HomeMy WebLinkAbout192546 12/07/2010 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
0 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $3,589.98
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
oN INDIANAPOLIS IN 46204 CHECK NUMBER: 192546
CHECK DATE: 121712010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 140992 3,119.82 MEDICAL EXAM FEES
1120 4340701 14138 470.16 MEDICAL EXAM FEES
Public Safety Medical Services
324 E. New York Street
E Suite 300
W
a: Indianapolis, IN 46204
Carmel Police Department l CARMEPD 11/29/2010
0_ 3 Civic Square Terms Page 1
Carmel, IN 46032 Invoice Date
m Invoice 04- 14099 -,Z
Date Patient Name Procedure Account Amount
11/15/10 Carey, Luckie A. CMP Carmel Police Department 15.30
11/15/10 Carey, Luckie A. CBC W /Diff And Plat Carmel Police Department 12.24
11/15/10 Carey, Luckie A. Lipid Panel Carmel Police Department 15.30
11/15/10 Carey, Luckie A. Venipuncture Fee Carmel Police Department 3.06
11/15/10 j Carey, Luckie A. PSA Carmel Police Department 3570
11/15/10 Carey, Luckie A. Quantiferon Tb Gold Carmel Police Department 51.00
11/15110 Hobson, Phillip L. CMP Carmel Police Department 15.30
11115/10 Hobson, Phillip L. CBC W /Diff And Plat Carmel Police Department 12.24
11/15/10 Hobson, Phillip L. Lipid Panel Carmel Police Department 15.30
11/15/10 Hobson. Phillip L. Venipuncture Fee Carmel Police Department 3.06
11/15/10 Hobson, Phillip L. HIV 1 2 Carmel Police Department 13.26
11/15/10 Hobson, Phillip L. Quantiferon Tb Gold Carmel Police Department 51.00
11/15/10 McNair, Harland J. Quantiferon Tb Gold Carmel Police Department 51.00
11/15/10 McNair. Harland J. CMP Carmel Police Department 15.30
11/15/10 McNair. Harland J. CBC VV/Dill And Plat Carmel Police Department 12.24
11/15/10 McNair, Harland J. Lipid Panel Carmel Police Department 15.30
11/15/10 McNair, Harland J. Venipuncture Fee Carmel Police Department 3.06
11/15/10 McNair, Harland J. HIV 1 2 Carmel Police Department 13.26
11115/10 McNair, Harland J. PSA Carmel Poiice Department 35.70
11/19/10 Bickel, Joseph E. Comprehensive Physical Carmel Police Department 92.82
11/19110 Bickel, Joseph E. Health Risk Appraisal (Motivat Carmel Police Department 16.32
11119/10 Bickel, Joseph E. RespiratorWedical Review Carmel Police Department 16.32
11/19/10 Bickel, Joseph E. BIA (Bio -Elec Imped Anal) Carmel Police Department 14.28
11/19/10 Bickel, Joseph E. Flexibility Check Carmel Police Department 10.20
11/19/10 Bickel, Joseph E. Waist/Hip Ratio Carmel Police Department 3.06
11119/10 Bickel, Joseph E. Muscle Strength Endurance Carmel Police Department 26.52
11/19/10 Bickel, Joseph E. Treadmill (PFE) Carmel Police Department 156.00
11/19/10 Bickel Joseph E. Tonometry Carmel Police Department 36.72
11/19110 1 Bickel, Joseph E. Vital Signs HT WT BP P R Carmel Police Department 7.14
11/19110 Bickel Joseph E. Vision Titmus Carmel Police Department 26.52
11/19110 Bickel, Joseph E. PFT W /lnterp Carmel Police Department 33.66
11/19/10 Bickel, Joseph E. Audiometry Carmel Police Department 14.28
11/19/10 Bickel, Joseph E. ECG WI lnterp Carmel Police Department 20.40
11/19110 Bickel. Joseph E. Urinalysis dipstick Carmel Police Department 3.06
11/19/10 Dixon, Micheal R. Comprehensive Physical Carmel Police Department 92.82
11/19/10 Dixon, Micheal R. Health Risk Appraisal (Motivat Carmel Police Department 16.32
11/19/10 Dixon, Micheal R. Respirator /Medical Review Carmel Police Department 16.32
11/19/10 Dixon, Micheal R. BIA (Bio -Elec Imped Analy) Carmel Police Department 14.28
11/19/10 Dixon, Micheal R. Flexibility Check Carmel Police Department 1020
11/19/10 Dixon, Micheal R. Waist /Hip Ratio Carmel Police Department 3.06
11/19110 Dixon. Micheal R. Treadmill (PFE) Carmel Police Department 156.00
11/19/10 Dixon, Micheal R. Tonometry Carmel Police Department 36.72
11/19/10 Dixon, Micheal R. Vital Signs HT WT BP P R Carmel Police Department 7.14
11/19/10 Dixon, Micheal R. Vision Titmus Carmel Police Department 26.52
11/19/10 Dixon, Micheal R. PFT W /interp Carmel Police Department 33.66
11/19/10 Dixon, Micheal R. Audiometry Carmel Police Department 14.28
11/19/10 Dixon, Micheal R. ECG W/ lnterp Carmel Police Department 20.40
11/19/10 Dixon, Micheal R. Urinalysis Dipstick Carmel Police Department 3.06
11/19110 Fogarty Michael D. Comprehensive Physical Carmel Police Deoartment 92.82
11/19/10 1 Fogarty. Michael D. j Health Risk Appraisal (Motivat Carmel Police Department 18.32
Public Safety Medical Services
324 E. New York Street
Suite 300
Indianapolis, IN 46204
Charges To Be Billed or With Outstanding Balance 11/29/2010
Page 2
Period 11/1512010 to 11/19/2010
Account Carmel Police Department
Date Patient Name Procedure Account Amount
11/19/10 Fogarty, Michael D. Respirator/Medical Review Carmel Police Department 16.32
11119/10 Fogarty, Michael D. BIA (Bio -Elec Imped Analy) Carmel Police Department 14.28
11/19/10 Fogarty, Michael D. Flexibility Check Carmel Police Department 10.20
11/19/10 Fogarty, Michael D. Waist/Hip Ratio Carmel Police Department 3.06
1111911D Fogarty, Michael D. Treadmill (PFE) Carmel Police Department 156.00
11/19/10 Fogarty, Michael D. Tonometry Carmel Police Department 36.72
11/19/10 Fogarty Michael D. Vital Signs HT WT BP P R Carmel Police Department 7.14
11/19110 Fogarty, Michael D. Vision Titmus Carmel Police Department 26.52
11/19/10 Fogarty, Michael D. PFT W /lnterp Carmel Police Department 33.66
11/19/10 Fogarty, Michael D. Audiometry Carmel Police Department 14.28
11/19/10 Fogarty, Michael D. ECG WI lnterp Carmel Police Department 20.40
11/19/10 Fogarty, Michael D. Urinalysis Dipstick Carmel Police Department 3.06
11/19/10 Hobson, Phillip L. Comprehensive Physical Carmel Police Department 92.82
11/19/10 Hobson, Phillip L. Health Risk Appraisal (Motivat Carmel Police Department 16.32
11/19/10 Hobson, Phillip L. RespiratorlMedical Review Carmel Police Department 16.32
11/19/10 Hobson, Phillip L. BIA (Bio -Elec Imped Analy) Carmel Police Department 14.28
11/19/10 Hobson, Phillip L. Flexibiiity Check Carmel Police Department 10.20
11/19/10 Hobson, Phillip L. Waist/Hip Ratio Carmel Police Department 3.06
11119/10 Hobson, Phillip L. Treadmill (PFE) Carmel Police Department 156.00
11119/10 Hobson, Phillip L. Tonometry Carmel Police Department 36.72
11/19/10 Hobson, Phillip L. Vital Signs HT WT BP P R Carmel Police Department 7.14
11/19/10 Hobson, Phillip L. Vision Titmus Carmel Police Department 26.52
11/19/10 Hobson, Phillip L. PFT W1lnterp Carmel Police Department 33.66
11119/10 Hobson, Phillip L Audiometry Carmel Police Department 14.28
11/19/10 Hobson, Phillip L ECG W/ lnterp Carmel Police Department 20.40
11/19/10 Hobson, Phillip L. Urinalysis Dipstick Carmel Police Department 3.06
11!19110 Horner, Jeffrey J. Comprehensive Physical Carmel Police Department 92.82
11/19110 Horner, Jeffrey J. Health Risk Appraisal (Motivat Carmel Police Department 16.32
11119/10 Horner, Jeffrey J. Respirator/Medical Review Carmel Police Department 16.32
11119'10 Horner. Jeffrey J. BIA (Bio -Elec Imped Analy) Carmel Police Department 14.28
11119/10 Horner, Jeffrey J. Flexibility Check Carmel Police Department 10.20
11/19/10 Horner, Jeffrey J. WaisUHip Ratio Carmel Police Department 3.06
11/19/10 Horner, Jeffrey J. Treadmill (PFE) Carmel Police Department 156.00
11119110 Horner, Jeffrey J. Tonometry Carmel Police Department 36.72
11/19/10 Horner, Jeffrey J. Vital Signs HT WT BP P R Carmel Police Department 7.14
11/19/10 Horner, Jeffrey J. Vision Titmus Carmel Police Department 26.52
11/19110 Horner. Jeffrey J. PFT W /lnterp Carmel Police Department 33.66
11/19/10 Horner, Jeffrey J. Audiometry Carmel Police Department 14.28
11119/10 Horner, Jeffrey J. ECG WI lnterp Carmel Police Department 20.40
11(19110 Horner, Jeffrey J. Urinalysis Dipstick Carmel Police Department 3.06
11/19/10 Klein, Marc A. Comprehensive Physical Carmel Police Department 92.82
11/19/10 Klein. Marc A. Health Risk Appraisal (Motivat Carmel Police Department 16.32
11/19110 Klein. Marc A. Respirator /Medical Review Carmel Police Department 16.32
11/19/10 Klein, Marc A. BIA (Bio -Elec Imped Analy) Carmel Police Department 14.28
11(19110 Klein, Marc A. Flexibility Check Carmel Police Department 10.20
11/19/10 Klein, Marc A. WaisUHip Ratio Carmel Police Department 3.06
11/19/10 Klein, Marc A. Treadmill (PFE) Carmel Police Department 156.00
11119110 Klein. Marc A. Tonometry Carmel Police Department 36.72
11/19/10 Klein. Marc A. Vital Signs HT WT BP P R Carmel Police Department 7.14
11/19110 Klein, Marc A. Vision Titmus Carmel Police Department 26.52
Public Safety Medical Services
324 E. New York Street
Suite 300
Indianapolis, IN 46204
Charges To Be Billed or With Outstanding Balance 11/29/2010
Page 3
Period 11/15/2010 to 11/1912010
Account Carmel Police Department
Date Patient Name Procedure Account Amount
11/19/10 Klein, Mare A. PFT W /lnterp Carmel Police Department 33.66
11/19/10 Kiein, Marc A. Audiometry Carmel Police Department 14.28
11/19/10 Klein, Marc A. ECG W1 lnterp Carmel Poke Department 20.40
11/19/10 Klein, Marc A. Urinalysis Dipstick Carmel Police Department 3.06
Number of Charges 104 3119.82
Balance due 15 days from
In -voice date
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
$3,119.82
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1110 140992 43- 407.01 $3,119.82 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized rthereon for
which charge is made were ordered and
received except
Thursday, December 02, 2010
C hie f o f Polic
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No 201 (Rev_ 1995)
ACCOUNTS PAYABLE VOUCHER
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11/29110 140992 $3,119.82
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
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
d
W- Indianapolis, IN 46204
O Carmel Fire Department I CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 19/2912010
m Invoice 00 -14138
Date Employee Description Amount Balance Due
11/19/10 Reeves. Stephen J. Comprehensive Physical $99.96 $99.96
OnMed Program $0.00 $0.00
Respirator/Medical Review $16.32 $16.32
Health Risk Appraisal Motivation 0.00 $0.00
Treadmill (PFE) $156.00 $156,0 0
Flexibility Check $10,20 $10.20
Waist/Hi Ratio $3.G6 $3,06
Muscle Strength Endurance $26.52 $26.52
BIA Bio -Elec Im ed Anal 14.28 $14.281
Bladder Cancer Screen $45.90 $45.90
Vital Sicin HT WT 5P P R
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
Urinal sis Di s #ick $3.06 $3.06
Total Charges $470.16
Total Payments Balance Due $0.00 $470.16
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from
Invoice date
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$470.16
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO, ACCT #!TITLE AMOUNT Board Members
1120 14138 43- 407.01 $470.16 1 hereby certify that the attached invoice(s), or
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
DEC 6 2010
a
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No 201 (Rev_ 1995)
ACCOUNTS PAYABLE VOUCHER
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
14138 $470.16
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