invoice invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
8125110 00 -13514 Medical fees 195.00
913110 13562 Medical fees 65.00
Total 260.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with 1C 5- 11- 10 -1.6
1 20
Clerk-Treasurer
Voucher No. Warrant No.
00350364 Public Safety Medical Services Allowed 20
324 E. New York Street, Ste 300
Indianapolis, IN 46204
In Sum of
260.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center 1 108 ESE
PO# or Board Members
Dept INVOICE NO. ACCT #/TITL AMOUNT
1091 00 -13514 4340700 195.00 1 hereby certify that the attached invoice(s), or
1081 -99 13562 4340700 65.00 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
9 -Sep 2010
Signature
260.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund