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Home My WebLink About196518 04/13/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $,7,470.88 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 196518 CHECK DATE: 4/13/2011 DEPARTMENT ACCO PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4340700 00 -14755 130.00 MEDICAL FEES 1110 4340701 00 -14844 894.36 MEDICAL EXAM FEES 1110 4340701 00 -14878 6,446.52 MEDICAL EXAM FEES INVOICE o Public Safety Medical Services 324 E. New York Street Suite 300 of Indianapolis, IN 46204 o Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 03!3012011 m Invoice 00 -14844 Date Employee Description Amount Balance Due 03/21/11 Collins, Willie H. Quantiferon Tb Blood $51.00 $51.00 CMP (Comp Metabolic Panel 19.52 519.52 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 PSA Prostate S ecific A Blood 35.70 $35.70 Loveall Gre o A. Quantiferon Tb Blood 51.00 $51.00i CMP (Comv Metabolic Pane! 19.52 $19.52 CBC om Blood Count 17.68 17. Lipid P IB lood) $2 $20.74 Veni uncture $3.06 $3.06 HIV 1 2 Blood 13.26 $13.26 Moore, Scott L. Quantiferon Tb Blood 51.00 $51.00 CMP jComp 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 Specific A Blood 35.70 $35.70 Scott. Curtis D. PSA Prostate S ecific A Blood 35.70 35.70 Q uantiferon Tb Blood) 51.00 51.00 P (Comp Metabolic Panel) $1 2 S19.521 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 03/22/11 Miller Michael G. Quantiferon Tb Blood 51 A0 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 HIV 1 2 Blood 13.26 $13.26 03/25/11 Hasty, Zachery R. Quantiferon Tb Blood $51.00 $51.00 ,QM,E (Qomp Metabolic Panel) $19.52 $19.52 CBC (Comp Blood Count $17.68 $17.68 Lipid Panel Blood $20.74 $20.74 Veni uncture $3.0 6 $3.0 6 HIV 1 2 Blood 13.26 1326 He B Titer SAb Quantitative Blood 35.70 $35.70 Total Charges $89436 Total Payments Balance Due $0:00 $894.36 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 Jate INVOICE 0 Public Safety Medical Services ,j 324 E. New York Street E Suite 300 m W Indianapolis, IN 46204 G Carmel Police Department I CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 04/0512011 m Invoice 00 -14878 Date Employee Description Amount Balance.Due 03/28111 Bodenhorn Wendy M. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Flexibility Test $10.20 $1020 Body Fat Test BIA Bio -Elec Imp Anal 14.28 114.28 Waist/Hi Ratio $3.06 $3.0 6 Treadmill Submax $156.00 $156.00 Tonomet Glaucoma Test 36.72 $36.72 Vital Signs HT WT BP P R SO.00 $0.001 Vwsion -A uity $26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinal sis Dipstick $3.06 $10 6 Collins Shane P. OnMed Program 0.00 0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review 116.32 16.32 Com rehensive Physical Exam $99.96 $99,96 Treadmill Submax $156.00 $156.00 Flexibility Test 110.20 $10,201 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hir) Ratio $3,06 $3.0 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 $14.28 EKG WI Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.0 6 Collins Willie H. OnMed Program $0.00 $0.0 4 Health Risk Aporaisal Motivation 0.00 $0.00 Res irator /Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Treadmill x $15 1 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 Tonometr 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 Audiometry 14.28 $14.28 EKG W/ Inter 20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Hill Nathaniel W. OnMed Pro ram $0M 0.00 INVOICE t° Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Police Department! CARMEPD E- 3 Civic Square Terms Carmel, IN 46032 Invoice Date 04/0512011 m Invoice 00 -14878 :Date Employee Description Amount Balance Due Health Risk ADDraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Com rehensive Physical Exam $99,96 $99.9 T readm 11 Flexibilit Test $10.20 $10.20 Bodv Fat Test BIA Bio -Elec Imp Anal $14.28 1 $14.28 Waist/Hi Ratio 3.06 $3.06 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 Audiornetry $14.28 $14.28 EKG W/ Inter 20.40 $20.40 Urinalysis. Dipstick $3.06 $3.0 6 Loveall GregoU A. OnMed Pro ram $0.00 $0.0 0 Healt Risk Appra 5al (Motiv Res iratorlMedical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Treadmill Submax $156.00 156.00 Flexibilitv Test $10.20 $10.20 Bodv Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3. 06 Tonometr 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 3. 6 $33.66 Audiomet 14.2 $14.2 E KG W 2 4 $20.4 Urinalysis Dipstick $3.06 $3. 06 Tilson. Travis C. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 4.00 so.00l Respirator/Medical Review $16.32 $16.321 Comprehensive Physical Exam $99.96 $99.96 Flexibility Test 10.20 $10,20 Body Fat Test BIA Bio -Eiec Imp Anal 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 so.00l Mis ion Acuity 2 2 $26.52 PFT Pulmonary Function Test $33.66 $33.65 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Tro er Darin M. Urinalysis Dipstick $3.06 $3.06 OnMed Pro ram 0.00 $O.OD Health Risk Appraisal Motivation 0.00 $0.00 INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 a Indianapolis, IN 46204 G Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 04!05/2011 m Invoice 00 -14878 Date Employee Description Amount Balance Due 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 Waist/Hi Ratio 3.06 $3.06 Treadmill Submax $156.00 $156.0 0 Tonomet Glaucoma Test 36.72 $36.7 2 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.521 PFT Pulmona Function Test $33.66 $33.66 Aud iornalry $14.28 $14 EKG W/ Interp $20.40 $20.40 Wiegman, Chad R. OnMed Program 0.00 $0.00 Health Risk Appraisal Motivation 0.00 1 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Flexibility Test $10.20 $10.2 0 Body Fat Test BIA Bio -Eiec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.061 Treadmill Submax $156.00 $156.00 Tonometry f Glaucoma Test 36.72 13 6.72 Vital Sin HT WT BP P R $0.00 $0.00 Vision A PFT Pulmonary Function Test $3166 $33.66 Audiometry $14.28 $14.28 EKG WI Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.0 6 03/31111 Hast Zachery R. OnMed Program 0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator /Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Flexibilitv Test $10.20 $10,2 0 Body Fat Test BIA Bio -Ele Im Anal 14.28 1428 WaisUHip Ratio 3.06 Treadmill Submax 15 Tonomet Glaucoma Test $36.72 $36.72 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity $26.52 $26.5 2 PFT Pulmonary Function Test 33. $33.661 Audiometry 1428 14.28 EKG W/ Inter 20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Miller Michael G. OnMed Pro ram 0.00 $0.00 Health Risk Aporaisal Motivation 0.00 0.00 Re it for /Medical Review $16.32 16.32 Com rehensive Ph I Exam $99.96 $99.96 INVOICE H Pubic Safety Medical Services r 324 E. New York Street E Suite 300 W- Indianapolis, IN 46204 G Carmel Police Department I CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 0410512011 Invoice 00 -14878 Date Employee Description Amount Balance Due Flexibility Test $10.20 $10.20 Body Fat Test BIA f Bid -Elec Im Anal 14.28 $14.28 Waist/Hip Ratio $3.06 $3,06 Treadmil l Submax $156.00 11-56-0-0. 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 $14.28 EKG W/ Inter 20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.0 6 Moore Scott L. OnMed Program $0.00 0.00 Health Risk Appraisal Motivation 0.00 0.00 Respirator/Medical Review $16.32 $16.32 Com rehensive Physical Exam $99.96 $99.96 Flex bility e st $10,20 $1 Body Fat Test BIA Bio -Elec Imp Anal $14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax t26. $156.00 Tonomet Glaucoma Test 36.72 Vital Signs HT WT BP P R $0.00 Vision Acuity 26.52 PFT Pulmonary Function Test 33.66 Audiornetry $14.28 $14.28 EKG W/ Interp $20.40 20.40 Urinalysis Dipstick $3.06 $3.0 Sed berry, Jeffrey T. OnMed Pro ram $0.00 0.00 H ealth R' r I (Motivation) 0 Respirator/Medical Review $1632 $16.32 Comprehensive Physical Exam $99.96 $99.96 Flexibility Test $10.20 $10.20 Body Fat Test BIA (Bb-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 $0.0 0 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.661 Audiometry 14.28 1428 40 .4 Urinal sis Di stick $3.06 $3.06 Snow, Donald C. Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 156.00 Tonomet Glaucoma Test $36.72 1 $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 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 ix Indianapolis, IN 46204 G Carmel Police Department/ CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 04/0512011 0o Invoice 00 -14878 Date Employee Description Amount Balance Due Audiometry 14.28 $14.28 EKG W/ Interp $20.40 $20.4 D Urinalysis Dipstick $3.06 106 OnMed Program $0.00 $0.00 Health Risk Aprraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 16.32 Comprehensive Physical Exam 5n96 $99.96 Flexibility Test $10.20 10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.281 Stites William R. OnMed Pro r m $0.00 $0.00 Health Risk Appraisal tiv i Respirator/Medical Review $16.32 $16.32 Cam rehensive Physical Exam $99.96 $99.96 Flexibility Test 10.2D $10.2 0 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 Si ns HT WT BP P R $0,00 $0.0D Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test 33.66 33.66 Audiometry 14.28 14.28 EKG W1 i nterp $20AQ $20.4 $20A Urinalysis Dipstick $3.06 $3.06 Strona. David C. 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 $10.2C Body Fat Test BIA Bio -Elec Imp Analyl $14,28 $14.28 Waist/Hi Ratio $3.06 3.06 Treadmill Submax 156.00 $156.0 0 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 Audiometry $14 14 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Total Charges $6 Total Payments Balance Due $0.00 $6,446.52 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date 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 Public Safety Medical Services 324 E New York St Purchase Order No. Suite 300 Indpls, IN 46204 Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 3/30/11 00 -14844 payment for officer physicals 894.36 4/5/11 00 -14878 payment for officer physicals 6,446.52 Total 7,340.88 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 Suite 300 Indpls, IN 46204 7,340.88 ON ACCOUNT OF APPROPRIATION FOR police general fund Board Members PO# or INVOICE NO. ACCT /TITLE AMOUNT ere y DEPT. I hereby certify that the attached invoice( s or 1110 00 -14844 407 -01 894.36 bill(s) is (are) true and correct and that the 1110 0- 14878 1 407 -01 6,446.52 materials or services itemized thereon for which charge is made were ordered and received except April 4, 20 11 Signature Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund INVOICE 0 Public Safety Medical Services 324 E. New York Street Suite 300 ar Indianapolis, IN 46204 9 Carmel Clay Parks Recreation CARMELPARK 1411 E 116th Street Terms Carmel, IN 46032 Invoice Date 0311612011 1:0 Invoice 00 -14755 .Date Employee Description Amount Balance Due 03/06/11 Roudebush Dana R. Hepatitis B Vaccination #3 65.00 $65.00 In'ection Fee $0.00 0.00 03/10/11 McLean Dennis M. Hepatitis B Vaccination #3 $65.00 $65.00 In ection Fee $0.00 $0.00 Total Charges $130.00 Total Payments Balance Due $0.00 $130.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 qafmm Purchase J 4 Description I Y e lL! e aL �P.S M A R �4� P.O.4 PorF G.L# /OQ f,� V 0?0 0 Budget Q Line Descr rr Purchaser Date..-- Approval Date 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 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 3116/11 14755 Medical fees 130.00 Total 130.00 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_ 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 I •F 130.00 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members Dept 1091 14755 4340700 130.00 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 7 -Apr 2011 Signature 130.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund