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Home My WebLink About169589 03/04/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $9,094.00 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 `o INDIANAPOLIS IN 46204 CHECK NUMBER: 169589 CHECK DATE: 3/4/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 10582 701.00 MEDICAL EXAM FEES 1110 4340701 10614 575.00 MEDICAL EXAM FEES 1110 4340701 10643 7,818.00 MEDICAL EXAM FEES INVOICE H ,Qublic Safety Medical Services w 324 E. New York Street E Suite 300 m I Indianapolis, IN 46204 o' Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 02/12/2009 m Invoice 00 -10582 Date Employee Description Amount Balance Due 02102/09 Collins. Shane P. CMP $16.00 $16.00 CBC W /DiffAnd 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 Quantiferon Tb Gold $50.00 $50.00 McAllister. John W. CMP $16.00 $16.00 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 $13.0 0 Quantiferon Tb Gold $50.00 $50.00 Sedberrv. Jeffrev T. CMP $16.00 $16.00 CBC W /Dill And Plat $13.00 $13.00 Li id Panel $16.00 $16.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 S13.00 $13.00 Quantiferon Tb Gold $50.00 $50.00 02/03/09 Elliott. John R. CMP $16.00 $16.0 0 CBC W /DiffAnd Plat $13.00 $13.00 Li id Panel $16.00 $16.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.0 0 PSA $35.00 $35.00 Quantiferon Tb Gold $50.00 $50.00 02/05/09 Lytle. Blake A. CMP $16.00 $16.00 CBC W /Dill And Plat $13.00 $13.00 Li id Panel $16.00 $16.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 13.00 Quantiferon Tb Gold $50.00 $50.0 0 Wiegman, Chad R. CMP $16.00 $16.0 0 CBC W /Dill And Plat $13.00 $13.0 0 i id Panel $16.00 $16.0 0 Veniouncture Fee 1 $3.00 1 $3.001 HIV 1 2 $13.00 $13.00 Quantiferon Tb Gold $50.00 $50.00 Total Charges $701.00 Total Pavments Balance Due $0.00 $701.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date INVOICE o /.Iublic Safety Medical Services w' 324 E. New York Street .E Suite 300 IY Indianapolis, IN 46204 G Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 02117/2009 0o Invoice 00 -10614 Date Employee Description Amount Balance Due 02/09/09 Dawson. Gregory F. CMP $16.00 $16.00 CBC W /Dill And Plat $13.00 $13.00 Lipid Panel $16.00 $16.00 Veni uncture Fee $3.00 $3.00 PSA $35.00 $35.00 Quantiferon Tb Gold $50.00 $50.00 02/10/09 Pirics. John D. Comprehensive Phvsical $91.00 $91.00 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 16.00 $16.0 0 Respirator/Medical Review $16.00 $16.00 Treadmill (PFE) $153. 0 $153.0 Flexibili Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Tonometry $36.00 36.00 Body Fat Check Bod Pod $14.00 $14.00 Total Char es $575.00 Total Payments Balance Due $0:00 $575:00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Prescribed 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 E. New York Street, Suite 300 Terms Indianaplis, IN 46204 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 9119109 10582 or officer physicals 701.00 2/17/n9 10614 payment or officer physicals 575.00 Total 1 276.00 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 P ublic Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 1,276.00 ON ACCOUNT OF APPROPRIATION FOR police general fund Board Members Po# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1110 10582 407 -01 701.00 bill(s) is (are) true and correct and that the 1110 10614 407 -01 575.00 materials or services itemized thereon for which charge is made were ordered and received except February 25 20 09 Signature Chief of POlice Cost distribution ledger classification if Title claim paid motor vehicle highway fund INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 02/24/2009 m Invoice 00 -10643 Date Employee Description Amount Balance Due 02/14/09 Fisher, Charles B. HB SAb Quantitative Titer $35.00 $35.00 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 $13.0 0 Quantiferon Tb Gold $50.00 $50.00 02/16/09 Bodenhorn Wendy M. CMP $16.00 $16.0 0 CBC W /Dill And Plat $13.00 $13.0 0 Li id Panel $16.00 $16.00 Venipuncture Fee $3.00 HIV 1 2 $13.00 $13.00 Quantiferon Tb Gold $50.00 $50.00 HB SAb Quantitative Titer $35.00 $35.00 Hobson Phillip L. CMP $16.00 $16.00 CBC W /Dill And Plat $13.00 $13.00 Lipid Panel $16.00 $16.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.0 0 Q uantiferon Tb Gold $50.00 $50.00 Laker Jeffrey W. CMP $16.00 $16.DO CBC W /Dill And Plat $13.00 $13.0 0 Li id Panel $16. $16.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 PSA $35.00 $35.00 Quantiferon Tb Gold $50.00 $50.0 0 HB SAb Quantitative Titer $35.00 $35.0 0 Robbins. Todd CMP $16.00 $16.00 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 Q uantiferon Tb Gold $50.00 $50.0 HB SAb Quantitative Titer $35.00 $35.0 Towle, John R. CMP $16.00 $16.00 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 $13.0 0 PSA $35.00 $35.00 Quantiferon Tb Gold $50.00 $50.00 02/17/09 Collins Shane P. Comprehensive Physical $91.00 $91.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Health Risk Appraisal Motivation 16.00 $16.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 a: Indianapolis, IN 46204 G Carmel Police Department CARMEPD f- Terms 3 Civic Square Carmel, IN 46032 Invoice Date 02/24/2009 m Invoice 00 -10643 Date Employee Description Amount Balance Due Treadmill (PFE) $153.00 $153.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Vital Sicins -HT WTBPPR $7.00 $7.0 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Tonometry $36.00 $36.0 0 Dawson Gregory F. Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.001 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Motivation 16.00 $16.0 0 Treadmill (PFE) $153.00 $153.00 Flexibilitv Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiometry 14.00 $14.0 0 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Tonometry $36.00 $36.00 Elliott John R. Comprehensive Physical $91.00 $91.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Health Risk Appraisal tiv tin $16.00 16.0 Hemoccult $5.00 $5.00 Treadmill (PFE) $153.00 $153.00 BIA Bio -Elec Im ed Anal $14.00 $14.0 0 FlexibilitV Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.001 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 Audiometry 14.00 $14.0 0 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Tonometry $36.00 $36.0 0 Fisher Charles B. Comprehensive 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 Treadmill (PFE) $153.00 $153.00 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.nn INVOICE ►-0 Public Safety Medical Services 324 E. New York Street E Suite 300 ir Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 02/24/2009 Invoice 00 -10643 Date Employee Description Amount Balance Due Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $25.0 0 PFT W/Interp $33.00 $33,0 0 Audiametry $14.00 $14.00 ECG Wl Interp $20.00 $20.00 Urinalysis Di stick 3.00 $3.00 Tonometry $36.00 $36.0 0 Goodman Leland C. Comprehensive Physical $91.00 91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Health Risk Appraisal Motivation $16.00 $16.00 Treadmill (PFE) $153.00 $153.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibilitv Check $10,00 $10.00 WaistlHi Ratio $3,00 $3.00 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 Audiometry 14.00 $14.0 0 ECG Wl Inter 20.00 $20.00 Urinalysis Dipstick 3.00 $3.00 Tonometry $36,00 36.00 Howard Lana M. Comprehensive Physical 91.00 $91.0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Health Risk Appraisal Motivation 16.00 $16,00 Treadmill (PFE) $153.00 $153.00 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibilitv Check $10.00 $10,0 0 Muscle Strength Endurance $26.00 $26.00 Waistlft Ratio $3.00 $3.001 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.D 0 PFT WlInterp $33.00 $33.0 A udiometry 14.00 $14,0 ECG W1 Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Tonomet $36.00 $36.00 Lvtle Blake A. Comprehensive Physical $91.00 $91.0 0 OnMed Pro ram $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Health Risk Appraisal Motivation 16.00 $16,00 Treadmill PFE 153.00 $153.00 Flexibility Check $10,00 $10.0 0 Waist /Hi Ratio $3.00 $3.00 Vital Si ns HT WT BP P R $7.00 $7.00 INVOICE o Public Safety Medical Services w 324 E. New York Street E Suite 300 Indianapolis, IN 46204 G Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 02/24/2009 m Invoice 00 -10643 Date Employee Description Amount Balance Due Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiometry 14.00 $14.0 0 G W Inter $20-00 $2 Urinalysis Dipstick $3.00 $3.00 Tonometry $36.00 $36.00 McAllister. John W. Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Motivation 16.00 $16.0 0 Treadmill (PFE) $153.00 $153.00 Flexibility Check $10.00 sio.00 Waist/Hi Ratio $3.00 $3.00 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 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Tonornetry $36.00 $36.00 Sedberry Jeffrey T. Comprehensive Physical $91.00 $91.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Motivation 16.00 $16.00 Treadmill PFE 153.00 $153.00 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $10.0 0 Waist/Hit) Ratio $3.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiometry 14.00 14.00 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 TonornetrV $36.00 $36.00 Stites William R. Comprehensive Physical $91.00 $91.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Health Risk r i I (Motivation) 1 16.00 Treadmill (PFE) $15 .00 $1 53.00 Flexibilitv Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiometry 14.00 $14.00 ECG W/ Interp 1 $20.00 20.00 INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 C Carmel Police Department CARMEPD F 3 Civic Square Terms Carmel, IN 46032 Invoice Date 02/24/2009 m Invoice 00 -10643 Date Employee Description Amount Balance Due Urinalysis Dipstick $3.00 $3.00 Tonometry $36.00 $36.0 0 White II Robert E. Comprehensive Physical $91.00 $91.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Motivation 16.00 $16.0 0 Treadmill (PFE) $153.00 $153.00 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision T' mus $26.00 $26. 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 Tonometry $36.00 $36.0 0 02/18/09 Hill. Nathaniel W. Indiana Police /Fire PERF $575.00 $575.00 Chest PA/LAT $55.00 $55.0 0 Tb Skin Test $0.00 $0.00 Applicant Health Screen PERF $0.00 $0.00 02/19/09 Miller Michael G. CMP $16.00 $16.0 0 CBC W /Dill And Plat $13.00 $13.00 i id Panel $16.00 $16.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Quantiferon Tb Gold $50.00 $50.0 0 02/20/09 Herron James C. Indiana Police /Fire PERF $575.00 $575.00 Chest PA/LAT $55.00 $55.00 Tb Skin Test $0.00 $0.00 Applicant Health Screen PERF $0.00 $0.00 Thomas Richard E. Indiana Police /Fire PERF $575.00 $575.00 Chest PA/LAT $55.00 $55.0 0 Tb Skin Test $0.00 $0.00 Aon licant Health Screen PERF $0.00 $0.00 Til on Travis C. CHIP $16.00 $1 6.00 CBC W /DiffAnd Plat $13.00 $13.00 Lipid Panel $16.00 $16.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.0 0 HB SAb Quantitative Titer $35.00 $35.00 Quantiferon Tb Gold $50.00 50.00 Total Charges $7,818.00 Total Payments Balance Due $0.00 $7,818.00 Please write invoice number on payment check. INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department CARMEPD F 3 Civic Square Terms Carmel, IN 46032 Invoice Date 02/24/2009 m Invoice 00 -10643 Date Employee Description Amount Balance Due Our Federal Employer Identification Number is 35- 2079797 Prescrited 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 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)) 2/24 09 1064 payment for officer physicals 7,818.00 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 7.818.00 ON ACCOUNT OF APPROPRIATION FOR p olice general fund Board Members PO# or INVOICE NO. ACCT /TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1110 10643 407 -01 7 818.00 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 February 26 20 09 Signature {'hi Pf of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund