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Home My WebLink About178831 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES 2! CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $6,310.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 178831 CHECK DATE: 10/28/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION '1120 4340702 11809 88.00 SHOTS INOCULATIONS 1110 4340701 11855 2,158.00 MEDICAL EXAM FEES 1120 4340701 11892 700.00 MEDICAL EXAM FEES '1110 4340701 11893 3,364.00 MEDICAL EXAM FEES INVOICE F 0 Public Safety Medical Services 324 E. New York Street E Suite 300 CD Indianapolis, IN 46204 G Carmel Police Department 1 CARMEPD 3 Civic Square berms Carmel, IN 46032 Invoice Date 10h412009 m Invoice 00 -11855 Date Employee Description Amount Balance Due 10/05109 Dixon, Micheal R. CMP $16.00 $16.00 CBC W /Dill And Plat $13,00 $13.0 0 Lipid Panel $16.00 $16.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.0c PSA 35.00 $35.0 0 Quantiferon Tb Gold $50.00 $50.0 0 Fogartv, Michael D. CMP $116.00 $16,0 0 CBC W /Dill And Plat $13.00 $13.0 0 Li id Panel $16.00 $16.00 Veni un tur Fee 13.QQ $3.0 HIV 1 2 $13.00 $13.00 PSA $35.00 $35.00 Quantiferon Tb Gold $50.00 $50.00 Graham Bruce A. CMP $16.00 $16.00 CBC W /Dill And Plat $13.00 $13.0 0 Lipid Panel $16.00 $16.0 0 Veni uncture Fee $3.00 3.00 HIV 1 2 $13.00 $13,0 0 Quantiferon Tb Gold $50.00 $50,00 Horner Jeffrey J. CMP $16.00 $16.0 0 CBC W /Dill And Plat $13.00 $13,0 0 Lipid Panel $16.00 16.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Quantiferon Tb Good $50.00 $50.00 Kinkade, Matthew P. CMP 16.00 $16.0 0 CBC W /Dill And Plat 1100 $13.00 Li id Panel $16.00 16.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Q uantiferon Tb Gold $50.00 $50.00 Klein Marc A. CMP $16.00 $16.00 CBC W Diff And Plat $13.00 113.0 0 Li id Panel $16,QQ S16,001 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Quantiferon Tb Gold $50.00 $50.00 Leach Aaron M. CMP $16.00 $16.00 CBC WIDiff And Plat $13.00 $13.00 Lipid Panel $16,00 $16.001 Veni uncture Fee $3.00 $3,00 HIV 1 2 $13.00 $13.0 0 Q uantiferon Tb Gold $50.00 $50.0 0 10/07/09 Brady, Sean P. CMP $16.00 $16.0 0 CBC W /Diff And Plat $13.00 $13.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 tY Indianapolis, IN 46204 G Carmel Police Department 1 CARMEPD F 3 Civic Square Terms Carmel, IN 46032 Invoice Date 10114!2009 Invoice 00 -11855 Date Employee Description Amount Balance Due Lipid Panel $16.00 $16.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 1100 $13.0 0 u ntiferon Tb Gold $50.00 $50.0 0 Dixon, Micheal R. BIA Bio -Elec im ed Ana! $14.00 $14.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Hemoccult $5.00 $5.00 Vital Signs HT WT BP P R $7.0D $7,00 Vision Titmus $26.00 $26.00 PFT W/Intern $33.00 $33.0 0 Audiornetry $14.00 $14.00 ECG W1 Inter 20.00 $20.0 0 Urinalysis Di stick $3.00 $3,00 ComiDrehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Motivation $16.00 $16.00 Green Timothy J. Comprehensive Physical 591.00 $91.00 Health Risk Appraisal Motivation 16.00 16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Flexibility Check $10.00 $10.00 Waist/Hip Ratio $3.00 3.00 Treadmill (PFE) $153.00 $153.00 Hemoccult $5,00 $5.00 Vital Signs HT WT BP P R ST00 $7. Vision Titmus $26.00 $26.00 PFT Wllnter $33.00 $33.00 Audiomet 14.00 $14.00 ECG W1 Interp $20.00 $20.00 Urinalysis Dipstick $3.OD $3.00 Jellison Ryan D. Comprehensive Physical $91.00 $91.00 Health Risk A2praisal Motivation 16.00 $16.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Flexibility Check 10.00 $10.00 Waist/Hi Ratio $3,00 $3.00 Treadmill (PFE) $15 .00 $153.0 0 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiometry $14.00 $14.00 ECG W( Inter 20.00 $20.00 Urinalysis Dipstick $3.00 3.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 ix Indianapolis, IN 46204 G Carmel Police Department/ CARMEPD I 3 Civic Square Terms Carmel, IN 46032 Invoice Date 10!1412009 Invoice 00.11855 Date Employee Description Amount Balance Due Total Charges $2,158.00 Total Payments Balance Due $0.00 $2,158.00: Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date INVOICE I o Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Police Department I CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 10/21/2009 m Invoice 00 -11893 Date Employee Description Amount Balance Due 10!15109 Brady Sean P. Comprehensive Physical $91.00 $91.00 OnMed Program $0,00 $0.00 Respirator/Medical Review $16.00 116.0 0 Health Risk Appraisal f Motivation 16.00 16.00 Flexibilitv Check $10.00 $10.0c Waist/Hi Ratio $3.00 $3,00 Treadmill (PFE) $153.00 $153.00 Hemoccult $5.00 $5.0 0 Tonometry $36.00 $36.0 0 Vital Si ns HT WT BP P R STQQ $7.00 Vision Titmus 26.00 $26.0 0 PFT W/Interp $33.00 $33.00 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Fogarty Michael D. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16,0 0 OnMed Program $O.OD $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE $1 53.QO $153.0 Tonometry $36.00 $36.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W/Interp $33.00 $33.0 0 Audiornetry $14.00 $14,0 0 ECG W1 Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Hedrick Brad A. Com rehensive Physical 191.00 $91.0 0 Health Risk A raisa! Motivation 16.00 $16.00 OnMed Program 0.00 $0.00 Res irator Medic I Review $16,00 $16.0 0 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Tonomet $36.00 $36.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.0 0 Audiometry 14.00 14.00 ECG W/ Interp $20,00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Kinkade Matthew P. Comprehensive Physical 91.00 91.00 Health Risk Anl2raisal Motivation 16.00 $16.0 0 1 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 tY Indianapolis, IN 46204 G Carmel Police Department CARMEPD H 3 Civic Square Terms Carmel, IN 46032 Invoice Date 10!2112009 Invoice 00 -11893 Date Employee Description Amount Balance Due OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Flexibility Check $10.00 $10,0 0 Wais Hi R t iQ $3,00 3. Treadmill (PFE) $153.00 $153.00 HB SAb Quantitative Titer $35.00 $35.00 Tonometry $36.00 $36.00 Vital Si ns HT W i BP P R $7,00 7.00 Vision Titmus $26.00 $26,0 0 PFT W/Interp $33,00 $33.0 0 Audiomet $14.00 $14,0 0 ECG W/ Interp $20,00 $20.00 Urinalysis Dipstick $3.00 $3.00 Leach Aaron M. Comprehensive Physical $91.00 $91.0 0 Health Risk Aippraisal Motivation 16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Flexibilitv Check $10.00 $10.00 BIA (Bic)-Elec Im ed Anal $14.00 $14.00 WaisUHi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Tonometry $36.00 $36.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W/Interp $33.00 $33,00 Audiomet $14.00 $14,0 0 ECG WI Inter 20.00 $20.00 Urinal sis Di ti k $3.00 Smiley, LandEy Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation $16.00 $16.00 OnMed Program $0.00 $0.00 Respirator /Medical Review $16.00 $16.00 Flexibility Check 10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) 1153.00 $153.00 CMP $16.00 $16.D 0 CBC W1DiffAnd Plat 1100 $13.0 0 Li id Panel $16.00 $16.00 V nr uncture Fee $3.00 $3.00 uantiferon Tb Gold $50.00 $50.00 Tonornetry $36.00 $36.00 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiometry 14.00 $14.0 0 ECG W1 Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 INVOICE c Public Safety Medical Services 324 E. New York Street E Suite 300 lY Indianapolis, IN 46204 o Carmel Police Department I CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 10/21/2009 m Invoice 00 -11893 Date Employee Description Amount Balance Due 10/16/09 Thomas Richard E. Indiana Police /Fire PERF $175.00 $175.00 Chart Review/Completion $52.00 $52.0 0 Chest PAlLAT $60,00 $60.0 0 Tb Skin Test 7.00 $7.00 Applicant Health Screen PERF $101.00 101.00 Drug Screen 8 GCIMS WIMRO 70.00 $70.0 0 Vital Signs HT WT BP P R $7,00 $7.0 0 Vision Titmus $26.00 $26.D 0 Color Vision Ishihara 26.00 $26,D 0 PFT W(Inter 33.00 33.00 Audiomet 14 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Tonomet $36.00 $36.00 Total Charges $3,364.00 Total Payments Balance Due $0.00 $3,364.00 Please write invoice number on payment check. Balance due 1.5 days from invoice Our Federal Empioyer identification Number is 35- 2079797 date Prescribgd by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 291 (Rev. 1995) 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 Public Safety Medical Services Purchase Order No. 324 E. New York STreet, Suite 300 Terms Indianapolis, IN 46204 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 10/14/09 11855 paVment for officer physicals 2,158.00 10/21/0 11893 payment for officer and applicant physicals 3,364.00 Total 5,522.00 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 5,522.00 ON ACCOUNT OF APPROPRIATION FOR police general fund Board Members PO# or D PT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or 1110 11855 407 -01 2 ,158.00 bill(s) is (are) true and correct and that the 1110 11893 407 -01 3 ,364.00 materials or services itemized thereon for which charge is made were ordered and received except October 23 20 09 Ignature Chief: of POlice Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE t: Public Safety Medical Services 324 E. New York Street E Suite 300 a Indianapolis, IN 46204 C Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 10107I2009 m Invoice 00 -11809 Date Employee Description Amount Balance Due 10102/09 Sutton Sean B. Injection Fee $10.00 $10.00 Hepatitis A Vacc Havrix #2 $78.00 $78.00 Total Charges $88.00 Total Payments Balance Due $0.00 $88.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 INVOICE '0 Public Safety Medical Services 324 E. New York Street E Suite 300 tx Indianapolis, IN 46204 Carmel Fire Department! CARMEFD Terms 2 Civic Square Invoice Date 10/21/2009 m Carmel, IN 46032 Invoice 00 -11892 Date Employee Description Amount Balance Due 10 /14 /09 Haboush David G. Health Ed Presentation Nutrition $175.00 $175.00 Health Ed Presentation Nutrition 175.00 $175,0 0 10/15/09 Haboush David G. Health Ed Presentation Nutrition 175.00 $175.00 Health Ed Presentation Nutrition $175.00 175.00 Total Charges $700.00 Total Payments Balance Due 1 $0.00 $700.00S Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date VO UCHER N O. WARRANT NO. ALLOWED 20 Public*Safety Medical Services IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $788.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 1120 11809 43- 407.02 $88.00 1 hereby certify that the attached invoice(s), or 1120 11892 43- 407.01 $700.00 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 OCT 2 6 2009 d f /7 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board ofAecounts City Ferm 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)) 11809 $88.00 11892 $700.00 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