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Home My WebLink About197792 05/26/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $3,644.80 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 197792 CHECK DATE: 5/26/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 15108 3,644.80 MEDICAL EXAM FEES INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 c Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 05/11/2011 Invoice 00 -15108 'Date Employee Description Amount Balance.'Due 05/03/11 Collins Lar J. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 0.00 Res irator /Medical Review $16.32 $16.32 Com rehensive Physical Exam $99.96 $99.96 Muscular Strencith Endurance Test $26.52 126.52 Flexibility Test $10.20 $10.2 0 Body Fat Test BIA Blo -Elec Imp Anal 14.28 $14.28 Waist/H Ratio 13.06 $3.06 Treadmill Submax $156.00 $156.00 Tono et (Glaucoma Test) 6.7 .7 V' P Vision Acuity $26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.65 Audiometry 14.28 $14.28 EKG W/ Intem $20,40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Dunlap, Christopher T. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical xam $99.96 $99.96 Flexioility Test $10.20 $10.2 0 Bodv Fat Test Ic Imp Analy) $14.28 $1 4.28 Treadmill Submax $155.00 $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 W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.05 Harting, Charles V. OnMed Program $0.00 0.00 He alth k Appraisal M i atio l]) $0.00 $0.0 Respirator/Medical iew 3 1 -Q=rghensjyg Physical Exam $99,96 $99.96 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec ImR Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 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 $33.66 $33.66 Audiometry 14.28 $14.28 EKG W/ Interp $20.40 $20.40 Ur' 's D' sti fi 3 0 -Ho od, Bryan L OnMed Program $0 INVOICE F 0 F324 public Safety Medical Services E. New York Street E Suite 300 Indianapolis, IN 46204 Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 05/1112011 m Invoice 00 -15108 Date :Employee Description Amount.Balance Due Health Risk Aporaisal Motiv tionl $0.00 $0.00 Re it d' al Review $16.32 Comprehensive Physi I Exam $99,96 $99,9 Bodv Fat Test BIA Bio -Eiec Imp Anal $14.28 $14.28 WaistlHi 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 W1 InteM $20.40 $20.4 0 I D' 0 Oua ntiferon T ood $51 0 1.0 Venipunctu Pelzer, Robert S. 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 Flexibility Test $10.20 $10.2 0 Body Fat Test BIA Bio -Eiec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax 156.00 $156.00 Tonomet Glaucoma Test 36.72 $36.72 Vi Sign HT WT BP PR so.00 $0.00 Visio Acuity 6 2 $26.52 PET Pulmonary F T est $33.66 Audiomet $14.28 $14.28 EKG W/ Inte $20.40 $20.40 Urinalysis Dipstick 3.06 $3.06 Smith Trov D. 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 Flexibility Test $10.20 $10.20 Bodv Fat Test BIA Bio -Eiec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill $156.00 $156M Tonometry (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 W1 Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 3.06 Thomas Richard E. Quantiferon Tb Blood 51.00 $51.00 F INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 ;W. Indianapolis, IN 46204 o Carmel Police Department I CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 05/11/2011 m Invoice 00 -15108 Date Employee Description Amount Balance.Due. 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 Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator /Medical Review $16.32 $16.32 Com rehensive Physical Exam $99.96 $99.96 Flexibility Test $10,20 $10.2 t- WaistlHi 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 Audiometry $14,28 $14.28 EKG W1 Intero $20.40 $20.40 Urinalysis Di stick $3.05 $3.06 VanNatte Shane R. Urinalysis Dipstick $3.06 $3.06 O P -Ug-,alffi-Ris�Draisal (Motivation) $0.00 $Q-O 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 $156.00 Tonomet Glaucoma Test $36,72 Vital Si ns HT WT SP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test 6 333-5 6 Audigmeir 14.2 14. Total Charges $3;644:80 Total.P:ayments &Balance Due $0:00' $3,644:80 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date INVOICE 'o Public Safety Medical Services 324 E. New York Street -:E Suite 300 K am Indianapolis, IN 46204 o Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 05/11/2011 m invoice 00 -15108 Date Employee Description Amount Balance Due. 05/03/11 Collins, Larry J. 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 Muscular Strength Endurance Test $26.52 $26.52 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 Tonometr (Glaucoma Test 36.72 13 72 V' P Vision Acuity $26.52 $26.52 PFT Pulmonary Function Test $33.66 133.66 Audiometry $14.28 $14.28 EKG W/ Intem $20.40 $20,40 Urinalysis Dipstick $3.06 $3.06 Dunla Christopher T. OnMed Program $0.00 $0.00 Health Risk Aopraisal f Motivation 0.00 $0.00 Res irator /Medical Review $16,32 $16.321 Comprehensive Physical Exam $99.96 199.96 Flexibilit Test $10.20 $10.20 Bo F t Test BIA o -E ec Anal $14.8 14.26 Wai 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 Audiornetry $14.28 $14.28 EKG W/ Interp $20,40 20.40 Urinalysis Dipstick $3.06 $3.Q6 Hartina. Charles V. OnMed Program $0.00 $0.00 Health Risk ApipraisgI (Motivation) $0.00 $0.0 Respirator/MediQal Review S16,32 $16.32 Phys ical 9 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 Treadmill Submax $156.00 $156,00 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 Audiametry $14.28 $14.28 EKG Wl Intern 1 $20.40 20.40 Urinalysis Dipstick $3.06 $3.06 Hood. n. OnMed Pro cram $0.00 00 INVOICE Public Safety Medical Services F 324 E. New York Street Suite 300 W; Indianapolis, IN 46204 o Carmel Police Department I CARMEPD I 3 Civic Square Terms Carmel, IN 46032 Invoice Date 05I11/2011 Invoice 00 -15108 :Date Employee Description Amount Balance Due Health Risk Apmaisal f Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 F lexibilh Test $10.20 1 Bodv Fat Test BIA Bio -Elec Imp Anal $14.28 $14.28 Waist /Hi Ratio $3.06 $3.06 Treadmill Submax $156.0o $156.00 Tonomet Glaucoma Test 36.72 $36.72 Vital Signs HT WT BP P R $0,00 $0.00 Vision Acuity 26.52 $26,62 PFT Pulmonary Function Test $33.66 $33.66 AudiometU $14.28 $14.28 EKG W/ Inter 20.40 $20.40 Ur' I i Dimfick $3-06 antiferon Tb (Blood) 51 0 51. 0 V $3.06 $3.0 Pelzer, Robert S. 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 $99.95 Flexibility Test $10.20 $10.2 0 Body Fat Test BIA Bio -Elec ImQ Anal 14.28 $14.281 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 10.00 10.00 V sion Acuity $26.52 $26.52 FT P F c' n Test $33.66 Audiomet $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3,0 6 Smith Trov D. 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 Flexibility Test $10.20 $10.2 0 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax 1 $156.0 Tes Vital Signs HT WT BP P R $0.00 $0.00 Vision AcuitV $26.52 $26.52 PFT PulmonarV Function Test $33.66 $33.66 AudiometEy $14.28 $14.28 EKG W/ Interp $20.40 $20,40 Urinalysis Dipstick $3.06 $3.06 Thomas Richard E. Quantiferon Tb Blood $51.00 $51.0 0 INVOICE Public Safety Medical Services 324 E. New York Street `E Suite 300 .0: Indianapolis, IN 46204 o Carmel Police Department/ CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice mate 05/11/2011 �m Invoice 00 -1510$ Date Employee Description Amount Balance. Due. CMP (Comp Metabolic Panel 19.52 $19.52 CBG (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 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 $10,2 0 Body Fa Tgs BIA I 14 1 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 W/ interp $20.40 $20.40 Urinal sis Dipstick $3.06 $3.06 VanNatter. Shane R. Urinalysis Di stick $3.06 13.06 OnMed Program $0.00 $0.00 Health Risk Moraisal (Mo Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Flexibilit Test $10.20 10.20 BodV Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.D6 $3.0 6 Treadmill Submax $156.00 $156.00 Tonometr Glaucoma Test 36.72 $36,72 Vital Signs HT WT BP P R $0.00 M0 Vision Acuity 26.52 $26.62 PFT Pulmon Function Test $33.66 $33.66 Audiomet 14.28 $14.28 EKG W/ r Total Charges $3;644:80 Total Payments &'Balance Due I$0:00 $3,644:80 Please write invoice number on payment check. Balance due 15 days from invoice 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 $3,644.80 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1110 15108 43- 407.01 $3,644.80 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 Thursday May 19, 2011 Chief of Po Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Fora 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)) 0511 1111 15108 payment for officer physicals $3,644.80 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