The URL can be used to link to this page

Home My WebLink About201382 09/13/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $3,957.34 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 201382 CHECK DATE: 9/13/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 15909 3,957.34 MEDICAL EXAM FEES INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 0$13112011 m Invoice 00 -15909 Date Employee Description Amount Balance Due 08/22/11 Amos Chad B. Quantiferon Tb Blood $51.00 $51.0 0 CMP (Comp Metabolic Panel 19.52 $19.52 CBC (Comp Blood Count 17.68 $17.6B Lipid Panel Blood 20.74 $20.74 Veni uncture $3.06 $3.06 Dewald Gregory S. 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 Imp Anal 14.28 S141 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Tonomet 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 Audiomet 14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 3.06 Hedrick Brad A. Quantifero n Tb Blood 51.00 $51.00 CMP (Comp Metabolic Panel 19.52 $19.52 B Q (Qgmp E31 Count) $17.68 $17. Lipid Panel Blood $20.74 $20.74 Veni uncture $3.06 $3.06 HIV 1 2 Blood 13.26 $13.26 08/24111 Bowman. Gary 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 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 onom t laucoma Test) 2 $3 6.72 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 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Broadnax Matthew 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 Flexibility Test $10.20 $10.2 0 INVOICE 0 Public Safety Medical Services 324 E. New York Street Suite 300 Indianapolis, IN 46204 Q Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08!3112011 m Invoice 00 -15909 Date Employee Description Amount Balance Due 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 T et T est) $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 $14.28 EKG W/ Inter 20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Grose James E. Quantiferon Tb Blood 51.00 $51,00 CMP fComp 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 BI 1 Harris. Sarah 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 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 $156.00 $156.00 Tonomet Glaucoma Test 36.72 36.72 Vitale Signs HT WT BP P R 0.00 0.00 Vision Acuity 26.52 26.52 FT Plmn F T 6 $33 Audiometry $14.28 $14.28 EKG W/ lnter $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Kin on. David M. 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 Flexibility Test $10.20 $10.2 0 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 WaisUHO Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Tonomet[y (Glaucoma Test) $3 6.7 2 S36.72 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 Audiomet 14.28 14.28 EKG W/ Interp $20.40 20.40 Urinalysis Dipstick $3.06 $3.06 Lytle, Blake A. I OnMed Program 0.00 $0.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Police Department CARMEPD I 3 Civic Square Terms Carmel, IN 46032 invoice Date 08/31/2011 m Invoice 00 -15909 Date Employee Description Amount Balance Due Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Ph sical Exam $99,96 $99.96 Flexibilitv Test $10,20 $10.20 Body Fat Test BIA Bio -Elec Im Anal 14.28 14.28 WaistlHi 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 Test $33.6 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinal sis Dipstick 3.06 $3.06 McIntyre, Trent 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 Flexibility Test 110.20 $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 T m Test) .72 $3672 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/ Interp S20.40 20.40 Urinalysis Dipstick $3.06 $3.061 White Kari E. OnMed Program 0.00 0.00 Health Risk Appraisal Motivation 0.00 $0.00 Flexibility Test S1020 $10.20 Comprehensive Physical Exam 99.96 $99.96 Flexibilitv Test $10.20 10.20 Body Fat T st -BIA (Bio-Elec Imp Anal S14.28 $14 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 Audiometry 14.28 $14.2B EKG W/ Interp $20.40 $20.4 0 Urinal sis Dipstick $3.06 $3.06 08/25/11 Locke Robert E. Quantiferon Tb Blood 51.00 51.0 CMP (Comr, Metabolic Panel 19.52 19.52 INVOICE t o Public Safety Medical Services 324 E. New York Street E Suite 300 IY Indianapolis, IN 46204 C Carmel Police Department 1 CARMEPD F 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08131/2011 m Invoice 00 -15909 Date Employee Description Amount Balance Due CBC (Comp Blood Count 17.68 $17.68 Li id Panel Blood 20.74 20.74 Veni uncture $3.06 3.06 HIV (Blood) 1 Total Charges $3,957.34 Total Payments Balance Due $0.00 $3,957.34 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 $3,9 57. 3 4 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 1110 15909 43- 407.01 $3,95734 I I 1 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, September 02, 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)) 08/31/11 15909 payment for officer phyicals $3,957.34 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