155961 01/23/2008 CITY OF CARMEL, INDIANA VENDOR: 360695 Page 1 of 1
ONE CIVIC SQUARE WOODVIEW PSYCHOLOGY GROUP
CARMEL, INDIANA 46032 70 E 91ST ST SUITE 210 CHECK AMOUNT: $100.00
INDIANAPOLIS IN 46240 CHECK NUMBER: 155961
CHECK DATE: 1/2312008
DEP ARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
J
G51 5023990 010908 100.00 EMPLOYEE PENSIONS B
a
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: 01/09/2008
John Duffy
City of Carmel
760 3rd Ave. SW
Carmel, IN 46032
d al
Date Procedure Charges And Credits y Amount h ,�G Your Portion
r
n�a<.�,�,..
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
01/09/2008 90806 Individ. psych., insight oriented; 45 -50 130.00 25.00
minutes
01/09/2008 Fee Reduction -24.70
Amount Your Portion
Previous Balance 0.00 0.00
Total Charges $494.10 $100.00
Total Payments $0.00 $0.00
Total $494.10 $100.00
Please Pay $100.00
VOUCHER 077096 WARRANT ALLOWED
T1013 IN SUM OF
OODVIEW PSYCHOLOGY GROUP
?70 EAST 91 ST STREET STE 210
INDIANAPOLIS, IN 46240
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
.010908 01- 7040 -08 $100.00
Voucher Total $100.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
�4
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T1013
WOODVIEW PSYCHOLOGY GROUP Purchase Order No.
70 EAST 91 ST STREET STE 210 Terms
INDIANAPOLIS, IN 46240 Due Date 1/11/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/11/2008 010908 $100.00
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 aN
Date Officer