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Home My WebLink About198717 06/22/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES s CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $2,480.34 INDIANAPOLIS IN 46204 CHECK NUMBER: 198717 CHECK DATE: 6/22/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 15314 2,480.34 MEDICAL EXAM FEES INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 d a: Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 06/08/2011 m Invoice 00 -15314 Date Employee Description Amount Balance Due 06/03/11 Dawson, Gregory F. OnMed Program $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Ph sical Exam $99.96 $99.96 Tonomet Glaucoma Test $36.72 $36.72 Vital Signs HT WT BP P R $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 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Flamina, Anna G Flexibility T est $10.20 $1 0.20 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 Infection Fee $10.20 $10.2 0 Td Tetanus Diphtheria) Vacc $20.40 $20.4 0 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 $20.40 Unn I sis Di stick $3.06 $3.06 OnMed r r Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Govin. John K. 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 $99.961 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imo Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.0 6 Treadmill Submax $156.00 $156.0 0 Tonometry (Glaucoma T est) $36.72 $36 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 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Lipid Panel Blood (Repeat N/C 0.00 $0.00 CMP Com p Metabolic Panel Repeat $0.00 $0.00 He B Titer SAb Quantitative Blood 35.70 $35.70 Veni uncture (Repeat N/C 0.00 $0.00 Long, Scott D. In ection Fee $10.20 10.20 11 1 INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 4) a: Indianapolis, IN 46204 o Carmel Police Department CARMEPD H 3 Civic Square Terms Carmel, IN 46032 Invoice Date 06/08/2011 m Invoice 00 -15314 Date Employee Description Amount Balance Due Td Tetanus Diphtheria) Vac c 20.40 $20.40 OnMed Program $0.00 $0.001 Health Risk Armraisal Motivation 0.00 $0.00 Respirat or/Medical Rev 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 $3.06 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 $20.4 0 i Paris, Mark J. OnMed Pro ram $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 -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 P Function T Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinal sis Dipstick $3.06 $3.06 Injection Fee $10.20 $10.20 Td Tetanus Diphtheria) Vacc $20.40 $20.40 Stein. Amy J. 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 Fat Test BIA Bio -Elec Imn Anal 14.28 $14.28 W ti 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 Audiometry 14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 m of Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 06/08/2011 0o Invoice 00 -15314 Date Employee Description Amount Balance Due Total Charges $2,480.34 Total Payments Balance Due $0.00 $2,480.34 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from Invoice 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 06/08/11 15314 payment for officer physicals $2,480.34 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. WARR NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $2,480.34 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 15314 43- 407.01 $2,480.34_ 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 17, 2011 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund