The URL can be used to link to this page

Home My WebLink About202275 09/27/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 �J� ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $21,481.78 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 202275 CHECK DATE: 9/27/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 24216 15908 10,392.64 ANNUAL EXAMS 1120 4340701 24216 15955 7,277.76 ANNUAL EXAMS 1110 4340701 15957 3,653.38 MEDICAL EXAM FEES 1120 4340701 24216 16011 158.00 ANNUAL EXAMS INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 09/08/2011 m Invoice 00 -15957 Date Employee Description Amount Balance Due 08/29/11 Rodriguez, Cristhian R. 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 Hen B Titer SAb Quantitative Blood 35.70 $35.70 Veni uncture $3.06 $3.06 Treadmill Submax $156.00 $156.00 Flexibility Test $10.20 $10.20 Bodv Fat Test BIA Bio -Elec Imip Anal 14.28 $14.28 Waist/1-14) Ratio $3.06 $3.06 T t [y (Glaucoma Test) .7 .7 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/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 09101/11 Amos, Chad B. 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 Stren th Endurance Test $26.52 $26.52 Flexibility Test $10.20 $10.2 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 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 Audiometry 14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinal sis Di stick $3.06 $3.0 6 Byrne, Timothy L. OnMed Program $0.00 $0.0 0 Health I (Motivation) $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 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 Audiometry 14.28 $14.28 EKG W/ Inter 20.40 $20.4 0 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 IY Indianapolis, IN 46204 C Carmel Police Department CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 09/08/2011 m Invoice 00 -15957 Date Employee Description Amount Balance Due Urinalysis Di stick $3.06 $3.06 Gerdt Andrew P. OnMed Pro ram $0.00 $0.00 Health Risk Aorwaisal Motivation 0.00 $0.00 Reso irator/Medical Review 1 1 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 WaistlHi 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 $0.0 0 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiornetry $14.28 $14.28 EKG W Inter 20.40 $20.4 0 Urinalysis Dipstick $3.06 Grose 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 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waistlft 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 V Acuity 22 PFT Pulmonary Function Test $33.66 $33.66 Audiomet $14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinal sis Dipstick $3.06 $3.06 Haymaker, William 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 M14.28 10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 W i H' R ti Treadmill Submax $156.00 Hemoccult $0.00 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 Audiometry 14.28 $14.28 INVOICE �o Public Safety Medical Services 324 E. New York Street E Suite 300 m W. Indianapolis, IN 46204 C Carmel Police Department CARMEPD F 3 Civic Square Terms Carmel, IN 46032 Invoice Date 09/08/2011 m Invoice 00 -15957 Date Employee Description Amount Balance Due EKG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Hedrick, Brad A. 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 OnMed Program $0.00 $0.00 Health Risk Anpraisal Motivation 0.00 $0.00 Resoirator/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 Repeat Quantiferon Tb Blood 0.00 $0.00 Veni uncture not Processed On 8/22/11 0.00 $0.00 Tonomet Glaucoma Test 36.72 $36.72 Vital Signs HT WT BP P R $0.00 $0.00 Herron James C. No Show Fee $40.00 $40.0 0 L ocke, bert E. T n et ry (Glaucoma Test) 2 $36.7 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 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 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 Total Charges $3,653.38 Total Payments Balance Due $0.00 $3,653.38 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date 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)) 09/08/11 15957 payment for officer physicals $3,653.38 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $3,653.38 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 I 15957 I 43- 407.01 I $3,653.38 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 Thursday, September 22, 2011 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE H Public Safety Medical Services y 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Fire Department CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 08/31/2011 m Invoice 00 -15908 Date Employee Description Amount Balance Due 07/25/11 Platt Jace P. Coronary Calcium Scan (CCS) 4 -Week $79.00 $79.0 0 07/26/11 Edwards Steven L. Coronary Calcium Scan (CCS) 4 -Week $79.00 $79.0 0 08/07/11 Watts. Trent E. Coronary Calcium Scan (CCS) 4 -Week $79.00 $79.0 0 08/22/11 DeLon Michael T. Chest X -Ray PA/LAT (Digital) 61.20 $61.2 0 Edwards Steven L. Chest X -Ray PA/LAT (Digital) 61.20 61.20 Horner David W. Chest X -Ray PA/LAT Di ital 61.20 61.20 Lux Michael T. Chest X -Ray PA/LAT (Digital) 61.20 61.20 Mitchell James C. Chest X -Ray PA /LAT (Digital) 61.20 61.20 Paddock Ronald D. Chest X -Ray PA/LAT (Digital) 61.20 61.20 Utzi Todd T. Chest X -Ray PA/LAT Di ital 61.20 61.20 Yon Alan R t X -R PA/LAT i it 1.2 $61.2 Young, Kevin M. Chest X -Ray PA/LAT (Digital) $61.20 $61.20 08/23/11 Bowles, Orbie H. 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 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imo 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 2 2 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 106 Brant. Kenneth E. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 so.001 Res irator /Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.00 Flexibility Test $10.20 $10.2 0 Body Fat Test BIA Bio -Elec Im Anal 14.28 $14.28 Waist/Hip 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 AudiometrV $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Davis. James M. Hemoccult $0.00 $0.00 Com rehensive Physical Exam $99.96 $99.96 OnMed Program $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 Res irator /Medical Review $16.32 $16.32 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W- Indianapolis, IN 46204 o Carmel Fire Department CARMEFD t- Terms 2 Civic Square Carmel, IN 46032 Invoice Date 08/31/2011 m Invoice 00 -15908 Date Employee Description Amount Balance Due Treadmill Submax $156.00 $156.00 Muscular Stren th Endurance Test $26.52 $26.521 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bi -EI c Imp Anal $14.28 14. Waist/Hi Ratio $3.06 $3.06 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 Audiornetry $14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Fa in. Timothy D. 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 Audionjetcy $14.28 $14.2 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 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 $156.00 Muscular Strength Endurance Test $26.52 $26.52 Flexibility Test $10.20 $10.2 0 Bodv Fat Test BIA Bio -Elec lm Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Hoffman, Matthew F. Comprehensive Physical Exam $9 9.96 Treadmill Submax $156.00 $156.00 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 106 $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 Audiornetry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Di stick $3.06 $3.06 MP m Metabolic Panel) $1 1 2 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 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 M Indianapolis, IN 46204 o Carmel Fire Department CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 08/31/2011 m Invoice 00 -15908 Date Employee Description Amount Balance Due Respirator/Medical Review $16.32 $16.32 Chest X -Ray PA/LAT (Digital) 61.20 $61.2 0 Lenze Theodore 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 Treadmill Submax $156.00 $156.00 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 R atio $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 $14.28 EKG W/ Interp $20.40 $20. 40 Urinalysis Dipstick $3.06 $3. 06 McNeely, Michael 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 Treadmill Submax $156.00 $156.00 Mu�cu End Tst $26. $2 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 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/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Mead David L. OnMed Pro ram $0.00 so.00 Health Rik Appraisal (Motivation) 0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Ph sical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.00 Muscular Strength Endurance Test g$61.20 0 .52 26.52 Flexibilit Test .20 10.20 Body Fat Test BIA Bio -Elec Imp Anal .28 14.28 Waist/Hi Ratio .06 3.06 Chest X -Ray PA/LAT Di ital $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 E]� INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Fire Department CARMEFD t- Terms 2 Civic Square Carmel, IN 46032 Invoice Date 08/31/2011 m Invoice 00 -15908 Date Employee Description Amount Balance Due Audiometry 14.28 $14.28 EKG W/ Intero $20.40 $20.401 Urinalysis Di stick $3.06 $3.06 Reeves, to h n J OnMed Pro ram Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 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 $3.0 6 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 14.2 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Hemoccult $0.00 0.00 Comprehensive Physical Exam $99.96 $99.96 Sutton Sean B. 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 Flexibility Test 10.20 10.20 Body Fat Test BIA Bi -EI c Imp An I 14.2 14.2 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 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Toney, James D. 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 Treadmill Submax $156.00 $156.00 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 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 INVOICE o Public Safety Medical Services r 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 O Carmel Fire Department CARMEFD F- Terms 2 Civic Square Carmel, IN 46032 Invoice Date 08131/2011 m Invoice 00 -15908 Date Employee Description Amount Balance Due 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 Weaver Virgil L. OnMed Program $0.00 $0.00 Health Risk Aporaisal 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 Flexibility Te t $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 $14.28 EKG W/ Inter 20.40 20.40 Urinalysis Dipstick $3.06 $3.06 Young, Andrew S. Treadmill Submax $156.00 $156.001 Muscular Strength Endurance Test $26.52 $26.52 Flexibilitv Test $10.20 $10.2 0 Body Fat Test BIA (Bio-Elec Imp Anal y) $14.28 $14. Waist/Hi Ratio $3.06 $3.06 Health Risk Appraisal Motivation $0.00 1 $0.00 08125/11 Bailey, Mark 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 Bodv Fat Test BIA Bio -Elec Imo Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.0 6 Treadmill Submax $156.00 $156.0 0 Vital Sians HT WT BP P 0. 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 Brisco, Michael D. 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 H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 08/31/2011 m Invoice 00 -15908 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 Vital Signs HT WT BP 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 Buttler. James N. 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 Body Fat Test BIA Bio -Elec Im Anal 14.28 $14.28 Waist/Hip Ratio 3. 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 AL)diometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Di stick $3.06 $3.06 Cummins Frank C. 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 $99.961 Muscular Stren h Endurance Test $26.52 $2 6.52 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 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 $20.40 $20.40 Urinalysis Di stick $3.06 $3.061 Haboush David G. OnMed Pro ram $0.00 $0.00 Health Risk Armraisal (Motivati $0.0 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 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 0 W Indianapolis, IN 46204 o Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/31/2011 m Invoice 00 -15908 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 W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Moharty, John F. Audiometry 14.28 $14.28 EKG W/ Inter 20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 OnMed Program $0.00 $0.00 Health Risk Aporaisal (Motivati $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 $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 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 Ray, Lucas M. OnMed Pr r m $0. 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 $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 A diom t [y $14.28 $14.2 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Reynolds, Shawn 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 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/HiD Ratio 3.06 $3.06 Treadmill Submax 156.00 156.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 0 Carmel Fire Department CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 09/08/2011 m Invoice 00 -15955 Date Employee Description Amount Balance Due 08/30/11 Bondurant Jeff S. 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 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 2 2 $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 Brandt. Gary D. 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 $99.961 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 W i 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 Di stick $3.06 $3.06 Butts Joseph A. OnMed Program $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.0 0 Muscu Strenath 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 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/ Inter 20.40 $20.4 0 Urinalysis Di stick $3.06 $3.061 Fisher Gary L. OnMed Pro ram $0.00 $0.00 INVOICE 0 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 09/08/2011 m Invoice 00 -15955 Date Employee Description Amount Balance Due Health Risk Appraisal Motivation 0.00 $0.00 Res irator /Medical Review $16.32 $16.32 Com rehensive Physical Exam $99.96 $99.96 M uscular tren th Endur T est $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 $0.0 0 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiornetry $14.28 $14.28 EKG W/ Inter 20.40 $20.40 Urinalysis Di stick $3.06 $3.06 Re eat Chest X -Ray PA/LAT $61.20 $61.20 Freer, Keith T. Flexibifity 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 $33.66 Audiornetry $14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinal sis Dipstick $3.06 $3.06 OnMed Pro ram $0.00 $0.001 Health Risk Armraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $15.32 Comprehensive Physical Exam $99.96 $99.96 Muscular Strength Endurance Test $26.52 $26.52 Frenzel Eric C. 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 Im o 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 2 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiornetry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinal sis Dipstick $3.06 $3.06 OnMed Program $0.00 $0.00 Griffin Timothy M. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 INVOICE F Public Safety Medical Services 324 E. New York Street E Suite 300 IY Indianapolis, IN 46204 o Carmel Fire Department CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 09/08/2011 m Invoice 00 -15955 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 FlexibilitV Test $10.20 $10.2 0 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 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 4 28 $14.2 EKG W/ Interp $20.40 $20.40 Urinal sis Dipstick $3.06 $3.0 6 Howard. Wendell E. 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 $99.96 $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 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 C he s t X- P LAT (Digital) $61.2 61. 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 Reppert, Ian T. 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 Muscular Stren th Endurance Test $26.52 $26.52 Flexibility T est $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 Acuit 26.52 26.52 PFT Pulmonary Function Test 33.66 $33.66 Audiometry 14.28 $14.28 EKG W/ Intero $20.40 $20.40 Urinalysis Di stick $3.06 $3.06 Robinson Mark G. OnMed Program $0.00 $0.00 Health Risk Aopraisal Motivation 0.00 0.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Fire Department CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 09/08/2011 m Invoice 00 -15955 Date Employee Description Amount Balance Due 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 $10.2 Body Fat Test BIA Bio -Elec Imp Anal $14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax M$26.52 156.00 Vital Signs HT WT BP P R 0.00 Vision Acuity 26.52 PFT Pulmona Function Test 33.66 Audiomet $14.28 EKG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Steele Jeffrey A. Urinalysis Di stick $3.06 $3.06 OnMed Pro ram $0.00 $0.00 Health Risk ADDTaiSai (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 $10.2 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 -Ray PA /LAT (Digital) 61.20 $61.2 0 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 Audi m t [y $14.28 $14.28 EKG W/ Interp $20.40 $20.40 08/31/11 Deitsch Marc W. Repeat Vision Acuity $0.00 $0.00 Ellison Christopher M. 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 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Vital Sions 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 Frye, Steven R. I OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 X Indianapolis, IN 46204 C Carmel Fire Department CARMEFD H Terms 2 Civic Square Carmel, IN 46032 Invoice Date 09108/2011 m Invoice 00 -15955 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 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 Audiomet $14.28 $14. EKG W/ Interp $20.40 $20.40 Urinal sis Dipstick $3.06 $3.06 Fuchs Jeffery W. Chest X -Ray PA/LAT (Digital) 61.20 $61.20 Harrington, 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 Imip 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 Test $33.66 $33.66 Audiometry 14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Hensley, Robert P. Chest X -Ray PA/LAT (Digital) 61.20 $61.20 Knott Bruce 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 Muscular tr n th Endurance Test $26. $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 $61.201 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 Di stick $3.06 3.06 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/31/2011 m Invoice 00 -15908 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 Audiornetry $14.28 14. EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Schooley Dustin 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 Im Anal 14.28 14.28 WaisUI -1 Ratio 3.06 3.06 Treadmill Submax 156.00 156.00 Vital Sians HT WT BP P R Vision Acuity $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 Dipstick $3.06 $3.06 Total Charges $10,392.64 Total Payments Balance Due $0.00 $10,392.64 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date INVOICE to- Public Safety Medical Services 324 E. New York Street E Suite 300 Q Indianapolis, IN 46204 G Carmel Fire Department CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 09/08/2011 m Invoice 00 -15955 Date Employee Description Amount Balance Due Maroon Emie R. OnMed Program $0.00 $0.00 Health Risk Armraisal Motivation 0.00 $0.00 Res irator /Medical Review $16.32 $16.32 Comp 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 $61.2 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 U rinalysis k $3.06 $3 Total Charges $7,277.76 Total Payments Balance Due $0.00 $7,277.76 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance Due 15 days from invoice date INVOICE H 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 09/14!2011 m Invoice 00 -16011 Date Employee Description Amount Balance Due 08/09/11 Kelsheimer Troy W. CCS 4 -Week Results 79.00 $79.0 0 08/30/11 Brandt. Gary D. CCS 4 -Week Results $79.00 $79.00 09/06/11 Crisler. John H. Chest X -Ray (Comparison) 0.00 0.00 Cromlich Mark A. Chest X -Ray (Comparison) 0.00 $0.00 Phillips. Craig M. I Chest X -Ray (Comparison) 0.00 0.00 Sharp. Adam C. Chest X -Ray 0.00 0.00 Total Charges 1 $158.00 Total Payments Balance Due $0.00 1 $158.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date 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)) 16011 $158.00 15955 $7,277.76 15908 I $10,392.64 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $17,828.40 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 24216 16011 43- 407.01 $158.00 1 hereby certify that the attached invoice(s), or 24216 15955 43- 407.01 $7,277.76 bill(s) is (are) true and correct and that the 24216 I 15908 I 43- 407.01 I $10,392.64 materials or services itemized thereon for which charge is made were ordered and received except i /7 .-r Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund