HomeMy WebLinkAbout200076 08/03/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $22,668.32
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
}6� `o INDIANAPOLIS IN 46204 CHECK NUMBER: 200076
CHECK DATE: 8/3/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 R4340799 24186 11 -10340 2,500.00 WORK PERFORMANCE EVAL
1120 4340701 24216 15579 8,187.86 ANNUAL EXAMS
1120 4340701 24216 15621 5,540.04 ANNUAL EXAMS
1110 4340701 15622 447.18 MEDICAL EXAM FEES
1120 4340701 24216 15665 5,456.50 ANNUAL EXAMS
1110 4340701 15666 536.74 MEDICAL EXAM FEES
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
m
a: Indianapolis, IN 46204
0 Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/13/2011
m Invoice 00 -15579
Date Employee Description Amount Balance Due
07/05/11 Brandt. Gary D. CMP (Comp Metabolic Panel $19.52 $19.52
CBC (Comp Blood Countl $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
PSA Prostate Specific A Blood $35.70 $35.70
Butts. Joseph A. CMP Com Metabolic Panel $19.52 $19.52
CBC (Como Blood Count) $17.68 $17.68
Lipid Panel Blood 2074 $20.74
Veni uncture $3.06 S3.06
PSA Pr ostate Soecific An (BlQod) $35,70 $35.70
Condra. Kyle E. 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
Cox. Justin M. 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
CMP (Comp Metabolic Panell $19.52 $19.52
Deitsch. Marc W. CMP (Com o Metabolic Panel) $19.52 $19.52
B lood CBC (Comr) n 17 17
Lipid Panel (Blood) $20.74 $20.74
Veni uncture $3.06 $3.06
HIV 1 2 (Blood) $13.26 $13.26
Edwards. Daniel E. 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
PSA Prostate Specific A (Blood) $35.70 $35.70
Fisher. Gary MP (Como Metabolic Panel 19.52 $19.52
BC (Comp Blood Count) $17.68 $17.68
Lipid Panel 74 $20.7
Veni uncture $3.06 $3.06
HIV 1 2 (Blood) $13.26 $13.26
PSA Prostate Specific A (Blood) $35.70 $35.70
Frenzel. Eric C. CMP (Como Metabolic Panel) $19.52 $19.52
CBC (Como Blood Count) $17.68 $17.68
Li id Panel (Blood) $20.74 $20.74
Veni uncture $3.06 $3.06
PSA Prostate Specific A (Blood) $35.70 $35.70
Griffin. Timothy M. Lipid Panel Blood) $20.74 $20.74
Ven uncture 3 -06 $3.06
HIV 1 2 (Blood) $13.26 $13.26
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
W
i= Indianapolis, IN 46204
o Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/13/2011
m Invoice 00 -15579
Date Employee Description Amount Balance Due
PSA Prostate Specific A Blood 35.70 $35.70
CMP (Como Metabolic Panel 19.52 $19.52
CBC Com Blood Count 17.68 $17.
Johnson. Jeremy S, CIVIP (Comp Metabolic P an 1) %19,52 $1 9.52
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
Kelsheimer. Troy 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
PSA Prostate Specific Aci (Blood $35.70 35 7
Cholinesterase RBC Plasm Blood $45.90 S45.90
B radley P Metabolic P 1
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
Cholinesterase RBC Plasma (Blood) $45.90 $45.90
Osborne. Scott K. PSA Prostate Specific A (Blood) $35.70 $35.70
Cholinesterase RBC Plasma (Blood) $45.90 $45.90
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 0 1
Pavne. Thomas C. 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
Reecer. Jason L. CMP (Comp 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
PSA Prostate S ecific A Blood 35.70 $35.70
Cholinesterase R C Plasma (Blood) $45.90 $45.9Q
Rev nolds Shawn J. CMP I Pane Paneh $19,52 1
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
PSA Prostate Specific A (Blood) $35.70 $35.70
Rohr, Christopher M. CMP (Como Metabolic Panel) $19.52 $19.52
CBC (Como $1
Blood Count) $17.68 7.68
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
a)
tr Indianapolis, IN 46204
o Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/13/2011
m Invoice 00 -15579
Date Employee Description Amount Balance Due
Lipid Panel (Blood) $20.74 $20.74
Veni uncture $3.06 $3.06
HIV 1 2 (Blood) $13.26 $13.26
PSA Prostate Specific A Blood $35.70 $35.70
S elbrin James E. CMP Como 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
PSA Prostate Specific A' Blood 35:70 $35.70
Tierney. Scott A. CMP (Como Metabolic Panel 19.52 $19.52
Blo CBC (Comp 17 1
Lioid Panel (Blood) $20.74 $20.74
Veni uncture $3.06 $3.06
HIV 1 2 Blood $13.26 $13.26
PSA Prostate Specific A (Blood) $35.70 $35.70
Walker. Christopher E. 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
Weaver. Virgil L. CMP (Comp Metabolic Panels $19.52 $19.52
CBC (Como Blood Count 17.68 $17.68
Lip id Panel (Blood) $20 $20.74
Veni uncture $3.06 $3.06
HIV 1 2 (Blood) $13.26 $13.26
Wendzel. Jason D. 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
W ant. Andrew D. CMP (Como Metabolic Panel) $19.52 $19.52
CBC (Como Blood Count $17.68 $17.68
Lip id Panel Blood/ $20.74 $20.7
Veniouncture $3.06 $3.06
HIV 1 I ood) $13.26 $1 3.26
07/06111 DeCrastos. Richard A. CMP (Comp Metabolic Panel) $19.52 $19.52
CBC (Como Blood Countj $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
PSA Prostate Specific A Blood) $35.70 $35.70
Edwards. Steven L. CMP (Comp Metabolic Panel) $19.52 $19.52
CBC (Comp Blood Count $17.68 $17.68
Lipid Panel Blood/ $20.74 $20.74
Veni u cture $3.06 .06
PSA Prostate Specific A Blood 35.70 35.70
INVOICE
H Public Safety Medical Services
324 E. New York Street
W
Suite '300
Indianapolis, IN 46204
0 Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/13/2011
m Invoice 00 -15579
Date Employee Description Amount Balance Due
Force, Jason S. CMP (Comp Metabolic Panel 19.52 $19.52
CBC (Como Blood ourit $17.68 17 68
Li id Pane Blood 20.74 $20.74
Venipunctur
Fuchs. Jeffery 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 $1126
Cholinesterase RBC Plasma Blood $45.90 $45.90
Gipson. Bruce E. CMP (Comp Metabolic Panel) $19.52 $19.52
CBC (Comp Blood Count $17.68 $17.68
Li id Panel (Blood) $20.74 $20.74
Veni un ture $3.06 $3.06
HIV 1 (Blood) 13.26 $13.26
PSA r 'fi A 1 $35.70 $35
Gu el. Mark E. CMP (Comp Metabolic Panel $19.52 $19.52
CBC (Comp Blood Count) $17.68 $17.68
Livid Panel (Blood) $20.74 $20.74
Veni uncture $3.06 $3.06
HIV 1 2 Blood $13.26 $13.26
PSA Prostate Specific A (Blood) $35.70 $35.70
Cholinesterase RBC Plasma (Blood) $45.90 $45.90
Hensley. Robert P. CMP (Comp Metabolic Panel) $19.52 $19.52
CBC (Comp Blood Count) $17.68 $17.68
i id Panel Blood 20.74 $20.74
Ven uncture $3.06 $3.06
HIV 1 BI 1
PSA Prostate Specific A (Blood) $35.70 $35.70
Hulett. Mark A. CMP (Como 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
PSA Prostate Specific A Blood $35.70 $35.70
Marsh. Michael A. CMP (Comp Metabolic Panel 19.52 $19.52
CBC (Comp Blood Courit 17.68 $17.68
Lipid Panel Blood 20.74 $20.74
Veni uncture $3.06 $3.0 6
HIV to 6 $13.261
PSA Prostate Specific A (Blood) $35.70 $35.70
McNab. John D. 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
PSA Prostate Specific A (Blood) $35.70 $35.70
INVOICE
H Public Safety Medical Services
324 E. New York Street
a�
Suite 300
X Indianapolis, IN 46204
C Carmel Fire Department CARMEFD
2 Civic Square Terms
Invoice Date 07/13/2011
Carmel, IN 46032
00 Invoice 00 -15579
Date Employee Description Amount Balance Due
McNair, Travis L. 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
Paddock Ronald D. 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
P Joseoh P CMP P anel) $19.52 $19.
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
PSA Prostate Specific A Blood $35.70 $35.70
Cholinesterase RBC Plasma Blood $45.90 $45.90
Reeves. Neil P. 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 13.6 $13.
R BC PI 1 $45 $45.9
Smith. Brian E. CMP (Comp 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
PSA Prostate Specific A Blood $35.70 $35.70
Stindle. Kevin P. CMP (Comp Metabolic Panel/ $19.52 $19.52
CBC (Comp Blood Count 17.68 $17.68
Lipid Panel Blood 20.74 $20.74
Venipunct ure $3.06 $3.06
HIV 1 2 (Blood) 13.26 $13.2
St rouo Scott A. MP el 1
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
Utzi Chad M. 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
Cholinesterase RBC Plasma Blood 45.90 $45.90
Watts. Trent E. CMP (Como Metabolic Panel S19.52 19.52
INVOICE
0 Public Safety Medical Services
324 E. New York Street
a�
Suite 300
ir Indianapolis, IN 46204
C Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07113/2011
m Invoice 00 -15579
Date Employee Description Amount Balance Due
CBC Com Blood Count 17.68 $17.68
'joid Panel (Blood) 0.74 $20.74
Veni uncture $3.06 $3. 06
HIV 1 1
Cholinesterase RBC Plasma (Blood) $45.90 $45.90
Zeller. Michael J. CMP (Comp 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
Cholinesterase RBC Plasma Blood $45.90 $45.90
1 07/07/11 Allen. Brad A. CMP (Comp Metabolic Panel! $19.52 $19.52
CBC Com Blood Count 17.68 $17.68
Li id Panel (Blood) 20.74 $20.74
Veni uncture $3.06 $3.0 6
V 1 (Blood) $13.26 $1 3.26
Baskerville. Anthony A. 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
Butts. Renee L. 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
C allahan. Mark. CMP (Como Metabolic Panel) $19.52 $19.52
CBC (Comn Blood Count 17.68 $17.68
Lio id Panel 74 $20.7
Veni uncture $3.06 $3.06
HIV 1 2 (Blood) $13.26 $13.26
PSA Prostate Specific Ao (Blood) $35.70 $35.70
Contino. David M. 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
Cholinesterase RBC Plasma (Blood) $45.90 $45.90
Crane. Barry L. CMP (Comp Metabolic Panel 19.52 $19.52
C13C (Como Blood Count 17.68 $17.68
Lio id Panel I 0.74 $20.7
Veni uncture $3.06 $3.06
HIV 1 2 (Blood) $13.26 $13.26
PSA Prostate Specific Ao (Blood! $35.70 $35.70
Foster. James P. CMP (Como Metabolic Panel) $19.52 $19.52
CBC Como Blood Count) $17.68 $17.68
Li id Panel (Blood) $20.74 $20.74
Veni uncture $3.06 $3.06
INVOICE
t o Public Safety Medical Services
324 E. New York Street
m
Suite 300
W Indianapolis, IN 46204
C Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/13/2011
m Invoice 00 -15579
Date Employee Description Amount Balance Due
HIV 1 2 (Blood) $13.26 $13.26
PSA Prostate Specific A (Blood) $35.70. $35.70
Cholinesterase RBC Plasma (Blood) 45.90 $45.90
Grimes. Jeffrey A. CMP (Como Metabolic Panel/ $19.52 $19.52
CBC (Comp Blood Count) $17.68 $17.68
Lipid Panel Blood/ $20.74 $20.74
Veniouncture $3.06 $3.06
HIV 1 2 Blood 13.26 $13.26
PSA Prostate Specific A Blood) 35.70 $35.70
Haus Joshua S. CMP Com Metabolic Panel) 19.52 $19.521
CBC (Com Bl ood n t) $17.68 $17
Lipid Panel (Blood) $20.74 $20.74
Veni uncture $3.06 3.06
HIV 1 2 (Blood) $13.26 $13.26
Howard. Wendell E. CMP (Como 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
PSA Prostate Specific A Blood 35.70 $35.70
Hughes. Chad L. CMP (Como Metabolic Panel $19.52 $19.52
BC (Comp Blood Count $17.68 $17.6
L ioid Panel .74 $20.74
Veniouncture $106 $3.06
HIV 1 2 Blood $13.26 $13.26
PSA Prostate Specific Ao (Blood) $35.70 $35.70
Mead Jr.. Donald R. CMP (Como 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
PSA Prostate Specific A (Blood) $35.70 $35.70
Nicley Wes W. CMP (Como Metabolic Panel) 19.52 $19.
CBC (Como Blood Count 17.68 $17.68
Lio id I 74 $20,74
Veni uncture $3.06 $3.06
HIV 1 2 (Blood) $13.26 $13.26
Phillips. Crain M. CMP (Como 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
PSA Prostate Specific A Blood 35.70 $3530
Reeves. Stephen J. CMP (Como Metabolic Panel 19.52 $19.52
CBC (Como Blood Count 17.68 $17.68
Li id Panel Blood 20.74 $20.74
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite'300
d
M Indianapolis, IN 46204
o Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/13/2011
m Invoice 00 -15579
Date Employee Description Amount Balance Due
Veni uncture $3.06 $3.06
HIV 1 2 Blood $13.26 $13.261
PSA Prostate S ecific A Blood 35.70 $35.70
Rob inson. P P anel) $19.52 $1 9.52
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
PSA Prostate Specific A Blood $35.70 $35:70
Robinson. Mitchell L. 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
PSA Prostate Specific A Blood 35.70 $35.70
Stee Jeffrey A. CMP (Como Metabolic Panel
CBC (Comp Blood Count) $17.68 $17.68
Lipid Panel Blood $20.74 $20.74
Veni uncture $3.06 $3.06
PSA Prostate Specific A (Blood) $35.70 $35.70
Thordarson. Erik M. 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
Cholinesterase R C Plasma Blood $45.90 $45.
Woodburn, Scott E. CMP (Corn Metabolic Panel) 1 2 $19.52
B lood CBC (Corno t 17
Lipid Panel (Blood) $20.74 $20.74
Veni uncture $3.06 $3.06
HIV 1 2 Blood $13.26 $13.26
07/08/11 Collins. Tonv A. 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
PSA Prostate S ecific A (Blood) $35.70 $35.70
Dorsch. James E. CMP (Com Metabolic Panel) $19.52 $19.52
CBC (Corn Blood Count $17.68 $17.68
Li id Panel (Blood) $20.74 $20.74
V eniouncture $3.06 $3,06
HIV 1 2 Blood $13.26 $13.26
PSA Prostate Specific A (Blood) $35.70 $35.70
Drake. Carl D. 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) 1 $13.26 $13.26
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite-300
m
tY Indianapolis, IN 46204
C Carmel Fire Department I CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/13/2011
m Invoice 00 -15579
Date Employee Description Amount Balance Due
PSA Prostate Specific A (Blood) $35.70 $35.70
Haboush. David G. 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
PSA Prostate Specific A Blood 35.70 $35.70
Cholinesterase RBC Plasma Blood 45.90 $45.90
Holubik. Steven W. CMP (Comp Metabolic Panel 19.52 19:52
CBC (Comp Blood Count) $17.68 $17.68
L ioid P I 74 $20.74
Veni uncture $3.06 $3.06
HIV 1 2 Blood $13.26 $13.26
PSA Prostate Specific A (Blood) $35.70 $35.70
Horner. David W. CMP (Como 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
PSA Prostate Specific A Blood 35.70 $35.701
Kinney. Jared N. CMP (Como Metabolic Panel) $19.52 $19.52
CB (Como Blood Count 17.68 $17
Lip id Panel I 74 $20.7
Veni uncture $3.06 $3.06
HIV 1 2 (Blood) $13.26 $13.26
Lenze. Theodore A. CMP (Como Metabolic Ranel $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
Lux. Michael T. CMP (Como Metabolic Panel) $19.52 $19.52
CBC (Comp Blood Count) $17.68 $17.68
Li id Panel (Blood) 0.74 $20.74
Veni uncture $3.06 $3.06
V 1 $13.26
PSA Prostate Specific A (Blood) $35.70 $35.70
Maroon. Ernie R. 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 $3.0 6
HIV 1 2 Blood $13.26 1 $13.26
PSA Prostate Specific A Blood) 35.70 35.70
Schooler. Dustin D. CMP (Como Metabolic Panel) 19.52 19.52
CBC Com Blood Count 17.68 17.68
Li id Panel Blood 0.74 20.74
Veni uncture 3.06 $3.06
INVOICE
0 Public Safety Medical Services
324 E. New York Street
d
Suite 300
Indianapolis, IN 46204
H Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/13/2011
m Invoice 00 -15579
Date Employee Description Amount Balance Due
HIV 1 2 Blood 13.26 $13.26
Utzia, Todd T. CMP (Comp Metabolic Panel 19.52 $19.52
CBC (Com Blood Count $17.68 $17.68
Lbid Panel 7a
Veni uncture $3.06 $3.06
HIV 1 2 (Blood) $13.26 $13.26
Weddinoton. Kurt L. CMP (Comp 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
PSA Prostate Specific A Blood 35.70 $35.70
Witsken. Steven J. CMP (Comp Metabolic Panel $19.52 $19.52
CBC Com Blood Count) $17.68 $17.68
L' id Panel Blood/ $20.74 $20.74
Venbu ncture $3,0
HIV 1 2 (Blood) $13.26 $13.26
PSA Prostate Specific A (Blood) $35.70 $35.70
Workman. William J. CMP Comp 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
PSA Prostate Specific A (Blood) $35.70 $35.70
Wynn. Barbara M. CMP (Comp Metabolic Panel) $19.52 $19.52
CBC Com Blood Count 17.68 $17.68
L ipid Panel Blood 20.74 $20.74
Ve re
HIV 1 2 (Blood) $13.26 $13.26
Young, Alan R. 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
PSA Prostate Specific A Blood 35.70 $35.70
Total Charges $8,187.86
Total Payments &Balance Due $0.00 $8.187.86
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797 date
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
m
x Indianapolis, IN 46204
c Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/20/2011
m Invoice 00 -15621
Date Employee Description Amount Balance Due
07/11/11 Anderson Donovan C. 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
PSA Prostate S ecific A Blood 35.70 $35.70
Bartrom Brad A. CMP (Comp Metabolic Panel 19.52 $19.52
CBC (Comp Blood Count) 17.68 $17.68
Lipid Panel Blood 20.74 $20.74
Venipuncture $3.06 $3.061
PSA Prostate Specific A Blood $35.70 $3530
Benbow, Kip S. 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 $3.061
HIV 1 2 Blood 13.26 $13.261
Bowles. Orbie H. CMP Corn 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 $13.26 $1 3.26
P
Cromlich. Mark A. 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
PSA Prostate Specific A Blood 35.70 $35.70
DeLona, Michael T. CMP Corn Metabolic Panel 19.52 $19.52
CBC (Como Blood Count 17.68 $17.68
Li id Panel Blood $20.74 $20.74
Venbuncture $3.06 $3.0
IV 1 2 (Blood) $13.26 $13.26
Essex-Cm Q 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
Gehlbach Marc A. Veni uncture $3.06 $3.06
HIV 1 2 Blood 13.26 $13.26
PSA Prostate Specific A Blood 35.70 $35.70
CMP (Comp Metabolic Panel 19.52 $19.52
CBC Com Blood Count 17.68 $17.68
I (Blood) 74 7
G iles, Wil i m o Metabolic Panel) 9 $19.5
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
d
X. Indianapolis, IN 46204
c Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/20/2011
m Invoice 00 -15621
Date Employee Description Amount Balance Due
CBC Com Blood Count 17.68 $17.68
Pane (Blood) 4 $20.7
Veniouncture
PSA Prostate Specific A Blood $35.70 $35.70
Cholinesterase RBC Plasma Blood $45.90 $45.90
Holden Adam D. CMP (Comp Metabolic Panel $19.52 $19.521
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
PSA Prostate Specific A Blood 35.70 $35.70
Hoover Anthony B. CMP omp Metabolic Panel) 19.52 $19,52
CBC omp B lood Count) 7
-L b id Panel 7 4
Venqpuncture $3.06 $3.06
PSA Prostate Specific A Blood $35.70 $35.70
Love. Joseph B. CMP (Como 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
PSA Prostate Specific A Blood 35.70 $35.70
Maners Jeremy B. CMP (Como Metabolic Panel 19.52 $19.52
CBC (Como Blood Count 17.68 $17.68
L ipid P 74 $20.74
Veniouncture $3.06 $3.06
Cholinesterase RBC Plasma Blood $45.90 $45.90
Martin, Richard A. 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 $3.061
HIV 1 2 Blood 13.26 $13.261
PSA Prostate Specific A Blood 35.70 $35.70
Mitchell James C. CMP (Como Metabolic Panel 19.52 $19.52
CBC (Como Blood Count 17.68 $17.68
Li id Panel (Blood) 20.74 $20.74
Venbuncture $3.06
1
Mowery. Anthony 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
Mulford. David A. CMP (Comp Metabolic Panel $19.52 $19.52
CBC (Como Blood Count 17.68 $17.68
INVOICE
0 Public Safety Medical Services
324 E. New York Street
d
Suite 300
W Indianapolis, IN 46204
c Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/20/2011
m Invoice 00 -15621
Date Employee Description Amount Balance Due
Lipid Panel Blood 20.74 $20.74
Veni uncture $3.06 $3.0 6
HIV 1 2 (Blood)13.26 13.26
PSA Prostate Specific A Blood 35.70 $35.70
Plumer. Charles J. CMP (Comp 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 $3.0 6
HIV 1 2 Blood 13.26 13.26
PSA Pr e ifi A (Blood) $35.70
Chofinesterase RBC Plasma (Blood) $45.90 $45.90
Ryan, Christopher D. 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
Sombke. Brad D. 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 13.6 $13.26
PSA Prostate Soecific A (Blood) .7 5
B. CIVIP (Como 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
Thompson, James L. 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
P SA Prostate Soecific (Blood) 3 5
T onev. James D. CMP Metabolic el $19.52 $19
CBC (Comp Ulood 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
PSA Prostate Specific A Blood 35.70 $35.70
Cholinesterase RBC Plasma Blood 45.90 $45.90
Vallone. Frank CMP (Comp Metabolic Panel 19.52 $19.52
CBC (Comp Blood Count 17.68 $17.68
Lipid Panel Blood 20.74 $20.74
Veni u cture $3.06 $3.06
HIV 1 I $13.26 $13.26
PSA Pro t to S ecific Blood 0 $35.70
INVOICE
F 0 Public Safety Medical Services
324 E. New York Street
E Suite 300
m
W Indianapolis, IN 46204
0 Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07120/2011
m Invoice 00 -15621
Date Employee Description Amount I Balance Due
Young, Kevin M. CMP (Comp Metabolic Panel 19.52 $19.52
(C omo CBC lood Count) 1 1
Pane Upid (Blood) $20.74 $20.74
Venbuncture $3.06 $3.06
07/13/11 Bailey, Mark E. 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
HIV 1 2 (Blood)13.26 13.26
PSA Prostate Specific A Blood 35.70 $35.70
Baskerville Steven P. CMP (Comp Metabolic Panel 19.52 $19.52
CBC (Comn Blood $17.68 $17.68
Li id Panel Blood 0.74 $20.74
Veniouncture $3.06 $3.0
HIV do 6 $13.26
PSA Prostate Soecific Aa (Blood) $35.70 $35.70
Brant Kenneth E. 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
PSA Prostate Specific A Blood 35.70 $35.70
Brisco Michael D. CMP Com Metabolic Panel 19.52 $19.52
CBC Corn Blood Count 17.68 $17.68
Lipid Panel Blood 20.74 $20.74
Veniounctur
HIV I $13.26
PSA Prostate Si)ecific Aa (Blood) 135.70 S35.70
Buttler, James N. 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
Ca shaw. Jeffrey A. 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 $3.0 6
PSA Prostate Specific A Blood 35.70 $35.70
Conner Ti moth L. CMP (Comn Metabolic Panel 19.52 $19.52
B C (Como Blood Count) $17,68 17
Upid P 4
Veni uncture $3.06 $3.06
HIV 1 2 Blood 13.26 $13.26
PSA Prostate Specific A Blood 35.70 $35.7 0
Cholinesterase RBC Plasma Blood $45.90 $45.9 0
Crisler. John H. CMP (Comp Metabolic Panel 19.52 $19.52
CBC (Comp Blood Count 17.68 $17.68
Lipid Panel Blood 20.74 $20.74
INVOICE
Public Safety Medical Services
324 E. New York Street
E Suite 300
x Indianapolis, IN 46204
o Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/20/2011
m Invoice 00 -15621
Date Employee Description Amount Balance Due
Veni uncture $3.06 $3.06
HIV 1 2 (Blood)13.26 13.26
PSA Prostate Specific A Blood 35.70 $35.70
Davis James M. CMP (Comp Metabolic Panel 19.52 $19.52
CBC (Comp Blood Count 17.68 $17.681
Lipid Panel Blood 20.74 $20.741
Veni uncture $3.06 $3.061
HIV 1 2 Blood 13.26 $13.26
PSA Prostate S ecific A Blood 35.70 35.70
Faain. Timoth y D. CMP Metabolic Panel) 19
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
Frost Bruce S. 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 $13.261
Harrin ton Adam C. CMP (Como Metabolic Panel 19.52 $19.52
CBC Com Blood Count 17.68 $17.68
Uoid Panel o0 4 $2074
Venipuncture $3.06 $3.06
HIV 1 2 Blood $13.26 $13.26
PSA Prostate Specific A Blood $35.70 $35.70
Ha maker Samuel K. 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
PSA Prostate Specific A Blood 35.70 $35.701
Hutchison Brian P. CMP (Comp Metabolic Panel 19.52 $19.52
.CBC (Como Blood 1 1 68
Lip id Panel (Blood) 4 $20.74
Venoguncture $3.06 $3.06
HIV 1 2 Blood $12.26 $13.26
Keaton AnthonV R. CMP (Comp Metabolic Panel $19.52 $19.52
CBC (Como Blood Count 17.68 $17.68
Li id Panel Blood 20.74 $20.74
Veni uncture $3.06 $3.0 6
HIV 1 2 Blood 13.26 $13.26
Knott. Bruce A. CMP (Como Metabolic Panel 19.52 $19.52
CBC (Comp Blood Count 17.68 $17.68
Lipid Panel Blood 20.74 $20.74
Ven ncture $3.06 $3.0
P Prostate S ecifi (Blood) $35.70 .70
INVOICE
t o Public Safety Medical Services
324 E. New York Street
E Suite 300
m
Indianapolis, IN 46204
c Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/20/2011
m Invoice 00 -15621
Date 'Employee Description Amount Balance Due
Martin David D. CMP (Comp Metabolic Panel 19.52 $19.52
BC (Comp Blood 0 $17.68 7.
Lipid anel (Blood) $20- $20.74
HIV 1 2 Blood $13.26 $13.26
PSA Prostate Specific A Blood $35.70 $35.70
McNeely Michael W. CMP (Comp Metabolic Panel 19.52 19.52
CBC (Comp Blood Count $17.68 $17.681
Lipid Panel Blood 20.74 $20.74
Veni uncture $3.06 $3.06
HIV 1 2 Blood 13.26 1126
Mead David L. CMP (Como Metabolic Panel)19.52 19.52
CBC Corr Blood Count 17.68 $17.68
L ivid Panel (Blood) $20.74 $20.741
V enio ncture $3.0
PSA Prostate Specific A Blood $35.70 $35.70
Moriarty. John F. GMP (Comp Metabolic Panel $19.52 $19.52
CBC (Comp Btood 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
PSA Prostate Specific A Blood 35.70 $35.70
Orange, Dou alas D. CMP Com Metabolic Panel 19.52 $19.52
CBC (Comp Blood Count 17.68 $17,68
Uoid Panel (Blood) .74 $20,74
V cu
HIV 1
PSA Prostate Specific A Blood $35.70 $35.70
Peterson Vernon A. CMP (Como 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
PSA Prostate Specific A Blood 35.70 $35.70
Ray, Lucas M. CMP (Como Metabolic Panel 19.52 $19.52
CBC (Comp Blood Count 17.68 17.68
Lipid Panel Blood 20.74 $20.74
Veninuncttire $3.06 $3,0
Sharp. Adam C. CMP Cam Metabolic Panel $19.52 $19.52
CBC (Comp Blood Count $17.68 $17.68
Lipid Panel (BloodL $20.74 $20.74
Veni uncture $3.06 3.06
HIV 1 2 (Bloodl 13.26 13.26
PSA Prostate Specific A Blood 35.70 $35.70
Starr. Gregory A. I CMP (Como Metabolic Panel $19.52 19.52
I
INVOICE
Public Safety Medical Services
324 E. New York Street
E. Suite 300
0 Indianapolis, IN 46204
o Carmel Fire Department CARWIEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/20/2011
m Invoice 00 -15621
Date .Employee Description Amount Balance Due
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
PSA Prostate S ecific A Blood 35.70 S35.70
Steurv. Kent C. CMP (Como 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
IV 1 BI $13.26 $1 3,261
PSA Prostate Scecofic Ag (Blood) $35.70 $35.70
VanVoorst Robert J. CMP (Comp 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
PSA Prostate Specific A Blood 35.70 $35.70
Cholinesterase RBC Plasma Blood 45.90 $45.90
Viehe. Richard E. CMP Corn Metabolic Panel 19.52 $19.52
CBC (Comy Blood Count 17.68 S17.68
L' id Panel Blood 20.74 20.74
Veniounct re $3.06 $3.06
PSA Prostate Specific A Blood $35.70 $35.70
Younq, Andrew S. CMP (Como Metabolic Panel $19.52 $19.52
CBC (Comp Blood Count 17.68 17.68
Lad Panel Blood 20.74 $20,74
Veni uncture $3.06 $3.06
HIV 1 2 Blood 13.26 $13.26
Total Charges $5,540.04
Total Payments Balance Due
y 0.00 $5,540.04
Please write invoice number on payment check.
Balance due 15 days from
Our Federal Employer Identification Number is 35- 2079797 Invoice date
INVOICE
0 Public Safety Medical Services
324 E. New York Street
m
Suite 300
W Indianapolis, IN 46204
C Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/28/2011
m Invoice 00 -15665
Date Employee Description Amount Balance Due
07/18/11 Alverson Jonathan L. 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
Platt Jace P. PSA Prostate Specific A Blood 35.70 $35.70
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
G Blood C 17
Lipid Panel Blood $20.74 $20.74
Veni uncture $3.06 3.06
HIV 1 2 Blood 13.26 $13.26
CMP (Comp Metabolic Panel) 19.52 $19.52
07/21/11 Allen. Brad A. 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
Muscular Stren th Endurance Test 26.52 $26.52
Flexibility Test $10.20 $10.201
Body Fat Test BIA Bio -Elec Im Anal 14.28 $14.28
W i i Ratio
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/ Inter 20.40 20.40
Urinalysis Dipstick 3.06 $3.06
Baskerville AnthonV A. 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
Muscu Strenath Endurance T
Flexibilitv 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
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 Di stick $3.06 $3.06
Edwards Daniel E. Muscular Stren th Endurance Test $26.52 $26.52
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
of Indianapolis, IN 46204
o Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/28/2011
m Invoice 00 -15665
Date Employee Description Amount Balance Due
Flexibility Test $10.20 $10.20
Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28
Waist/Hi Ratio $3.06 $3.0 6
Treadmill Submax $156.00 1
Vital Signs HT WT BP P R $0.00 $0.00
Vision Acuity $26.52 1 $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 $3.0 6
OnMed Program $0.00 $0.001
Health Risk Appraisal Motivation 0.00 $0.00
Respirator/Medical Review $16.32 $16.32
Comprehensive Physical Exam $99.96 $99.96
Haus Joshua S. OnMed Program $0.00 $0.00
Heal iv tion
Respirator/Medical Review $16.32 $16.32
Com rehensive Physical Exam $99.96 $99.96
Muscular Strength Endurance Test $26.52 $26.52
Flexibility Test $10.20 $10.2 0
Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28
Waist/Hi Ratio $3.06 $3.061
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
Audiometry 14.28 $14.28
EKG W/ Interp $20.40 $20.401
Urinalysis Dipstick $3.06 $3.06
Mead Jr. Donald R. OnMed Program $0.00 $0.00
Health Risk Ao raisal (Motivation) $0.00 $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 $10.2 0
Body Fat Test BIA Bio -Elec Im Anal 14.28 $14.28
Waist/Hi Ratio $3.06 $3.06
Hemoccult 0.00 $0.00
Treadmill Submax $156.00 156.00
Vital S' T B
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
Platt Jace P. OnMed Program $0.00 $0.00
Health Risk Appraisal Motivation 0.00 $0.00
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
tY Indianapolis, IN 46204
G Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/28/2011
m Invoice 00 -15665
Date Employee Description Amount Balance Due
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 $10.2 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
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 2 14
EKG W/ Interp $20.40 $20.40
Urinalysis Dipstick $3.06 3.06
Robinson Mitchell L. 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
Hemoccult $0.00 $0.00
Muscular Strength Endurance Test $26.52 $26.52
Flexibility Test $10.20 $10.201
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
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
Spelbring, James E. 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 $26.52
Flexibility Test $10.20 $10.2
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
Audiometry 14.28 $14.28
EKG W/ Inter 20.40 $20.4 0
Urinalysis Dipstick $3.06 $3.06
Voskuhl Mark J. CMP (Comp Metabolic Panel 19.52 1 19.52
CBC (Comp Blood Count 17.68 17.68
INVOICE
0 Public Safety Medical Services
324 E. New York Street
Suite 300
M Indianapolis, IN 46204
G Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/28/2011
m Invoice 00 -15665
Date Employee Description Amount Balance Due
Lipid Panel Blood 20.74 $20.74
Veni uncture $3.06 $3.061
HIV 1 2 Blood 13.26 $13.26
C holinesterase RBC PI asma (Blood) $45.90 $45.
Walker, Christopher E. 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
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
Vital Si ns HT WT BP P R $0.00 $0.00
Vision Acuity 26.52 $26.52
PFT Pulmonary Function Test $33.66 $33.6
Audiornetry $14.28 $14.28
EKG W/ Interp $20.40 $20.40
Urinalysis Dipstick $3.06 $3.06
Wendzel Jason D. 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
Muscular Strength Endurance Test $26.52 $26.52
Flexibility Test $10.20 $10.2 0
Body Fat Test BIA Bio -Ele Im Anal 14.28 $14.28
Waist]Hi Ratio $3.06 $3.06
Treadmill Sub max $156.00 $1 56,0
Vital Signs HT WT BP P R $0.00 $0.00
Vision AcuitV $26.52 $26.52
PFT Pulmonary Function Test $33.66 $33.66
AudiornetrV $14.28 14.28
EKG W/ Interp $20.40 $20.40
Urinalysis Dipstick $3.06 $3.06
Woodburn Scott E. OnMed Program $0.00 $0.00
Health Risk Appraisal Motivation 0.00 $0.00
Respirator/Medical Review $16.32 $16.321
Com rehensive Physical Exam $99.96 $99.96
Muscular Strength Endurance Test $26.52 $26.52
Flex ibility Test $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
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
INVOICE
H Public Safety Medical Services
324 E. New York Street
Suite 300
iX Indianapolis, IN 46204
O Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/28/2011
m Invoice 00 -15665
Date Employee Description Amount Balance Due
EKG W/ Interp $20.40 $20.40
Urinalysis Dipstick $3.06 $3.06
W ant Andrew D. 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
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/1-14) Ratio $3.06 $3.0
Treadmill Subm $1 56-00 $156.00
Vital Signs HT WT BP P R $0.00 $0.00
Vision AcuitV $26.52 $26.52
PFT Pulmonary Function Test $33.66 $33.66
Audiometry 14.28 $14.28
EKG W/ Interp 1 $20.40 20.40
Urinalysis Dipstick 3.06 $3.06
Total Charges $5,456.50
Total Payments Balance Due $0.00 $5,456.50
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
P0UbU Safety Medical Services, Inc.
324E. New York U
Suite 300 Invoice Number: 11'10340
Indianapolis, IN 46204 Invoice Date: Jul 21.2O11
TIN 35-2079797
Page: 1
Voice: 1'317-972'1180
Fox: 1'317-872'1190
Carmel Fire Department
2 Civic Square
Carmel, IN 46032
CARMEFD Net 30 Days
hilp
Courier 8/20/11
Partial Billing for Work Performance 2,500.00
Evaluation
Subtotal 2,500.00
Sales Tax
Total Invoice A mount 2,500.
Check/Credit Merho No: Payment/Credit Applied
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$21,684.40
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. I ACCT /TITLE I AMOUNT Board Members
24186 11- -10340 43- 407.99 j $2,500.00 1 hereby certify that the attached invoice(s), or
1120 15621 43- 407.01 $5,540.04 bill(s) is (are) true and correct and that the
1120 I 15665 I 43- 407.01 I $5,456.50 materials or services itemized thereon for
1120 I 15579 I 43- 407.01 I $8,187.86 which charge is made were ordered and
received except
AUG
r
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
11- -10340 $2,500.00
15621 $5,540-04
15665 I I $5,456.50
15579 I I $8,187.86
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
INVOICE
0 Public Safety Medical Services
r 324 E. New York Street
E Suite 300
d
0� Indianapolis, IN 46204
c Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 0712012011
m Invoice 00 -15622
Date Employee Description Amount i Balance Due
07111/11 Lovitt, Richard A. Quantiferon Tb Blood 51.00 $51.0 0
CMP (Comp Metabolic Panel 19.52 19.52
CBC (Comp Blood Count 17.68 $17.68
Livid Panel Blood 20.74 20.74
Veni uncture $3. 06 t3.06
H!V 1 2 Blood? $12.26 $12.2E
PSA Prostate S eci @c A Blood 35.70 $35.70
Mabie Michael L. Quantiferon Tb (Bloodl $51.00 $51.0 0
CMP (Comp Metabolic Panel 19.52 19.52
CBC (Comp Blood n $17.68 $17.68
Lbid Panel (Blood) $20.74 $20.74
Veni uncture $3.06 $3.06
HIV 1 2 Blood 13.26 $13.26
PSA Prostate Specific A Blood 35.70 $35.70
Morrow. Scott A. Quantiferon Tb Blood 51.00 $51.00
CMP (Comp 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
Total Charges->] $447:18
Total Payments &'Balance Due $0.00 $447.18
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from
.Invoice date
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
$44
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1110 I 15622 I 43- 407.01 $447.18 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, July 29, 2011
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
07/20/11 15622 payment for officer exams $447.18
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
i
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
a)
X Indianapolis, IN 46204
C Carmel Police Department CARMEPD
F 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/28/2011
00 Invoice 00 -15666
Date Employee Description Amount Balance Due
07/18111 Frost Dwight D. 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
Harris. Sarah E. Quantiferon Tb Blood 51.00 $51.00
CMP (Comp Metabolic Panel 19.52 $19.52
CBC (Comp Blood Count 17.68 $17.68
Li id Panel Blood 20.74 $20.74
Venip uncture $3.06 $3.06
HIV 1 2 Blood $13.26 $13.26
White. Kari E. Quantiferon Tb Blood $51.00 $51.00
CMP (Comp Metabolic Panel t$20.74 19.52
CBC (Comp Blood Count 17.68
Lipid Panel Blood 20.74
Veni uncture 3.06
HIV 1 2 Blood $13.26
07/19/11 Spillman. R. Scott Quantiferon Tb Blood 51.00 $51.00
CMP (Comp Metabolic Panel 19.52 $19.52
CBC Com p Blood Count 17.68 $17.68
Li id Panel Blood 20.74 $20.74
Venbunctur
HIV 1 2 Blood $13.26 $13.26
PSA Prostate Specific A Blood $35.70 $35.70
Total Charges $536.74
Total Payments Balance Due $0.00 $536.74
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
7q
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
1110 15666 43- 407.01 $536.74
bill(s) is (are) true and correct and that the
I I I
materials or services itemized thereon for
which charge is made were ordered and
received except
Friday, July 29, 2011
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
07/20/11 payment for officer exams
07/28/11 15666 payment for officer physicals $536.74
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