The URL can be used to link to this page

Home My WebLink About177812 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES i/ CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $7,952.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 177812 CHECK DATE: 9129/2009 DEP ACCOUNT PO NUMBER IN VOICE NUMBE AMOUNT DESCRIPTION 1120 4340701 11650 /1,497.00 MEDICAL EXAM FEES 1110 4340701 11651 3,935.00 MEDICAL EXAM FEES 1120 4340701 11681 X2,520.00 MEDICAL EXAM FEES INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 0: Indianapolis, IN 46204 G Carmel Police Department I CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 0910912009 Invoice 00 -11651 Date Employee Description Amount Balance Due 08131109 Bickel Scott W. Com rehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Program 0.00 $0.00 Res iratorlMedical Review $16.00 $16.00 Flexibility Check $10,00 $10.0c Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE $153.00 $153.00 Tonomet $36.00 $36.0 0 Vital Signs HT WT BP P R $7.00 7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Byrne, Timothy L. Comprehensive Physical 91.00 $91.00 Health Risk Appraisal Motivation 16.00 $16.0 0 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) $153.00 $153.00 uantiferon Tb Gold 50.00 $50.0 0 T o n om e try $3 6.00 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 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.DO $3.00 Grose .lames E. Comprehensive Physical $91.OG $91,001 Health Risk AoPraisal Motivation 16.00 $16.00 OnMed Program $0,00 0.00 Respirator/Medical Review 16.00 16.00 BIA Bi le An 14.00 14.00 Flexibility Check 1 OM $10,0 0 Waist /Hi Ratio $3.00 $3.00 Treadmill (PFE $153.00 $153.00 Quantiferon Tb Gold $50.00 $50.00 Tonometry $36.OD $36.00 Vital Signs HT WT BP P R $7,00 $7.00 Vision Titmus $26.00 $26.00 PFT W/InteFp $33,DO $33.0 0 Audiometry 14. DO $14.0 0 ECG W/ Enter 20.00 $20.0 0 Urinal sis Dipstick $3.00 $3.00 Hill Nathaniel W. HB SAb Quantitative Titer $35.00 1 S35.00 INVOICE o, Public Safety Medical Services t 324 E. New York Street E Suite 300 IY Indianapolis, IN 46204 G Carmel Police Department I CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 09/09/2009 m Invoice 00 -11651 Date Employee Description Amount Balance Due Kin on David M. Com rehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation 16.00 $16,OC OnMed Program $0.00 $0,0 0 Resiplrator/Mgdical Review 1 0 $16. BIA Bic -Elec Im ed Anal $14.00 $14.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 TonometrV $36.00 $36.0C Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT VVIInterlp $33.00 $33.00 Audiometry 14.00 J14.0 0 ECG WI Interp $20.00 $20,00 Urinalysis Dipstick $3.00 100 Locke Robert E. Com rehensive 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 Tonomet $36.00 $36.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.001 PFT W/Interp $33.00 $33,00 Audiometry 14.00 $14.00 ECG W/ Interp $20,00 $20.00 Urinalysis Di stick $3.00 $3.00 Flexibility Check $10,00 $10.0 0 W is Hip Ratio $3.00 $3.QC Treadmill (PFE $153.00 $153.00 Matthews Daniel M. No -Show Fee $0.00 $0.00 McIntyre, Trent A. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation 16.00 6.00 OnMed Program $0.00 10.00 Respirator/Medical Review $16,00 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 uantiferon Tb Gold $50.00 $50.0 0 Tonornetry $36.00 3 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 Audiarnetry $14.00 $14,0 0 ECG Wl Interp $20.DO $20.0 0 Urinalysis Dipstick 3.00 $3.00 Pilkin ton Scott Comprehensive Physical $91.00 $91.00 •r INVOICE 0 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 4fiO32 Invoice Date 09/0912009 m Invoice 00 -11651 Date Employee Description Amount Balance Due Health Risk Appraisal Motivation $16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16,00 $16.0 0 Flexibility Check $10.00 $10,0 0 Waist/Hi Ratio $3,00 $3.00 Treadmill (PFE 153.00 $153.00 Hemoccult $5.00 $5.00 Tonometry $36.00 $36.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Intero $3300 $33.0 0 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinal sis Dipstick $3.00 $3.00 Rush Michael T. 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 Quantiferon Tb Gold $50.00 $50.0 0 Schmidt, Brian E. Com rehensive Physical 91.00 $91.00 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Pro ram $0,00 $0.00 Res irator Medical Review 1 .00 $16.Q Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 TonometrV $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 33.00 Audiomet 14.00 $14.0 0 ECG W/ Interp $20.00 $20.0 0 Urinalysis Di stick $3.00 $3.0 0 S iilm n (Scott) CMP $16.00 $16.0 0 CBC W /Dill And Plat $13.00 $13.00 Lipid Panel $16.00 $16.00 Veni uncture Fee $3.00 $3.00 HIV 1 &2 $13.00 $13.00 PSA $35.00 $35.00 Quantiferon Tb Gold $50.00 $50,00 WB SAb Quantitative Titer 35.00 $35,00 Total Charges $3,935.00 Total Payments Balance Due $0.00 $3,935.00 Please write invoice number on payment check. Balance due 15 days from invoice date Prescrided by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (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 F. New York 9frPPt, St>itP 100 Terms Tndiana olig, TN 46604 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 9/9/09 11651 payLnent for officer physica ,3 Total 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 VOUCHER NO. WARRANT NO. ALLOWED 20 P ublic Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 3,935.00 ON ACCOUNT OF APPROPRIATION FOR police general.i_fund Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1110 11651 407 -01 3 935.00 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 September 25 20 09 Signature Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund INVOICE 'Public Safety Medical Services 324 E. New York Street E Suite 300 0: Indianapolis, IN 46204 Carmel Fire Department/ CAi2MEFD Terms 2 Civic Square Invoice Date 09116/2009 m Carmel, IN 46032 Invoice 00 -11681 Date Employee Description Amount Balance Due 09/09109 Maners Jeremy B. Indiana Police /Fire PERF $570.00 $570.00 Chest PA/LAT 60.00 $60.00 Tb Skin Test $0. 00 $0.00 Applicant Health Screen PERF $0.00 $0.00 McNair Travis L. Indiana Police /Fire PERF $570.00 $570.00 Chest PA/LAT $60.00 $60.0 0 Tb Skin Test $0.00 $0.00 Avplicant Health Screen PERF $0.00 0.00 M_ owe Anthony W. Indiana Police /Fire PERF $570.00 $570.0 0 Chest PA/LAT $60,00 $60.001 Tb Skin Test $0.00 $0.0 Applicant Health Screen PERF $0.00 $0.00 Thordarson Erik M. Indiana Police /Fire PERF $570.00 $570.0 0 Chest PAILAT $60.00 $60.00 Tb Skin Test $O.00 $0.00 Applicant Health Screen PERF $0.00 $0.00 Total Charges $2,520.00 Total Payments Balance Due $0.00 $2,520.00 Please write invoice number on payment check. Balance due 5 days from invoice Our Federal Employer Identification Number is 35- 2079797 date INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Fire Department I CARMEFD t 2 Civic Square Terms Carmel, IN 46032 Invoice Date 09/09/2009 Invoice 00 -11650 Date Employee Description Amount Balance Due 08/31/09 Knott Bruce A. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 14.00 FlexibilitV Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 &00 Treadmill (PFE) $153.00 $153.0 0 Exercise Prescription $35.00 $35.0 0 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer S reen S45.00 $45. 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 Audiometa $14.00 14.00 ECG W! Interp $20.00 120.0 0 Urinalysis Dipstick $3.00 $3.00 09/01/09 DeLon Michael T. Comprehensive Physical $91.00 $91.0 0 OnMed Pro ram $0,00 $0.00 Health Risk A raisal Motivation 16.00 $16.00 Res irator /Medical Review $16.00 $16.0 0 Treadmill (PFE $153.00 $153.00 Exercise Pr scri tion $35,0 SIA Bio -Elec Im ed Anal $14.00 $14.00 Waist/Hi Ratio $3.00 $3.00 Flexibilitv Check $10.00 $10.0 0 Muscle Strength Endurance $26.00 $26.0 0 Nutri Assessment Questionnaire $16,00 $16.0 0 Bladder Cancer Screen $45.00 45.00 Vital Signs HT WT BP P R ST00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W/Intery $33.00 $33.0 0 AudiometrV $14.00 $14.00 EGG W/ Interp $20.00 $20.00 Urinalysis Di sti k $3.00 $3.0 Gipson Bruce E. Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $16.00 $16.00 Respirator/Medical Review $16.00 $16.00 Treadmill (PFE) $153.00 $153.00 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Waist/Hi Ratio $3.00 $3.00 Flexibility Check $10.00 10.00 Nuth Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45,00 $45.001 Vital Signs HT WT BP P R $7.00 7.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 m Indianapolis, IN 46204 o Carmel Fire Department I CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 09/09/2009 m Invoice 00 -11650 Date Employee Description I Amount Balance Due Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiomet 14.00 $14.00 EC W Interp $20.00 Urinal ysis Dipstick $3.00 $3.00 Total Charges $1,497.00 Total Pa ments A'Balance Due $0.00 $1,497.00,: Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date VOUCHER, NO. V''�,'ARRAN N O. ALLOWED 20 Public,Safety Medical Services IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $4,017.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 11650 43- 407.01 $1,497.00 1 hereby certify that the attached invoice(s) or 1120 11681 43- 407.01 $2 ,520.00 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 A 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 Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 11650 $1,497.00 11681 $2,520.00 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