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Home My WebLink About195177 03/02/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $3,505.00 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 195177 CHECK DATE: 3/2/2011 DEPARTMENT AC COUNT PO NUMBER I NVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 14605 648.74 MEDICAL EXAM FEES 1110 4340701 14648 2,856.26 MEDICAL EXAM FEES INVOICE 0 Public Safety Medical Services w 324 E. New York Street E Suite 300 m W Indianapolis, IN 46204 G Carmel Police Department/ CARMEPD F 3 Civic Square Terms Carmel, IN 46032 Invoice Date 02/15/2011 m Invoice 00 -14605 Date E=mployee Description Amount Balance Due 02/07/11 Goodman, Leland C. No Show Fee $0.00 $0.00 HenrV, David R. Quantiferon Tb (Blood) 51.00 $51.00 CMP (Comp Metabolic Panel 19.52 $19,52 CBC (Camp Blood Count 17.68 $17.68 Lipid Panel Blood 20.74 $20.74 Veni uncture $3.06 $3.06 HIV 1 2 Blood! $13.26 13.26 Sedberry, Jeffrey T. CMP $19.52 $19.52 CBC WIDiff And Plat $17.68 $17.68 Li id Panel 20.74 $20.74 Venioun F HIV 1 &2 $13.26 $13.26 Quantiferon Tb Gold $51.00 $51.00 Williams. Ashley L. Quantiferon Tb Blood 51.00 $51.00 CMP (Comp Metabolic Panel 19.52 $19.52 CBC (Comp Blood Count 17.68 $17.68 Lipid Panel Blood $20.74 $20.74 Veni uncture $3.06 $3.06 02111111 Fisher Charles B. Quantiferon Tb Blood 51.00 $51.00 CMP (Comip Metabolic Panel 19.52 $19.52 CBC (Comip Blood Count 17.68 $17.68 Lipid Panel Blood 20.74 120.74 Venipun HIV 1 2 Blood $13.26 $13.26 Laker Jeffrey W. Quantiferon Tb Blood $51.00 $51.00 CMP (Comp Metabolic Panel 19.52 $19.52 CBC (Comp Blood Count 17.68 $17.68 Li id Panel Blood 20.74 $20.74 Veni uncture $3.06 $3.06 HIV 1 2 Blood 13.26 $13.26 PSA Prostate S ecific A Blood 35.70 $35.70 Total Charges $648.74 Total Payments Balance Due $0.00 $648.74 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 IY Indianapolis, IN 46204 O Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 02123!2011 m Invoice 00 -14648 Date Employee Description Amount Balance Due 02/17111 Fisher Charles B. OnMed Program $0.00 0.00 Health Risk Appraisal Motivation 0.00 $0.0 0 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99,96 $99.96 FlexblitV Test $10.20 $10.2 0 Body Fat Test BIA Bio -Elec Imp Anai 14.28 $14.28 Waist/Hi Ratio 3.06 $3.06 Treadmill Submax $156.00 $156.0 0 Tonomet Glaucoma Test 36.72 36.72 Vital Si ns HT WT BP P R 0.00 0.00 V 6 PFT Pulmonary Function Test $33.66 $33.66 Audiometry 14.28 $14.28 EKG W/ Inter 20.40 $20.40 Urinalysis Dipstick 3.06 $3.06 Henrv, David R. OnMed Pro ram $0,00 $0,00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Flexibility Test $10.20 $10,201 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Tr.eadmil $1 56,00 $156.0 Tonomet Glaucoma Test $36.72 $36.72 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiometry $14.28 114. 28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Hughes Crystal K. Quantiferon Tb Biood 51.00 $51.0 0 CMP (Comp Metabolic Panel 19.52 $19.52 CBC Corn Blood Count 17.68 $17.68 Lipid Panel Blood 20.74 $20.74 Venbunctur HIV 1 2 (Blood) $13.26 $13.26 Hep B Titer SAb Quantitative Blood $35.70 $35.70 OnMed Program 0.00 $0.00 Health Risk Appraisal Motivation 0.00 0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Flexibility Test 110.20 $10.2 0 Body Fat Test BIA f Blo -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.0 Tonomet Glaucoma Test 36.72 $36.72 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 m jX Indianapolis, IN 46204 O Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 02123!2011 Invoice 00 -14648 :Date Employee Description Amount I Balance Due Vital Si ns HT WT BP P R $0.00 $0.00 Vi ion A uit 26.52 26. 52 PFT Pulmonary Function Test 33.6 33.66 u o 1 1 EKG W/ Inter $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Theis Adam G. Quantiferon Tb Blood 51.00 $51.0 0 CMP (Comp Metabolic Panel $19.52 $19.52 CBC (Comp Blood Count 17.68 $17.68 Lipid Panel Blood 20.74 $20.74 Veni uncture $3.06 3.06 HIV 1 2 Blood 13.26 $13.26 OnMed Pro ram 10.00 so.001 Health Risk Appraisal Motivation $0.00 so.001 Res irator Medical Review $16.32 $16.32 Physical Exam $99.96 199-9 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal $14.28 $14.28 Waist/Hi Ratio 3.06 $3.06 Treadmill Submax $156.00 $156,00 Tonomet Glaucoma Test 36.72 $36.72 Vital Signs HT WT BP P R $0.00 0.00 Vision Acuity 26.52 $26.52 PFT Pulmona Function Test $33.66 33.66 Audiomet 14.28 $14.28 EKG WI Interp $20.40 S20AQ Urinalysis Dipstick $3.06 $3.0 6 White 11, Robert E, OnMed Po r Health Risk Appraisal Motivation 0.00 $0. 00 Respirator/Medical Review $16.32 $16.32 Com rehensive Physical Exam $99.96 $99.96 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.0 6 Treadmill Submax $156.00 $156.00 Vital Si ns HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test 3166 $33.66 Audiometry 14.28 $14.28 EKG W1 Interp $20.40 $20.4 Urinalysis Dipstick $3.06 $3.06 Williams, Ashley L. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 INVOICE 1 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department I CARMEPD t 3 Civic Square Terms Carmel, IN 46032 Invoice Date 02123!2011 m Invoice 00 -14648 Date Employee Description Amount Balance Due Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Tonomet Glaucoma Test 36.72 $36,72 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test 33 -66 33.66 Audiometry 14.28 14.28 EKG WI Inter 20.40 20.40 Urinalysis Dipstick 3.06 3.06 Total Charges $2,856.26 Total Payments Balance Due $0.00 $2,856.26 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $3,505.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1110 14605 43- 407.01 $648.74 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 14648 43- 407.01 $2,856.26 materials or services itemized thereon for which charge is made were ordered and received except Friday, February 25, 2011 1 Chief of Police 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)) 02/15111 14605 payment for officer physicals $64834 02/23/11 14648 payment for officer physicals $2,856.26 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