HomeMy WebLinkAbout155558 01/10/2008 CITY OF CARMEL, INDIANA VENDOR: 360695 Page 1 of 1
1. ONE CIVIC SQUARE WOODVIEW PSYCHOLOGY GROUP
g 0 CHECK AMOUNT: $75.00
CARMF_L, INDIANA 46032 70 E 91ST ST SUITE 210
INDIANAPOLIS IN 46240 CHECK NUMBER: 155558
CHECK DATE: 1/10/2008
DDARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 75.00 7040.08XPENSES
i
Billing Statement
Woodview Psychology Group Client: Patrick Rigdon
70 East 91st Street, Suite 210 Diagnosis: 309.81
Indianapolis, IN 46240 Provider Name: Pam Christy, Psy.D., HSPP
(317) 573 -0149 Provider Tax Id: 20- 4661508
Provider License: 20041691A
Date: 12/19/2007
John Duffy
City of Carmel
760 3rd Ave. SW
Carmel, IN 46032
Date s Procetlure Char es Antl�Credits�
g Amount Your Portion
a z
.:vY„,
12/05/2007 90801 Psychiatric diagnostic interview 220.00 25.00
examination
12/05/2007 Fee Reduction 41.80
12/12/2007 90806 Individ. psych., insight oriented; 45 -50 130.00 25.00
minutes
12/12/2007 Fee Reduction -24.70
12/19/2007 90806 Individ. psych., insight oriented; 45 -50 130.00 25.00
minutes
12/19/2007 Fee Reduction -24.70
Amount Your Portion
Previous Balance 0.00 0.00
Total Charges $388.80 $75.00
Total Payments $0.00 $0.00
Total $388.80 $75.00
Please Pay $75.00
a
CITE f. EL
JAMES BRAINARD, MAYOR
December 5, 2007
Woodview Psychology
70 East 91" Street, Suite 210
Indianapolis, IN 46240
To Whom It May Concern:
City Of Carmel employee Patrick Rigdon has an appointment scheduled today (12/5/07)
with Dr. Pamela Christy.
The City has agreed to pay the $25 copay for Mr. Rigdon's current and future visits, up to
a maximum of 12 (twelve) visits in the next three (3) months.
Insurance claims for the visits should be submitted to Sagamore. We would appreciate it
if you would bill the $25 copays to the City of Carmel. The invoice can be sent to the
address below:
John Duffy, Utilities Director
760 3` Avenue SW
Carmel, IN 46032
Please call me (571 -2471) or Mr. Duffy (571 -2451) if you have any questions. I will be
out of town for the next few days, but will return next Tuesday, December 11.
Sincerely,
Barbara A. Lamb
Director of Human Resources
cc: John Duffy, Utilities Director
DEPARTMENT OF HUMAN RESOURCES, ONE CIVIC SQUARE, CARMEL, IN 46032
OFFICE 317.571.2465, FAx 317.571.2409
1 ?re m No 301 St Bo 1995) CCOUnts ACCOUNTS PAYABLE VOUCHER
i
Form No. 301 -5 (Rev. 1995)
TO
ADDRESS
Invoice Date Invoice Number Item Amount
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
1 19
Signature Title
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.
19
ffi r Title
Voucher No. Warrant No.
ACCOUNTS PAYABLE DETAILED ACCOUNTS
SANITATION DEPARTMENT ACCT.
CARMEL, INDIANA
W oo iew P50 o Fav Of,�oup 007
70 V5 It S f .5 le 21D
1�� Y6,2 YO
Total Amount of Voucher
Deductions
/2
75 00
Amount of Warrant
Month of 19
VOUCHER RECORD No.
Collection System
Operation
Plant
Commercial
General
Undistributed
Construction
Depreciation Reserve
Stock Accounts Merchandise
Total
Allowed
Board Members
Filed
BOYCE FORMS SYSTEMS 1- 800 3828702 325