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Home My WebLink About204625 12/13/2011 INVOICE 1 Public Safety Medical Services 324 E. New York Street E Suite 300 tY Indianapolis, IN 46204 0 Carmel Police Department 1 CARMEPD f 3 Civic Square Terms Carmel, IN 46032 Invoice Date 11/29/2011 m Invoice 00 -16582 Date Employee Description Amount Balance Due 08130/11 B rne. TimothV L. Cross Fit Assessment $0.00 $0.00 11115/11 Brady, Sean P. 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 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14,2B Waist/Hi Ratio $3.06 $3.0 6 Treadmill Submax $156.00 $156.0 0 Vital Si ns HT WT BP P R $0.00 $0.00 Vision Acui 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 Dixon Micheal R. No Show Fee $40.00 $40.0 0 Gilbert William J. OnMed Program $0.04 0.00 Health Risk A raisal 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 Body Fat Test BIA Bio -Elec Im Anal y) $14.28 $14.28 Waist/Hic Ratio $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 $33,66 Audiometry 14.2$ $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Di stick $3.06 $3.06 Hobson, Phillio L. Quantiferon Tb Blood 51.00 $51.0 0 QMP jComn Metabolic Panel 19.52 $19.52 CBC (Comp Blood Count $17.68 $17.68 Upid P (Bl 74 $20.741 Veni uncture $3.06 $3.06 HIV 1 2 Blood $13.26 $13.26 Keith. Brett A. 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 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 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Police Department I CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 11!2912011 m Invoice 00 -16582 Date Employee Description Amount. Balance Due Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.521 PFT Pulmonary Function Test $33.66 $33.66 Aud iomet $14 1 EKG W/ Interp $20.40 $20.40 Urinal sis Dipstick $3.06 $3.06 Miller. 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 199.96 $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 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 on metr y (Glaucoma Test) 7 .7 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 Dipstick $3.06 3.06 Inmection Fee $10.20 $10.20 Td Tetanus Diphtheria) Vacc $20.40 $20.40 O'Brian Mary K. Chart Review/Completion $82.60 $82.60 Indiana PERF Exam S185.64 $185.64 Applicant Blood Panel PERF S117.10 $117.101 Drua Screen 7 GUMS W MR 4 Veni uncture $3.06 $3.06 Chest X -Ray PAILA7 (Digital) $61.20 $61.20 Tb Skin Test $7.14 $7.14 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 Vision Color Ishihara 26.52 $26.52 PFT PulmonarV Function Test $33.66 $33.66 Audiometry $14.28 $14.28 EKG WI Interp $20.40 $20.4 0 Urinal ysis Di stick $3.06 $3,06 Tonometr Glaucoma Test 36.72 S36.721 Schalburg. Randly S. OnMed Pr aram $0.00 $0.0 Health Risk Appraisal Motivation $0.00 50.00 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 ImD Anal 14.28 $14.28 Waistildip Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 INVOICE F°— Public Safety Medical Services :t 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Police Department CARMEPD 3 Civic Square Terms Invoice Date 11/29/2011 Carmel, IN 46032 m Invoice 00 -16582 Date Employee Description Amount Balance Due 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 $20.4 0 Urinal sis Dipstick $3.06 $3.06 Total Char es $3,016.66 Total Payments &Balance Due $0.00 $3,016:66 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 $3,016.66 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1110 16582 43- 407.01 $3,016.fi6 I hereby certify that the attached invoice(s), or I I 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, December 08, 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)) 11/29/11 16582 officer physicals $3, 016.66 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 2Q Clerk- Treasurer