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Home My WebLink About200978 08/30/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $30,946.54 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 200978 CHECK DATE: 8/30/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 24216 15809 903.32 ANNUAL EXAMS 1110 4340701 15810 3,600.94 MEDICAL EXAM FEES 1120 4340701 24216 15861 25,619.32 ANNUAL EXAMS 1110 4340701 15862 822.96 MEDICAL EXAM FEES INVOICE t o Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 C Carmel Police Department I CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08117!2011 m Invoice 00 -15810 Date Employee Description Amount Balance Due 08/08/11 Frost Dwight 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 Flexibilit Test 10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 WaisUl -lip Ratio 3.06 $3.06 Treadmill Submax $156.00 $156.0 0 Tonomet Glaucoma Test 36.72 $36.72 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity $26,52 PFT Pulmonary Function Test $33.66 $33.66 Audiometry 14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinal sis Dipstick $3,06 $3.06 Harris Robert 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 $99,961 Flexibility Test 10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.2B Waist/Hi Ratio $3.06 $3.06 Treadmill Su 1 S 1%.00 Tonomet Glaucoma Test $36.72 $36.72 Vital Si ns 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 1428 EKG W/ Inter 20.40 20.40 Urinalysis Dipstick $3.06 $3.06 Lovitt Richard A. OnMed Program 0.00 $0.0 0 Health Risk Appraisal Motivation 0.00 $0.00 Res irator Medical Review $16.32 $16.32 om rehensive 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 Waistil-lin Ratio $3.06 $3.05 Treadmill Submax $156.00 $156.00 Tonometr 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 S14.28 EKG W/ Inter 20.40 $20.4 0 Urinalysis Di stick $3.06 $3.06 Morrow Scott A. OnMed Pro ram $0,00 $0.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 Carmel Police Department 1 CARMEPD Terms 3 Civic Square Invoice Date 0 8/1 71201 1 Carmel, IN 46032 Invoice 00 -15810 Date Employee Description Amount Balance Due Health Risk Aporaisal Motivation 0.00 $0.00 Res irator /Medical Review $16.32 $16.32 Com rehensive Physical Exam $99,96 $99.96 FIg4ibility Tesl $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 Tonometr 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 Audiametry $14.28 $14.28 EKG W1 Intem $20.40 $20.4 0 Urinalysis Dipstick 106 $3.06 Rush Michael T. OnMed Pro ram $0.00 0.00 Health i r i (Motivation 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 Tonometr 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 S33.66 Audiornetry $14.28 $14.28 EKG W $20,40 $2 Urinalysis Dipstick $3.06 $3.06 Spillman, R. Scott OnMed Program $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 10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio 3.06 106 Treadmill Submax $156.00 S156.001 Tonomet Glaucoma Test 36.72 $36.72 Vital Si ns HT WT BP P R SO.00 $0.00 Vision Acuity 2 .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 Vanderbeck David R. Quantiferon Tb Blood 51.00 $51.00 CMP (Comp Metabolic Panel 19.52 $19.52 OnMed Program $0.00 $0.00 INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 w Indianapolis, IN 46204 C Carmel Police Department! CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08/17/2011 m Invoice 00 -15810 Date Employee Description Amount Balance Due Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Flexibilitv Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 WaisUft Ratio $3.06 $3.06 Treadmill Submax 156.00 156.00 Tonomet Glaucoma Test 36.72 36.72 Vital Si ns HT WT BP P R 0.00 0.00 Vision Acuity 26.52 26.52 PFT Pulmonary Function Audiometry $14.28 $14.28 EKG W/ Inter 20.40 $20.40 Urinalysis Dipstick $3.06 3.06 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 08/11/11 Schmidt Brian E. OnMed Program $0.00 $0.00 Health Risk Al2Rraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 C omprehensive Physical Exam 9.96 $99.96 Treadmill Submax $156.00 $156.001 Flexibilitv Test $10.20 $10.20 BodV Fat Test BIA Bio -Elec Imp Anal $14.28 $14.28 WaisUft Ratio $3.06 $3.06 Tonomet Glaucoma Test 36.72 $36.72 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 Di stick $3.06 1 3.06 Total Char $3,600.94 Total Payments Balance Due $0.00 $3,600.94 Please write invoice number on payment check. Balance due 15 days from Our Federal Employer Identification Number is 35- 2079797 Invoice date INVOICE F o Public Safety Medical Services 324 E. New York Street E Suite 300 r Indianapolis, IN 46204 G Carmel Police Department 1 CARMEPD t 3 Civic Square Terms Carmel, IN 46032 Invoice Da 08/24/2011 m Invoice 00 -15862 Date Employee Description Amount. Balance Due 08/15/11 By rne, Timothy 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 Li id Pane! Blood 20.74 $20.74 Veni uncture $3.06 $3.06 HIV 1 2 Blood 13.26 $13.26 Haymaker. William E. Quantiferon Tb Blood 51.00 $51.00 CMP (Comp Metabolic Panell $19.52 $19.52 CBC Com Blood Count 17.68 $17.68 Lipid Panel Blood $20.74 20.74 V ni t re 6 6 HIV 1 2 Blood $13.26 $13.26 Kin on David M. Quantiferon Tb Blood 51.00 $51.00 CMP (Comp Metabolic Panel t20.74 $19.52 CBC (Comp Blood Count 17.68 Lipid Panel Blood 20.74 Veni uncture 3.06 HIV 1 2 Blood $13.26 McIntyre, Trent A. 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 VV,2ipuncture $3.QQ $3.06 HIV 1 2 Blood $13.26 $13.26 08/17/11 Bowman Gary A. Quantiferon Tb Blood $51.00 $51.00 CMP (Comp 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 PSA Prostate Specific A Blood 35.70 $35.70 Gerdt Andrew P. Quantiferon Tb Blood 51.00 $51.0 0 CMP Com Metabolic Panel 19.52 $19.52 CBC (Comp Blood Count 17.68 $17.68 i i PjInel I $20.74 .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 Total Charges 1 $822.96 Total Payments Balance Due $0.00 $822.96 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 $4,423.90 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #rrITLE AMOUNT Board Members 1110 15810 43- 407.01 $3,600.94 i hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 15862 43 407.01 $822.96 materials or services itemized thereon for which charge is made were ordered and received except Thursday, August 25, 2011 �v 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)) 08117/11 15810 payment for officer physicals $3,600.94 08/24/11 15862 payment for officer physicals $822.96 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 INVOICE o. Public Safety Medical Services 324 E. New York. Street E Suite 300 Indianapolis, IN 46204 C Carmel Fire Department 1 CARMEFD I 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/24/2011 Invoice 00 -15861 Date Employee Description Amount. Balance Due 07128111 DeCrastos Richard A. Coronary Calcium Scan (CCS) 4 -Week $79.00 79.00 0811501 Alverson. Jonathan L. 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 Treadmill Submax $156.00 $156.0 0 Muscular Strength 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 $3.06 Chest X -R P LAT Di i I $61 $61. 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 Anderson Donovan C. OnMed Pro ram 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 Treadmill Submax $156.00 $156.00 Muscu Str n th Endurance Test $2 6.52 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 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/ Interp $20.40 $20.40 Urinalysis Di stick $3.06 106 Contino David M. OnMed Program 0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 Respirator/Medical 1 1 2 Comprehensive Physical Exam $99.96 $99.96 Treadmill Submax $156.00 1 $156.00 Muscular Strength Endurance Test $26.52 $26.52 Flexibilitv Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hip Ratio 3.06 $3.06 Chest X -Ray PA /LAT Di ital 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 Audiomet 14.28 14.28 INVOICE h Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 o Carmel Fire Department I CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08!2412011 m Invoice 00 -15861 Date Employee Description Amount Balance Due EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Force Jason S. OnMed Program $0.00 $0.00 H eallh R sk Appraisal (M iv i n Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 CDL Form Completion $25.00 $25.00 Treadmill Submax 156.00 $156.00 Muscular Strength Endurance Test $26.52 $26.52 Flexibilitv Test $10.20 $10.2 0 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.0 6 Chest X -Ray PA/LAT (Digital) 61.24 $61.2 0 Vital Si ns HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 Pulmonary Functibn Test $3 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Holden Adam 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 Treadmill Submax $156.00 $156.00 Muscular Strength Endurance Test $26.52 $26.52 Flexibilly Test $10.20 $10,20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 W i 3.06 Chest X -Ray PAILAT (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 33.66 133.66 Audiomet 14.28 $14.28 EKG W/ Interp $20.40 $20,40 Urinalysis Dipstick $3.06 106 Hulett, Mark A. 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 T readmill Su m x M$26.52 1 Muscular Strength Endurance Test $26.52 Flexibilit Test $10.20 Bod Fat Test BIA Bio -Elec Im Analy 14.28 Waist/Hi Ratio 3.06 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 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 of Indianapolis, IN 46204 o Carmel Fire Department 1 CARMEFQ 2 Civic Square Terms Carmel, IN 46032 Invoice Date 0812412011 m Invoice 00 -15861 Date Employee Description Amount Balance Due Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick 3.06 $3.06 McNab John D. Hemoccult $0.00 $0.00 Comprehensive Physical Exam $99.96 $99.96 OnMed Pro ram 0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator /Medical Review $16.32 $16.32 Treadmill Submax E$26.52 156.00 Muscular Strength Endurance Test 26.52 FI xibilit T t 1 Bod Fat Test BIA Bio -Elec Im Anal $14.28 Waist/Hi Ratio 3.06 Vital Si ns 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 Urinal sis Dipstick 3.06 $3.06 Medlen Michael J. PSA Prostate S ecific A Blood 35.70 $35.70 CMP (Comp Metabolic Panel 19.52 $19.52 CBC Com Blood Count 17.68 $17.68 L Did Panel $M74 $20.741 Veni uncture $3.06 $3.06 HIV 1 2 Blood $13.26 $13.26 Price. Joseph P. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review 1632 $16.32 Com rehensive Physical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.00 Muscular Strength Endurance Test $26.52 $26.52 Flexibility Test $10.20 $10.2 0 Body Fat Test BIA Bio -Elec Imp AP 3 14.28 $14.2 Waist /Hi Ratio $3.06 $3.06 C hest X -R P AT i 1 61.2 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 Di stick $3,06 $3.06 Small Thomas D. 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 Treadmill Submax 156.00 15 0 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 w Indianapolis, IN 46204 O Carmel Fire Department 1 CARMEFD I- 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/24/2011 m Invoice 00 -15861 Date Employee Description Amount Balance Due Muscular Stren th 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 Rati 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 1nterp $20.40 $20.4 0 Urinal sis Dipstick $3.06 $3.06 Starr Gregory A. Hemoccult $0.00 $0.00 Com rehensive Physical Exam $99.96 $99.96 OnMed Program 10.00 $0.00 Health Risk Antpraisal Motivation 0.00 $0.00 Res irator /Medical Review $16.32 $16.32 Treadmill Submax 1 1 U.OQ Muscular Strength Endurance Test $26.52 $26.52 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anai $14.28 $14.28 Waist/Hi Ratio $3.06 3.06 Vital Signs HT WT BP P R $0.00 0.00 Vision AcultV $26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiometry 14.28 14.28 EKG W/ Interp $20.40 $20.401 Urinal sis Di stick $3,06 SID61 Utzig, Chad M. OnMed Pro ram $0.00 $0.00 Health Bisk Appraisal (Motivation) 0 0. Res irator /Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.00 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 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 KG W Intern 20.4 $20-4 Urinalysis Dipstick $3.06 $3.06 VanVoorst, Robert 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 Treadmill Submax 1 156.00 5156001 Muscular Strength Endurance Test 26.52 $26.52 INVOICE F o Public Safety Medical Services r 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/2412011 m Invoice 00 -15861 Date Employee Description Amount. Balance Due 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 i 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 Audiornetry 14.28 $14.28 EKG W1 Interp 20.40 $20.4 0 Urinal sis Dipstick $3.06 $3.06 Choline terase RBC /Plasma Re eat 0.00 0.00 QPL Eorm QD=Ietion 06/16/11 Baskerville, Steven 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 Strength Endurance Test $26,52 $26.52 Flexibility Test $10.20 $10.2 0 Body Fat Test BIA Big -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 P I n n tion Test $33.66 Audiornetry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 3.06 Benbow, Kip S. 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 Flexibility Test $10.20 $10.2 0 Bodv Fat Test BIA Bio -Elec Im AnalO $14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 r ill SubmQx $156.00 $156. 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 Audiornetry $14.28 $14.28 EKG W/ Interp $20.40 120.40 Urinalysis Dipstick $3.06 $3.06 Conner Timothy 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 $99.96 199.96 Muscular Stren th Endurance Test $26.52 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 O Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08!24!2011 m Invoice 00 -15861 Date Employee Description Amount Balance Due Flexibility Test $10.20 $1020 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio 3.06 $3.06 T readmill Submgx $156.00 $1 56-00 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity $26.52 $26.52 PFT Pulmonary Function Test $33.65 $33.66 Audiometry 14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.0 6 Essex. Co C. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 0.00 Res iratorlMedical Review $16.32 $16.32 Com rehensive Physical Exam 99.96 99.96 Muscular Strength Endurance Test 26.52 26.52 F lexibility Test 1 $10.2 Body Fat Test BIA Bio -Elec Imp Anal $14.28 $14.28 WaisUHi Ratio $3.06 $3.06 Treadmill Submax t$26.52 $156.00 Vital Signs HT WT BP P R $0.00 Vision Acuity 26.52 PFT Pulmonar Function Test 33.66 Audiomet $14.28 EKG WI Inter 20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Keaton Anthony R. OnMed Program S0.00 S0,00 Health Risk Appraisal (Motivationl $0.00 Respir2tgrjMedical Review $16.3 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 $156.00 Chest X -Ray PAIAT (Digital) $61.20 $61.2 0 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 PFT Puimonary Function Test $33.66 $33.66 Audiometry 14.28 $14.28 t $20.0 $20A Urinal sis Dipstick $3.06 $3.06 Maners, Jeremy B. 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 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 a, W Indianapolis, IN 46204 o Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 0812412019 Invoice 00 -15861 Date Employee Description Amount Balance Due 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 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/ Interp $20.40 $20.40 Urinalysis Di stick $3.06 S3.06 Martin David D. OnMed Program $0.00 0.00 Health Risk A r i I (Motivati 0 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 Bio -Elec Imp Anal 14.28 14.28 Waist/Hi Ratio 3.06 3.06 Treadmill Submax 156.00 156.00 Chest X -Ray- PAlLAT Di ital 61.20 $61.20 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 Audi ometry 14 14 EKG W/ I nterp $20.40 $20.40 Urinal sis Dipstick $3.06 $3.06 Martin. Richard 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 Strencith Endurance Test 26.52 26.52 Flexibilit Test 10.20 10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 14.28 Waist/Hi Ratio 3.06 3. Treadmill Submax 156.00 $156.00 C hest X- P AT (Digital) 1. 1 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 Wl Inter 20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Mulford, David A. OnMed Program 0.00 $0.00 Health Risk Appraisal Motivation 0.00 0.00 Res irator(Medical Review $16.32 $16.32 Corniprehensive Physical Exam $99.96 $99,96 Muscular Strencith Endurance Test S26,52 26.52 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 w Indianapolis, IN 46204 C Carmel Fire Department I CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08!2412011 oft Invoice 00 -15861 Date Employee Description Amount Balance Due Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec ImD AnaNl $14.28 14.28 Waist/Hi Ratio $3.06 3.06 T b max $156.00 $1 56,00 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 Urinalysis Dipstick $3.06 $3.06 Peterson. Vernon 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 Muscular Strength Endurance Test $26.52 $26.52 Flexibilitv T 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 $33.56 Audiornetry $14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinalysis Di stick $3.06 $3.06 Stroup, Scott A. OnMed Program SO.00 0.00 Health Risk Appraisal Motivation .00 $0.00 RespiratorlMp,dical Review $16.32 S16.32 Comprehensive Physical Exam $99.96 $99.96 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 33.6fi 33.66 Audiometry 14.28 14.28 EKG W/ Inter 20.40 20.40 i i ti k 3.06 $3.0 Vallone Frank 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 Imp Anal 14.28 $14.28 INVOICE o Pubic 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!2412011 m Invoice 00 -15861 Date Employee Description Amount Balance Due Waist/Hip 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 Audiornetry $14.28 $14.28 EKG W/ Inter 2040 $20.4 0 Urinalysis Di stick $3.06 $3.06 08/17/11 Callahan Mark OnMed Pro ram $0.00 $0.00 Health Ri i l (Motivation) $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 $10.20 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 $0.001 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiornetry $14.28 $14.28 EKG W Inter 4 Urinalysis Dipstick $3.06 $3.06 Castor, Rick S. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Res iratorlMedical 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 $10.201 Body Fat Test BIA Bio -Elec mo 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 $Q.GQ V' jo it $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 $3.0 6 Cox, Justin M. OnMed Program 0.00 0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Ph sical Exam $99.96 $99.96 Muscular Stren th Endurance Test $26.52 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 141 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 O Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/24/2011 00 Invoice 00 -15861 Date Employee Description I Amountj Balance Due Waist/Hip Ratio 3.06 $3.06 Treadmill Submax $156.00 S156.00 Chest X -Ray PA /LAT (Digital) 61.20 S61.2 0 t I WTBPPR Vision Acuity $26.52 $26.52 PFT Pulmonary Function Test $33.66 $3166 Audiornetry 114.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.0 6 Crane Barry L. 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 Strength Endurance Test 26.52 $26.52 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio-Elec Imp Anal $14.28 14 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 26.52 126.52 PFT Pulmonary Function Test $33.66 33.66 Audiornetry $14.28 $14.28 EKG W/ Interp $20.40 20.40 UrinaY sis Dipstick $3.06 $3.06 Deitsch Marc W. OnMed Pro ram $0.00 $0.00 Health Risk Aippraisal Motivation 0.00 $0,00 Respirator/Medical Review $16,32 $16.32 Corno rehen s ive Physical Ex Muscular Strength Endurance Test $26.52 $26.52 FlexibilitV 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 156.00 $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 Audiornetry $14.28 $14.28 EKG W/ Interp $20.40 20.40 Urinalysis Di stick $3.06 $3.06 Fisher Gary L. No Show Fee $0.00 so.001 Foster James 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 Strength Endurance Test $26.52 $26,52 Flexibilit Test $10.20 $10.2 0 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 INVOICE W Public Safety Medical Services 324 E. New York Street E Suite 300 m W Indianapolis, IN 46204 0 Carmel Fire Department 1 CARMEFD F 2 Civic Square Terms Carmel, IN 46032 invoice Date 08124!2011 m invoice 00 -15861 Date Employee Description Amount Balance Due 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 1428 $14.28 EKG W/ Inter 20.40 20.40 Urinalysis Dipstick 3.06 $3.06 Grimes Jeffrey A. OnMed Program $0.00 so.00l Health Risk Apmaisal Motivation 0.00 $0.00 RgspirgtorIMpdical Review 1 .3 1 Comprehensive Physical Exam $99.96 $99.96 Muscular Strength Endurance Test $26.52 $26.52 Flexibility 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 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 Audiomet 14.28 $14.28 EKG W/ Inter 20.40 $20.4 Urinalysis tick Holubik, Steven 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 Body 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 SO.00 Vision Acuity 26.52 $26.52 PFT Pulmonary FunctiQn Test $33.66 S33.661 Audiornetry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Hughes, Chad L. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.321 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/Hip Ratio $3.06 3.06 INVOICE 0 Public Safety Medical Services r 324 E. New York Street E Suite 300 a� Indianapolis, IN 46204 o Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08124/2011 m Invoice 00 -15861 Date Employee Description Amount Balance Due Treadmill Submax $156.00 $156.00 Vital Signs HT WT BP P R 0.00 S0.00 Vision Acuity 26.52 S26.52 P WI anaLy F�jnclion T t Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Rohr Christopher M. No Show Fee 10.00 $0.00 08/18/11 Ca shave Jeffrey A. OnMed Program $0.00 $0.00 Health Risk App raisal Motivation 0.00 $0.0 0 Respirator/Medical Review $16.32 $16.32 Comprehensive Ph sical Exam $99.96 $99.96 Muscular Strencith Endurance Test 26.52 26.52 Flexibility Test 10.20 10.26 Body Fat Test BIA Bio -Elec Imp Anal 14.28 14.28 Wi Hi R 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 Urinalysis Di stick 3.06 3.06 Cromlich. Mark A. OnMed Program 0.00 0.00 Health Risk A raisa) Motivation 0.00 0.00 Re irator /Medical Review 16.32 16.32 Comprehensive Physical Exam 99.96 99.96 Muscular Strength T t 2 Flexibilit 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 M$26- 156.00 Chest X -Ray PA/LAT Di ital 61.20 Vital Signs HT WT BP P R 0.00 Vision Acuit 26.52 PFT Pulmonary Function Test 33.66 Audiometry 14.28 EKG WI Inter 20.4 Urinal sis Di stick $3.06 maker. Samuel 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 $99.96 Muscular Strength Endurance Test $26.52 $26.52 Flexibility Test $10.20 $10.20 BodV Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 INVOICE 0 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 0812412011 Invoice 00 -15861 Date Employee Description Amount Balance Due Treadmill Submax $156.00 $156.00 Chest X -Ray PAIAT (Digital) 61.20 $61.20 Vital Si ns HT WT BP P R $0.00 0.00 Vision AcuitV $26.52 $26.52 PFT Pulmonary Function Test $33.56 3166 Audiometry 14.28 $14.28 EKG W/ Interp $20.40 $20.4 4 Urinalysis Dipstick $3.06 $3.06 Hoover Anthony B. OnMed Program $0.00 $0.00 Health Risk Nprraisal Motivation 0.00 $0.00 Resipirator/Medical R vi w $16.32 Comprehensive Physical Exam $99.96 $99.96 Muscular Strength Endurance Test $26.52 $26.52 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 $156.00 156.40 Chest X -Ray PA/LAT Di ital 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 Audiornetry $14.28 $14.28 EKG W Intprp $20.40 $20.4 Urinalysis- Di stick $3.06 $3.06 Marcum Bradley 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 $10.201 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 WaistlHi Ratio $3.06 $3.0 6 Treadmill Submax 156.00 156.00 Chest X -Ray PA/LAT Di ital 61.20 $61.20 Vital Sin HT WT BP P R $0.00 $0.0 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 Dipstick $3.06 $3.0 fi Osborne. Scott K. OnMed Program 0.00 0.00 Health Risk Aopraisal 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 S26.52 Flexibility Test 10.20 10.20 INVOICE 0 Public Safety Medical Services 324 E. New York Street W Suite 300 M Indianapolis, IN 46204 o Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 0812412011 m Invoice 00 -15861 Date Employee Description Amount Balance Due Body Fat Test BIA Bio -Elec Im Anal 14.28 $14.28 Waist/Hi Ratio $3.06 3.06 Treadmill Submax 156.00 $156.00 Ches X -R AT (Digital) 1. 1.20 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity M20.40 $26.52 PFT Pulmonary Function Test 33.66 Audiometry $14.28 EKG W1 Inter 20.40 Urinalysis Dipstick 3.06 Plumer Charles J. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 SO.00 Respirator/Medical Review 16.32 $16.32 Com rehensive Physical Exam $99.96 $99.96 Muscular Strength Endurance Test $26.52 $26.52 -E iaxi bihly T 10,20 1 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 AcuitV $26.52 $26.52 PFT Pulmonary Function Test $33,66 $33.66 Audiometry 14.28 $14.28 EKG Wl Enterp $20.40 $20,40 Urinal sis Dipstick $3.06 $3.06 Ryan, Christo her D. OnMed Pro ram $0.00 $0.00 Health Risk Aporaisal Motivation 0.00 $0.00 Res it for Medi I Review 6 S 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 S33.66 Audiometry 14.28 $14.28 EKG Wl Intero $20.40 $20.4 0 U rinalysis ti $106 Sharp Adam C. 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 INVOICE Public Safety Medical Services 324 E. New York Street Suite 300 W Indianapolis, IN 46204 G Carmel Fire Department 1 CARMEFD F- 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/24/2011 Invoice 00 -15861 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 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 W1 Inter 20.40 20.40 Urinal sis Di stick 3.06 $3.06 Sombke Brad D. OnMed Pro ram $0.00 $0.00 Health Risk Appraisal v ti n 0 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Muscular Strength Endurance Test 26.52 26.52 Flexibilit Test 10.20 10.20 Body Fat Test BIA Bio -Elec Im Anal 14.28 14.28 Waist/Ht Ratio 3.06 3.06 Treadmill Submax 156.00 $156.00 Chest X -Ray PA/LAT (Digital) 61.20 $61.20 Vital Si ns HT WT BP P R $0.00 SOM Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Aud $14.28 $14,2 EKG W/ Inter $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Steury, Kent C. OnMed Program 0.00 $0.00 Health Risk Aperaisal 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 Imp Anal 14.28 $14.28 Waist/Hi Ratio 3.06 $3.06 Treadmill Submax $156.00 $156.00 Chest X -R P (Digital) 1. 1 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 Youno, Andrew S. OnMed Program $0.00 $0.00 Respirator/Medical Review $16.32 $16,32 Comprehensive Physical Exam $99.96 $99.96 Vital Si ns HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department I CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 0812412011 Invoice 00 -15861 Date Employee Description Amount Balance Due PFT Pulmonary Function Test $33.66 $33.66 Audiometry 14.2 14.28 EKG W/ Intern $20.40 $20.4 0 .LjEjagg Dibsti .06 08/19/11 Butts, Renee L. 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 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 Chest X -Ray PAILAT (Digital) 61.20 6120 Vital Si ns HT WT BP P R $0.00 $0.0 Vision -Acuity 2 2 PFT Pulmonary Function Test $33.66 $33.66 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinal sis Dipstick $3.06 $3.06 Crisler, John H. OnMed Program $0.00 0.00 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.32 $16.321 Comprehensive Physical Exam $99.96 $99.96 Muscular Stren th 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 vva iautfin'satiQ $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 Dipstick $3.06 $3.06 Hemoccult $0.00 $0.00 Chest X -Ray PAILAT (Digital) 61.20 $61.20 Johnson Jerem S. OnMed Program 0.00 0.00 Health Risk Appraisal Motivation 0.00 S0.00 Re irat r Me i t Review $16-32 $16. 32 Comprehensive Phvsical Exam $99.96 $99.96 Muscular Strength Endurance Test $26.52 $26.52 Flexibility Test $10.20 $10.20 Bodv Fat Test BIA Bio -Elec Imp Anal $14.28 $14,28 Waist/Hip Ratio 3.06 3.06 Treadmill Submax $156.00 $156.00 Chest. X -Ray PAILAT (Digital) 61.20 $61.20 INVOICE H Pubfic Safety Medical Services r 324 E. New York Street E Suite 300 Indianapolis, IN 46204 o Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/24/2011 m Invoice 00 -15861 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 Audiometry 14.28 $14.28 EKG Wl Inter 20.40 $20,40 Urinalysis Dipstick $3.06 3.06 Kelsheimer, Troy 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 S99,96 Muscular Stren th Endurance Test $26.52 $26.52 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec fmp Anal 14.28 $14.28 WaisUHi Ratio $3.06 3.06 Treadmill Submax $156.00 $156.00 Vital Signs HT WT BP P R 10.00 $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 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Medlen Michael J. OnMed Program 0.0 0.00 Health Risk i sal (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 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 WaisUft 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 Audiornetry $14.28 $14.28 EKG W/ Inter $20,40 Urinal sis Dipstick $3.06 $3.06 Nicle Wes 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 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 1 S15 6.00 Vital Signs HT WT BP P R $0.00 SO.00 INVOICE F Public Safety Medical Services 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 08124!2011 m Invoice 00 -15861 Date Employee Description Amount Balance Due Vision Acuity 26.52 $26.52 PFT Pulmonar y Function Test $3 $33.66 Audiometry 14.28 $14.28 K W Int r 4 .4 Urinal sis Dipstick $3.06 $3.06 Phillips, Craip 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 Muscular Strength Endurance Test $26.52 $26.52 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 Chest X-Ray PAILAT Di ital 61.20 $61,2 0 Vital Sions HT WT BP P R Vision Acuity H20.40 6.52 $26.52 PFT Pulmonary Function Test 3.66 $33.66 Audiometry 4.28 $14.28 EKG Wl Inter $20.40 Urinal sis Di stick 3.06 3.06 Reecer Jason L. 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 Stren th Endurance Test S26.52 $26.52 Flexibility Test $10.20 $10.20 Body F T t- UIA Bi -EI Anal 14.28 S14. 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 3166 $33.66 Audiometry 14.28 $14.28 EKG W1 Interp $20.40 $20.40 Urinal sis Dipstick E E 3.06 Hemoccult 0 m Rohr Christopher M. OnMed Pro ra 0.00 Health Risk A raisal Motivation 0.00 Respirator/Medical vie 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 lm Anal $14.28 $14.28 WaisUft Ratio $3.06 $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 Q Indianapolis, IN 46204 G Carmel Fire Department 1 CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 0812412011 m Invoice 00 -15861 Date Employee Description Amount Balance Due Vision Acuit $26.52 $26,52 PFT Pulmonary Function Test $33.66 $33.66 Audlometry $14.28 $14.28 EKG Wl Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3,06 Thordarson Erik M. OnMed Pro ram $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0,00 Respirator/Medical Review $16,32 S16.32 Comprehensive Physical Exam 99.96 $99.96 Muscular Stren th Endurance Test $26.52 $26.52 Flexibility T est $10.20 $10. Body Fat Test BIA Bio -Elec Imp Anal $14.28 $14.28 Waist /Hi Ratio $3.06 306 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 AudiometrV $14.28 $14.28 EKG W/ Inter 20.40 $20.40 Urinalysis Dipstick $3.06 $3,06 Tierney, Scott A. OnMed Program $0,00 $0.00 Health Risk Aooraisal (Motivation) 0.04 $0.00 Respirator/Medical Revi w $16.32 $15 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 1428 $14.28 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 Si ns HT WT BP P R 10.00 $0.00 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiornetry $14.28 14.28 EKG W /Itr o $20-40 $2D.4 Urinalysis Dipstick $106 $3.06 Voskuhl, Mark J. OnMed Program $0.00 $0.00 Health Risk Appraisal (Motivation) $0.00 $0.00 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 10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio 3.06 $3.06 Treadmill Submax S156.00 $156.00 Vital Signs HT WT BP P R $0.00 $0.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 IY Indianapolis, IN 46204 o Carmel Fire Department CARMEFD t— Terms 2 Civic Square Carmel, IN 46032 Invoice Date 08I24I2011 m Invoice 00 -15861 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 W/ Interp $20.40 $20.4 Urinalysis Dipstick $3.06 $3.06 Total Charges $25,619.32 Total Payments Balance Due $0.00 $25,619.32 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from Invoice date INVOICE 0 Public Safety Medical Services 324 E. New York Street Suite 300 0: Indianapolis, IN 46204 Q Carmel Fire Department 1 CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 08117!2011 m Invoice 00 -15809 Date Employee Description Amount Balance Due 08/08/11 Baskerville AnthonV A. Chest X -Ray PA/LAT (Digital) $61.20 $61.2 0 Callahan Mark Chest X -Ra PA/LAT (Digital) 61.20 $61.2 0 Castor Rick S. Chest X -Ray PA/LAT (Digital) 61.20 61.20 Edwards. Daniel E. Chest X -Ray PA/LAT (Digital) 61.20 $61.20 Foster James P. Chest X -Ra PA/LAT (Digital) 61.20 $61.20 Holubik Steven W. Chest X -Ray PAILAT (Digital) 61.20 $61.20 Hu hes Chad L. Chest X -Ray PA/LAT (Digital) 61.20 $61.20 Mead Jr.. Donald R. Chest X -Ray PAILAT (Digital) 61.20 $61.20 Platt Jace R Chest X -Ray PA /LAT (Digital) 61.20 61.20 Robinson Mitchell L. Chest X -Ray PA/LAT (Digital) 61.20 S61.201 Spelbring. Chest -R PLLAT (Digital) $61,2Q 6 2 08/10111 DeCrastos, Richard A. Chest X -Ray (Comparison) $0.00 $0.00 Ellison Christopher M. Veni uncture 3.06 $3.06 HIV 1 2 Blood 13.26 $13.26 CMP (Comp Metabolic Panel 19.52 $19.52 CBC (Comp Blood Count 17.68 $17.68 Lipid Panel Blood 20.74 $20.74 08/11/11 Cummins. Frank 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 $3.061 HIV 1 2 Blood 13.26 $13.26 C holinesterase, m l0 4 PSA Prostate Specific A Blood $35.70 $35.70 08112/11 Baskervi Ile, Anthony A. Chest X -Ray (Comparison) $0.00 $0.00 Callahan, Mark Chest X -Ray (Comparison) 0.00 0.00 Foster. James P. Chest X -Ray (Comparison) 0.00 0.00 Total Charges $90332 Total Payments Balance Due $0.00 $903.32 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 $26,522.64 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOI CCT #/TITLE AMOUNT Board Members 24216 15861 43- 407.01 $25,619.32 1 hereby certify that the attached invoice(s), or 24216 15809 43- 407.01 $903.32 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 2-9 20p 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)) 15861 $25,619.32 15809 $903.32 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