HomeMy WebLinkAbout195623 03/16/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $591.20
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 195623
CHECK DATE: 3116/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 14683 591.20 MEDICAL EXAM FEES
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
a Indianapolis, IN 46204
H Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 03/01/2011
m Invoice 00 -14683
Date Employee Description Amount Balance Due
02121/11 Towle. John R. 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 3A6
HIV 1 2 Blood 13.26 $13.26
PSA Prostate Specific A Blood 35.70 $35.70
Troyer, Darin M. Quantiferen Tb Blood 51.00 $51.0 0
CMP (Comp Metabolic Panel 19.52 $19.52
CBC Corn Blood Count 17.68 $17.68
Lipid Panel I 74 $20,74
Veni uncture $3.06 $3.06
HIV 1 2 Blood 13.26 $13.26
02125/11 Towle John R. 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
Muscular Strength Endurance Test $26.52 $26.52
Flexibilitv Test $10.20 $10.20
Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28
Waist/Hi Ratio $3.06 $3.06
Tonomet Glaucoma Test 36.72 $36.72
Vital T BP
Vision Acuity $26.52 $26.52
PFT PulmonarV Function Test $33.66 $33.66
Audiometry 14.28 $14,28
EKG W/ Interp $20.40 20.40
Urinalysis Dipstick $3.06 3.06
Total Charges 1 $591.20
Total Payments Balance Due $o.00 $591.20
Please write invoice number on payment check.
Balance due 15 days from nvoice
Our Federal Employer Identification Number is 35- 2079797 date
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
$591.20
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO, ACCT /TITLE AMOUNT
Board Members
1110 146$3 43- 407.01 $591.20 I 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
Friday March 11, 2011
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))
03/01/11 14683 payment for officer physicals $591.20
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and 1 have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer