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Home My WebLink About200588 08/17/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $17,887.46 INDIANAPOLIS IN 46204 CHECK NUMBER: 200588 CHECK DATE: 8/17/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 15718 10,865.24 MEDICAL EXAM FEES 1110 4340701 15719 1,119.44 MEDICAL EXAM FEES 1120 4340701 15765 5,318.30 MEDICAL EXAM FEES 1110 4340701 15766 584.48 MEDICAL EXAM FEES INVOICE t o Public Safety Medical Services 324 E. New York Street E Suite 300 m of Indianapolis, IN 46204 o Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Hate 08/03/2011 m Invoice 00 -15718 Date Employee Description Amount Balance Due 07/25111 Bondurant. Jeff 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 $13.26 PSA Prostate Specific A Blood 35.70 $35.70 07/26/11 DeLong, Michael T. OnMed Program $0.00 0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.3 2 Comprehensive Physical Exam S99.96 $99.96 Muscular Strength e Test S26.52 2. 2 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 Si ns 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 W1 Interp $20.40 $20.40 Urinalysis Di stick $3.06 13.06 Edwards Steven L. OnMed Pro ram $0.00 $0.00 Health R sk A r is 1 (Motiv Respirator/Medical Review $16.32 $16.32 Comprehensive Ph sical 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 $156.0 0 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 PFT PulmonaFy Function Test $33.66 $33.66 Audiometry 14.28 $14.28 K G W1 Inten) S20,40 $20.4 Urinal sis Dipstick $3.06 $3.06 Fuchs Jeffery W. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 10.0 0 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 106 $3.06 Treadmill Submax $156.00 156.00 Vital Signs HT WT BP P R $0.00 $0.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 a Carmel Fire Department CARMEFD I- 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/03/2011 m Invoice 00 -15718 Date Employee Description Amount Balance Due Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test 33.66 $33.66 Audiometry 14.28 $14.28 EKG W1 Interp 20.40 0.4 Urinalysis Dipstick $3.06 $3.06 Gipson, Bruce E. OnMed Program $0.00 1 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review 16.32 $16.32 Comprehensive Physical Exam 199.96 $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 $156,0 0 Vital Si ns HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 PFT P Imon Functi Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Hensle Robert P. Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuit 26.52 $26.521 PFT Pulmonary Function Test $33.66 $33.66 Audiametry $14.28 $14.28 EKG WI Inter 20.40 20.40 Urinalysis Dipstick $3.06 $3.06 OnMed Program $0.00 Health Risk Apipraisal Motivation 0.00 $0.00 Resi)irator/Medical Review $15.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Muscular Strength Endurance Test $26.52 $26.52 FlexibilitV Test $10.20 $10.20 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 Horner David W. 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 Muscular Strength Endurance Test $26,52 $26-52 Te5t $10.20 $1 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 $33.66 Audiometry 14.28 $14.28 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Fire Department I CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/03/2011 m Invoice 00 -15718 Date Employee Description Amount Balance Due EKG W/ Interp $20,40 $20.40 Urinalysis Dipstick $3.06 $3.06 Lux Michael T. OnMed Program 0.00 0.00 Health Risk Appraisal f Motivation 0.00 $O.GO 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 $10.20 Body Fat Test BIA Bio -Elec Im Ana! 14.28 $14. 28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.0 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/ Interp $20.40 $20.40 Urinalysis Dipstick 3.06 $3.0 6 Mitchell James C. OnMed Program $0.00 0.00 Health Risk Appraisal Motivation 0.00 0.00 Respirator/Medical Review $16.32 $16.32 Com rehensive Physical Exam $99.96 99.96 Muscular Strength Endurance Test S26.52 $26.52 Flexibility Test $10.20 $1 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 WI Interp $20.40 20.40 Urinalysis Dipstick $3.06 $3.0 6 Paddock, Ronald D. OnMed Pro ram $0.00 10.00 Health Risk A raisal Motivation 0.00 $0.00 Respira tortMedical Review 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 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 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 9) 0� Indianapolis, IN 46204 O Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/03/2011 m Invoice 00 -15718 Date Employee Description Amount Balance Que Urinalysis Di stick $3.06 $3.06 Utzici, Todd T. OnMed Program $0.00 $0.00 Health Risk Aiporaisal Motivation 0.00 $0.00 i rMe cal Review $16-32 1 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/Hip-Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.0 0 Vital Signs HT WT BP P R 0. $0.0 0 Vision Acuity 26.52 $26.52 PFT Pulmona Function Test $33.66 $33.66 Audiomet 14.28 $14.28 EKG W/ Intero $20.40 $20.40 U rinalysis Dipt k Young, Alan R. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 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 $10.20 Body Fat Test BIA f Bio -Elec Imp Anal 14.28 $14.28 WaisUHi 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 6 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 3.06 Young Kevin M, OnMed Program 0.00 $0.00 Health Risk Appraisal Motivation $o.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 Flexibilit y 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 6. 0 $156.0 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/ Interp 20.40 20.40 Urinalysis Dipstick $3.06 $3.06 07!27111 Freer, Keith T. CMP (Comp Metabolic Panel 19.52 19.52 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 it Indianapolis, IN 46204 O Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/03/2011 Invoice 00 -15718 Date Employee Description Amount Balance Due CBC (Camp Blood Count 17.68 $17.68 Lipid Panel Blood $20.74 $20.74 Veni unclure $3.06 $3.06 HIV 1 2 Blood 13.26 1326 PSA Prostate Specific A Blood 35.70 $35.70 07/28/11 Collins Tony A. OnMed Program $0.00 $0.0 0 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 16.32 Com rehensive Physical Exam 99.98 $99.96 Muscular Strength Endurance Test $26.52 $26.52 _El ft I' ty Test $10.20 Body Fat Test BIA Bio -Elec Imp Anal y) $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 Wl Interp $20.40 $20.40 Urinalysis Di stick $3.06 $3.06 DeCrastos Richard A. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical R view $16,32 $16 Comprehensive Physical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.00 Chest X -Ray PA/LAT (Digital) 61.20 $61.20 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 1428 EKG W/ Inter 20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Muscular Strength Endurance Test 26.52 26.52 Flexibility Test 1020 $10.2 0 B ody a t A Bio -Ele Anal y) S14.28 S14 Waist/Hi Ratio $3.06 $3.06 Dorsch James E. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 0.00 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 1020 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 Chest X -Ray PA/LAT (Digital) 6120 61.20 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 0 W Indianapolis, IN 46204 O Carmel Fire Department/ CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 08/03/2011 m Invoice 00 -15718 Date Employee Description Amount Balance Due Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.521 PFT Pulmonary Function Test $33.66 $33.66 Aud iometry 14 8 $14.281 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Drake Carl D. OnMed Program o.0o $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.961 Muscular Strength Endurance Test $26.52 $26.52 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imn Anal 14.28 $14.28 Waist/Hi Ratio 3.06 $3.0 Treadmill Subm x $156.00 $156.00 P AT 1 1.2 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 AudiometrV $14.28 14.28 EKG W/ Inter 20.40 $20,40 Urinal sis Dipstick $3.06 $3.06 Love Joseph B. OnMed Program $0.00 S0.00 Health Risk Appraisal Motivation 0.00 0.00 Respirator/Medical Review $16.32 $16.32 Com rehensive Physical Exam $99.96 $99.96 Muscular Strength Endurance Test $26.52 $26.52 F Test $%20 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 Audlometry $14.28 $14.28 EKG W/ Interip 20.40 $20.40 Urinalysis Dipstick 3.06 $3.0 6 Marsh. Michael A. OnMed Program $0.00 $0.0 0 Health Risk A raisal Motivation 0.00 $0.00 ResD irator/Medical Review $16.32 Com rehensive 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 Chest X -Ray PA/LAT (Digital) $61.20 $61.20 INVOICE 0 Public Safety Medical Services r 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 0810312011 m Invoice 00 -15718 Date Employee Description Amount Balance Due. 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 Audiomet 14.28 $14,28 EKG WI Interp $20.40 $20.40 Urinalysis Dipstick 3.06 $3.06 McNair Travis L. OnMed Program $0.00 0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res iratorlMedical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Muscular Strenoth Endurance Test S26.52 $26.52 Flexibility Test $1020 $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/ Inter 20.40 $20.4 0 Urinalysis Dipstick 3.06 $3.06 Smith Brian E. OnMed Program 0.00 $0.00 Health Risk Agoraisal (Motivati 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 -Flee Imp Anal $14.28 14.28 Waist /Hi Ratio 3.06 3.06 Treadmill Submax 156.00 156.00 Chest X -Ray PA/LAT (Digital) 61.20 $61,20 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuit 26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Aud igmp lj)� 14 $14,2 EKG WI Interp $20.40 $20.40 Urinalysis Di stick $3.06 $3.06 Stindle Kevin P. 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 $10.20 Bodv Fat Test BIA Bio -Eiec Imip Anal 14.28 $14.28 WaistMi Ratio $3.06 .06 Treadmill Submax $156.00 156.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 invoice Date 08/03/2011 m Invoice 00 -15718 Date Employee Description Amount Balance Due Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test S33.66 $33.66 t [y $14.28 $14. EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Webb Gregory A. Veni uncture (Repeat) OAO so.00l OnMed Program $0.00 0.00 Health Risk Appraisal Motivation 0.00 $0.0 0 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 99.96 Muscular Strength Endurance Test $26.52 $26.52 Flexibility Test S10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156,90, $1 56,00 Chest X -Ray PA/LAT (Digital) $61.20 $61.20 Cholinesterase RBC (Repeat) $O.OD $0.00 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 120.40 $20.40 Urinalysis Dipstick $3,06 $3.061 Witsken. Steven J. OnMed Pro ram $0.00 0.00 Health Risk A raisal Motivation 0.00 $0.00 Res it torlM di al Review $16.32 $16.32 Corn x e hensiye Physical Muscular Strength Endurance Test $26.52 $26.52 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Ana! 14.28 $14.28 Waist /Hi Ratio $3.06 $3.0 6 Treadmill Submax $156.00 $156.00 Chest X -Ray PA/LAT (Digital) 61.20 $61.20 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/ Intem $20.40 $20.40 inI tik $3.06 S1 Workman William J. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 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 INVOICE H Public Safety Medical Services 324 E. New York Street Suite 300 W Indianapolis, IN 46204 G Carmel Fire Department CARMEFD f' 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/03/2011 m Invoice 00 -15718 Date Employee Description Amount Balance Due Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Chest X -Ray PA/LAT (Digital) 61.20 $61.2 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/ Intern $20.40 $20.40 Urinalysis Di stick $3.06 $3.0 6 Total Charges $10,865.24 Total Payments Balance Due $0.00 $10,865.24 Please write invoice number on payment check. Balance due 15 days from Our Federal Employer Identification Number is 35- 2079797 Invoice date INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 aD W Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/10/2011 m Invoice 00 -15765 Date Employee Description Amount Balance Due 07/26/11 Gipson Bruce E. Coronary Calcium Scan (CCS) 4 -Week $79.00 $79.00 08/01/11 Frye, Steven 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 Small Thomas D. 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 $13.26 CMP Com Metabolic Panel 19.52 $19.52 1 Condra. K OnMed Pro 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 $10.20 Bodv Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist /Hi Ratio $3.06 $3.0 6 Treadmill Submax $156.00 $156.00 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 33.66 14.28 26.52 PFT Pulmonary Function Test 33.66 Audiometry 14.28 EKG W I 4 $20.401 Urinalysis Dipstick $3.06 $3.06 Gehlbach Marc 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 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 Chest X -Ray PA /LAT (Digital) 61.20 61.20 Vt I i WT PP 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 Giles William G. OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Com rehensive Physical Exam $99.96 $99.96 Muscular Stren th Endurance Test $26.52 $26.52 Flexibility Test $10.20 10.20 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 0) 0: Indianapolis, IN 46204 o Carmel Fire Department CARMEFD f 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/10/2011 00 Invoice 00 -15765 Date Employee Description Amount Balance Due Body Fat Test BIA Bio -Elec 1mD Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.0 0 Vital S -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 $20.40 Urinalysis Dipstick $3.06 3.06 Gu el Mark E. OnMed Program $0.00 0.00 Health Risk Appraisal Motivation 0.00 0.00 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 Bodv Fat Test IA Bi An aly) $14.28 $1 4.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Chest X -Ray PA/LAT (Digital) $61.20 $61.20 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 Kinney, Jared N. OnMed Program $0.00 $0.00 Health Risk Anxaisal Motivation 0.00 $0.00 Resbrator/Medical Review 1 Comprehensive Ph sical Exam $99.96 $99.96 Muscular Stren th Endurance Test $26.52 $26.52 Flexibility Test $10.20 $10.2 0 BodV Fat Test BIA Bio -Elec Imp Anal $14.28 $14.28 Waist/Hi Ratio $3.06 $3.0 6 Treadmill Submax $156.00 $156.0 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 Urinalvsis c McNab John D. No Show Fee $0.00 $0.00 Mowery, Anthony W. 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 FlexibilitV Test $10.20 $10.20 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 Q W Indianapolis, IN 46204 o Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/10/2011 m Invoice 00 -15765 Date Employee Description Amount Balance Due Body Fat Test BIA Bio -El ec 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 M33 Vision Acuity 26.52 PFT Pulmonary Function Test 33.66 Audiomet 14.28 EKG W/ Inter 20.40 Urinalysis Di stick $3.06 $3.0 6 Reeves Neil P. OnMed Program $0.00 $0.00 H ealth I (Motivation 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 Bod 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 14.28 $14.28 G W/ Interp $20.40 Inter 4 Urinalysis Dipstick $3.06 $3.06 Watts Trent E. 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 Signs HT WT BP P R $0.00 $0.001 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 U rjnajy5L j Qipstick $3.06 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 Weddin ton. Kurt 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 Muscular Strength Endurance Test $26.52 $26.52 Flexibility Test $10.20 $10.2 0 Body Fat Test BIA Bio -Elec Imo Anal 14.28 14.28 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 d W Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/10/2011 m Invoice 00 -15765 Date Employee Description Amount Balance Due Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Chest X -Ray PA/LAT Di ital 61.20 $61.201 Vital Sians 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 $20.40 Urinalysis Dipstick $3.06 $3.06 Wynn Barbara M. 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 $10.20 Body Fat Test BIA Bio -Elec Im Anal 14.28 $14.28 W i st/Hii) Ratio $3 Treadmill Submax $156.00 $156.00 Chest X -Ray PA/LAT (Digital) $61.20 $61.20 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 Zeller. Michael J. OnMed Program $0.00 $0.00 Health Risk Aupraisal Motivation 0.00 $0.00 Res irator /Medical Review $16.32 $16.32 C 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 $156.0 0 Chest X -Ray PA/LAT (Digital) 61.20 $61.20 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 W1 Inter 20.40 $20.401 Urinalys Dipstick $3. 08/03/11 Castor Rick 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 $13.26 PSA Prostate Specific A Blood 35.70 $35.70 Reppert, Ian T. CMP (Comp Metabolic Panel 19.52 $19.52 INVOICE �o Public Safety Medical Services y 324 E. New York Street E Suite 300 a) Q� Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/10/2011 00 Invoice 00 -15765 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 Total Charges $5,318.30 Total Payments Balance Due $0:00 $5,318.30 Please write invoice number on payment check. Balance due 15 days from Our Federal Employer Identification Number is 35- 2079797 Invoice date VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $16,183.54 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 15718 43 407.01 j $10,865.24 1 hereby certify that the attached invoice(s) or 1120 15765 43 407.01 $5,318.30 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 AUG 1 5.2011 i �"�AO._.a.3'y..•� t 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 D ate Number (or note attached invoice(s) or bill(s)) 15718 $10,865.24 15765 $5,318.30 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 324 E. New York Street E Suite 300 CU W Indianapolis, IN 46204 O Carmel Police Department I CARMEPD F' 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08/03/2011 m Invoice 00 -15719 Date Employee Description Amount Balance Due 07/27/11 Mabie Michael 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 Flexibility Test $10.20 $10.20 Body Fat Test B €A Bio -Elec Im Anal 14.28 $14.28 Waist /Hi Ratio $3.06 106 Treadmill Submax $156.00 $156.0 0 Tonomet Glaucoma Test 36.72 $36.72 Vital Si ns HT WT BP P R $0.00 $D.QQ Vision 2.52 $2 PFT Pulmonaa Function Test $33.66 $33.66 Audiometry 14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Matthews. Daniel M. Quantiferon Tb Blood 51.00 $51.0 0 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 OnMed Program $0.00 $0.00 Hea lth Rik Anoraisal M tiv 'on $0.00 $0 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Flexibility Test 10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 WaisUHi Ratio $3.06 $3.06 Treadmill Submax M$26.52 156.00 Tonomet Glaucoma Test 36.72 Vital Signs HT WT BP P R 0.00 Vision Acuity 26.52 PFT Pulmonar Function Test $33.66 Audiometry 14.28 $14.28 K G W1 Inten) $2Q.40 $20.4 Urinal sis Dipstick $3.06 $3.06 07/29/11 Rush, Michael T. 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 f Blood 13.26 1326 Total Charges $1;119.44 Total Payments Balance Due $0.00 $1,119.44 Please write invoice number on payment check. Balance due 15 days from Invoice date INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 a> 0: Indianapolis, IN 46204 o Carmel Police Department CARMEPD l- 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08/10/2011 m Invoice 00 -15766 Date Employee Description Amount Balance Due 08/01/11 Broadnax Matthew L. Quantiferon Tb Blood $51.00 $51.0 0 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 Dewald Gregory S. Quantiferon Tb Blood 51.00 $51.0 0 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 $3.061 Ha rris, Metabolic Panel 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 Lytle, Blake A. CMP (Comp Metabolic Panel 19.52 $19.521 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 Q uantiferon Tb Blood 51.00 $51.00 08/02/11 Schmidt Brian E. Quantiferon Tb Blood 51.00 $51.00 CM P C o mp Metabolic Panel) 1 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 Ag LLIood) 35.70 35.70 Total Charges $584.48 Total Payments Balance Due $0.00 $584.48 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 $1,703.92 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 15719 43- 407.01 $1,119.44 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 15766 43- 407.01 $584.48 materials or services itemized thereon for which charge is made were ordered and received except Monday, August 15, 2011 r te— R N Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund I 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)) 08/03/11 15719 payment for officer physicals $1,119.44 08/10/11 15766 payment for office physicals $584.48 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