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Home My WebLink About198239 06/06/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 s4s'' �t. ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $4,542.92 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 198239 CHECK DATE: 6/6/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 15218 1,098.78 MEDICAL EXAM FEES 1110 4340701 15262 3,444.14 MEDICAL EXAM FEES INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 d W Indianapolis, IN 46204 C Carmel Police Department CARMEPD F 3 Civic Square Terms Carmel, IN 46032 Invoice Date 06/02/2011 m Invoice 00 -15262 Date Employee Description Amount Balance Due 05/23/11 Bickel Scott W. Injection Fee $10.20 $10.2 0 Td Tetanus Diphtheria) Vacc $20.40 $20.40 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator /Medical Review $16.32 $16.321 Comprehensive Physical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.00 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 T n r (Glaucoma T est) $36.72 $36.7 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 $3.06 Dietz. Aaron K. 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 Treadmill Submax 156.00 $156.00 F lexibilit y T est $10.20 $10.2 0 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 Signs HT WT BP P R $0.00 $0.0 0 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiometry 14.28 $14.28 EKG W/ Intero $20.40 $20.40 Urinalysis Di stick $3.06 $3.06 Tda Teta Di hth Pertussis Error/ $20.40 $20.4 0 In ection Fee $10.20 $10.20 F t r J hn th n A. OnMed Pr r Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.00 Flexibilitv Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imo Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Tonometr Glaucoma Test 36.72 $36.72 Vital Si ns HT WT BP P R $0.00 $0.00 Vision uity $26.52 $26.52 PFT Pulmonary Function Test 33.66 33.66 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 ix Indianapolis, IN 46204 G Carmel Police Department CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 06/0212011 m Invoice 00 -15262 Date Employee Description Amount Balance Due Audiometry 14.28 $14.28 EKG W/ Intery $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Malloy, rin Iniection F $10.20 1 Td Tetanus Diphtheria) Vacc $20.40 $20.40 Comprehensive Physical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.00 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 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. $33.66 Audiometry 14.28 $14.28 EKG W Intero $20.40 $20.4 Urinalysis Dipstick $3.06 $3.06 Quantiferon Tb Blood $51.00 $51.00 Veni uncture $3.06 $3.06 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 0.00 Respirator/Medical Review $16.32 $16.32 Pitman. Michael A. OnMed Program $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.00 Flexibility Test $10.20 $10.20 Bodv Fat Test BIA (Bio-Elec Imp Anal y) $14.28 $14,2 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 AcuitV $26.52 $26.52 PFT Pulmonary Function Test E$33.66 $33.66 Audiomet 14.28 EKG W/ Inter 20.4 Urinal sis Di stick 3.0 Tda Tet Di hth Pertuss Vacc Error 20.40 In ection Fee $10.20 $10.20 Schoeff Jr. Donald D. Tda Teta Di hth Pertussis Error $20.40 $20.4 0 In e tion Fee $10.20 $1 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 Treadmill Submax $156.00 $156.00 FlexibilitV Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 x Indianapolis, IN 46204 o Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 06/02/2011 m Invoice 00 -15262 Date Employee Description Amount Balance Due 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 Audiometry 14.28 $14.28 EKG W/ Intero $20.40 $20.40 Urinalysis Di stick $3.06 $3.06 Scott. Curtis D. OnMed Program $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.001 Respir R 16.2 1 .32 Comprehensive Phvsical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.00 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 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/ Inte 20.40 20.40 ri I i Di ti k .06 Tda Teta Di hther Pertussis Error $20.40 $20.40 Injection Fee $10.20 $10.20 Stein Am J. No Show Fee $40.00 $40.001 05/24/11 Flaming, Anna G. 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 HIV 1 2 Blood 13.26 13.26 Total Charges $3,444.14 Total Payments Balance Due $0.00 $3,444.14 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date Prescribed by Staie Board of Accoums 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 b ill(s)) 06/02/11 15262 payment for officer physicals $3,444.14 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 S 324 E. New York Street, Suite 300 Indianapolis, IN 46204 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT# /TITLE AMOUNT Board Members I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 15262 43- 407.01 S144414 materials or services itemized thereon for which charge is made were ordered and received except Monday, June 06, 2011 L Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE 0 Public Safety Medical Services 324 E. New York Street d Suite 300 W Indianapolis, IN 46204 o Carmel Police Department CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 05/2512011 m Invoice 00 -15218 Date Employee Description Amount Balance Due 05/16/11 Bickel. Scott W. 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 Quantiferon Tb Blood 51.00 $51.0 0 Foster Johnathan A. Quantiferon Tb (Blood) $51.00 $51.00 CMP (Comp Metabolic Panel 19.52 $19.52 CBC (Como Blood Count 17.68 $17.68 Li id Panel Blood 20.74 $20.74 Ven ipuncture $3.06 $3 HIV 1 2 Blood $13.26 $13.26 Govin, John K. 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 Malloy, Katherine E. CMP Com p 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 Pitman, I A. Quantiferon T (Blood) 1. 1. CMP (Comp Metabolic Panel $19.52 $19.52 CBC Com p 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 Schoeff Jr. Donald D. Quantiferon Tb Blood 51.00 $51.00 CMP (Comp Metabolic Panel $19.52 $19.52 CBC (Como 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 Stein. if r n T BI 0 $51. CMP Com 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 H!V 1 2 Blood 13.26 13.26 05/19/11 Paris Mark J. Quantiferon Tb Blood 51.00 $51.00 CMP Com 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 JE� INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 d W Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 05/25/2011 m Invoice 00 -15218 Date Employee Description Amount Balance Due PSA Prostate Specific A Blood 35.70 $35.70 05/20/11 L,,c,. Scott D. Quantiferon Tb Blood 51.00 $51.00 CMP Com Metabolic Panel 19.52 19.52 C (Comp Blood Count) 17 .68 $17. Lipid Panel Blood $20.74 $20.74 Veni uncture $3.06 $3.06 HIV 1 2 Blood $13.26 1 $13.26 Total Charges $1;098.78' Total Payments &Balance Due $0.00 $1,098.78 Please write invoice number on payment check. Balance due 15 days Our Federal Employer Identification Number is 35- 2079797 fr Sate om invoice Prescribed by State Board of Accounts City Form No. 201 (Rev. 199E) 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)) 05/25/11 15218 payment for officer physicals $1,098.78 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 Street, Suite 300 Indianapolis, IN 46204 $1,098.78 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 15218 43- 407.01 $1,098.78 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, June 03, 2011 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund