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Home My WebLink About176903 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 0 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $76,996.00 CARMEL INDIANA 46032 324 E NEW YORK ST SUITE 300 '4 0� INDIANAPOLIS IN 46204 CHECK NUMBER: 176903 CHECK DATE: 9/2/2009 D EZ.�ARTMENT ACCOUNT PO N INVOICE NUMBER AMOUNT DE SCRI PTI ON 1120 4340701 11423 4,206.00 MEDICAL EXAM FEES 1::20 4340701 11424 1,980.00 MEDICAL EXAM FEES 1120 4340701 11486 30,101.00 MEDICAL EXAM FEES 1120 4340701 11487 180.00 MEDICAL EXAM FEES 1110 4340701 11488 651.00 MEDICAL EXAM FEES 1120 4340701 11524 16,983.00 MEDICAL EXAM FEES 1120 4340701 11525 35.00 MEDICAL EXAM FEES 1110 4340701 11526 711.00 MEDICAL EXAM FEES 1120 4340701 11568 21,255.00 MEDICAL EXAM FEES 1120 4340701 11569 300.00 MEDICAL EXAM FEES 1110 4340701 11570 594.00 MEDICAL EXAM FEES INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 p< Carmel Fire Department 1 CARMELFD2 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/19/2009 m Invoice 00 -11525 Date Employee Description Amount Balance Due 08114/09 Castor Rick S. PSA $35.00 $35.00 Total Charges $35.00 Total Payments Balance Due $o.00 $35.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer identification Number is 35- 2079797 date INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 G) W Indianapolis, IN 46204 o Carmel Fire Department! CARMELFD2 2 Civic Square Terms Carmel, IN 46032 Invoice Date 0811212009 m Invoice 00 -11487 Date Employee Description Amount Balance Due 08/03/09 Bowles Orbie H. RBC Cholinesterase $45.00 $45.00 Cummins Frank C. RBC Cholinesterase $45.00 $45.00 Reecer Jason L. RBC Cholinesterase $45.00 $45.00 Wendzel Jason D. RBC Cholinesterase $45.00 $45.0 0 TotalCharges-,j $180.00 Total Payments &Balance Due $0.00 $180:00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 a� Indianapolis, IN 46204 C Carmel Fire Department 1 CARMELFD2 F 2 Civic Square Terms Carmel, IN 46032 Invoice Date 07129!2009 Invoice 00 -11424 Date Employee Description Amount Balance Due 07/20/09 Cromlich Mark A. PSA $35.00 $35.00 DeCrastos Richard A. PSA 35.00 $35,00 Fuchs Jeffery W. RBC Cholinesterase 45.00 $45.00 Giles, William G. PSA $35.00 $35.0 0 RBC Cholinesterase 145.00 45.00 Holubik Steven W. PSA 35.00 RBC Cholinesterase 45.0 Keaton Anthon R. RBC Cholinesterase 45.0 Kehl William D. PSA $35.0 0 Knott Bruce A. PSA $35.00 $35.00 Marsh. ich el A. PSA $35. Q S35. McNab John D. PSA $35.00 $35.00 Price Joseph P. PSA $35.00 $35.00 RBC Cholinesterase $45.00 $45.00 Vallone Frank PSA $35.00 $35.00 Voskuhl Mark J. RBC Cholinesterase $45,00 $45.00 07/21/09 Bartrom Brad A. PSA $35.00 $35.00 Brandt. Gary D. PSA $35.00 $35.0 0 Carter Gary L. PSA $35.00 $35.0 0 Cox Justin M. RBC Cholinesterase S45.00 $45.0 0 Dufek Gary J. PSA $35.00 $35,00 Essex CoU C. PSA $35.00 $35.00 Frenz I Eric C. PSA $35.00 $35.0 Haboush, David G. PSA $35.00 $35.00 RBC Cholinesterase $45.00 $45.00 Hoover. Anthony B. PSA $35.00 $35.00 Lenze Theodore A. RBC Cholinesterase $45.00 $45.00 Marcum Bradley D. RBC Cholinesterase $45.00 $45.0 0 Mead David L. PSA $35.00 $35.0 0 Moriarty, John F. PSA $35.00 $35.0 0 Plumer, Charles J. PSA $35.00 35.00 RBC Cholinesterase $45.DO $45.00 Sombke Brad D. PSA $35.00 $35.00 Starr- Greciory A. I PSA 135.00 $35.0 0 Toney, James D. PSA $35,00 $35.00 RBC Cholinesterase $45.00 $45.00 Whitaker Charles E. PSA $35.00 $35.00 Witsken Steven J. PSA $35.00 $35.00 07/22/09 Bowles Orbie H. PSA $35.00 $35.00 RBC Cholinesterase $45,00 $45.00 Butts Joseph A. PSA $35.00 $35.00 Cummins Frank C. PSA $35.00 $35.00 RBC Cholinesterase $45.00 $45.00 Hensley, Robert P. PSA $35.00 $35.00 Hulett Mark A. PSA $35.00 $35.0 0 Platt Jace P. $35.00 $35.0 0 INVOICE F- Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department CARMELFD2 f 2 Civic Square Terms Carmel, IN 46032 Invoice Date 07/29/2009 Invoice 00 -11424 Date Employee Description Amount Balance Due Reecer, Jason L. RBC Cholinesterase 45.00 $45.00 Robinson Mark G. PSA $35,00 $35.00 Steury, Kent C. PSA $35.00 $35.0 0 Thornoson. James P A $35.00 $35, Tierney, Scott A. PSA $35.00 $35.00 Wendzel, Jason D. I RBC Cholinesterase $45.00 $45.00 Total Charges $1,980.00 Total Payments Balance Due $1,980.00 Please write invoice number on payment check. Balance due 15 days from invoicc Our Federal Employer Identification Number is 35- 2079797 date INVOICE F°- Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 0 Carmel Fire Department I CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 07/29/2009 Invoice 00 -11423 Date Employee Description Amount Balance Due 07120(09 Cromlich Mark A. CMP $15.00 $15.00 CBC WIDiff And Plat $12.00 112.00 Li id Panel $15,00 $15.00 Veni uncture Fee 3.00 $3.00 HIV 1 &2 $13.00 $13.00 DeCrastos Richard A. CMP $15.00 15.00 CBC WIDiff And Plat $12.00 $12.0 0 Lipid Panel $15.00 $15.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 De Lona. Michael T. CMP $15,OQ $15. CBC WIDiff And Plat $12.00 $12.00 Li id Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 &2 $13.00 $13.00 Edwards Steven L. CMP 15.00 $15.0 0 CBC WIDiff And Plat $12.00 $12.0 0 Li id Panel $15.00 $15.0 0 Veni uncture Fee $3,00 $3,00 HIV 1 2 $13.00 $13.00 Fa in Timothy D. CMP $15.00 $15.0 0 CBC WIDiff And Plat $12.00 $12.0 0 Lipid Pane! 1 1 Veni uncture Fee $3.00 $3.00 HIV 1 &2 $13,00 $13.00 Fuchs Jeffery W. CMP $15.00 $15.00 CBC WIDiff And Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 13.00 HIV 1 2 $13.00 $13.0 0 Gehlbach Marc A. CMP $15.00 15.00 CBC WIDiff And Plat $12,00 $12.0 0 Livid Panel $15,00 $15.00 Venipungture F e HIV 1 2 S13. $13. Giles William G. CMP $15.00 $15.00 CBC W /DiffAnd Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13,00 $13.00 Hoiubik Steven W. CMP $15,00 $15,0 0 CBC WIDiff And Plat $12.00 $12,0 0 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $1.3.00 $13.00 Keaton Anthony R. CMP $15.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 0j M Indianapolis, IN 46204 C Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 07/29/2009 m Invoice 00 -11423 Date Employee Description Amount Balance Due CBC W /DiffAnd Plat $12.00 $12.00 Li id Panel $15.00 $15,00 Veni uncture Fee $3.00 13,00 H IV 1 &2 $13.00 $13.00 Kehl, William D. CMP $15.00 $15.00 CBC WIDiffAnd Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.0 0 Kinney, Jared N. CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 $12.00 Li id Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 13.00 $13.00 Knott Bruce A. CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 $12.0 0 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Marsh. Michael A. CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 $12.0 0 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 &2 $13.00 $13.0 0 McNab John D. CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 $12.00 Lipid Panel S15,00 $15.00 Veniounotu re Fee $3,00 $3.0Q HIV 1 2 $13.00 $13.00 Paddock Ronald D. CMP $15.00 $15.00 CBC W /DiffAnd Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 13.00 $13.00 Price Joseph P. CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 $12.0 0 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Ran Christopher D. MP si 15. CBC W /DiffAnd Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Stroup Scott A. CMP $15.00 $15,00 CBC W /Dill And Plat 12.00 $12.00 LOW Panel $15.00 15.00 INVOICE o Public Safety Medical Services H- 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 07129!2009 m Invoice 00 -11423 Date Employee Description Amount Balance Due Veni uncture Fee $3.00 $3.00 HIV 1 2 $13,00 $13.0 0 Vallone Frank CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 $12.0 0 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13,00 $13.0 0 Voskuhl Mark J. CMP $15.00 $15,00 CBC W /Dill And Plat $12.00 $12.00 Li id Panel $15.00 $15.00 V ni uncture Fee $3.00 $3,00 HIV 1 &2 $13.00 $1100 Youn Andrew S. CMP $15.00 15.00 CBC W /DiffAnd Plat $12.00 $12.0 0 Li id Panel $15.DO $15.00 Veni uncture Fee 100 $3.00 HIV 1 &2 $13.00 $13.0 0 07/21/09 Bartrom Brad A. CMP 115.00 $15.0 0 CBC W /Dill And Plat $12.00 $12.00 Li id Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 &2 $13.00 $13.0 0 Brandt, Gary D. OMP $15.00 $1 CBC W /DiffAnd Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 &2 $13.00 $13,00 Carter Gary L. CMP $15.00 $15.0 0 CSC W /Dill And Plat $12.00 $12.00 Lipid Panel $15.00 $15.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.0 0 Cox Justin M. CMP $15.DO $15.0 0 B W D ff And Plat $12.00 $12.00 Li id Panel $15.00 $15.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $1100 Dufek Gary J. CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 1100 HB SAb Quantitative Titer 35.00 35.00 Ellison Christopher M. CMP $15.00 $15,00 CBC W /Dill And Plat $12.00 1 12.00 Li id Panel $15.00 15.00 INVOICE �o 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 07/29/2009 m Invoice 00 -11423 Date Employee Description Amount Balance Due Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.0 0 Essex Cory C. CMP 15.00 $15,00 CB W Diff And Plat $12-00 112. Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 &2 $13.00 $13.00 Frenzel Eric C. CMP $15.00 $15.00 CBC WIDiff And Plat $12.00 $12,00 Lipid Panel 15.00 $15.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Frost Bruce S. CMP $15.00 $15.0 0 CBC WIDiff And Plat 12.00 $12.0 0 Li id Panel 15.00 15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.Q0 $13.00 Haboush David G. CMP $15.00 $15.00 CBC WOW And Plat $12.00 $12.00 Li id Panel 115.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.D0 Hoover Anthony B. CMP $15.00 $15.00 CBC WIDiff And Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 Hutchison Brian P. CMP $15.00 $15.00 B W iff And Plat $12.00 $12.0 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Blood Type $22,00 $22.00 Lenze Theodore A. CMP $15.00 $15.00 CBC WIDiff And Plat $12.00 112.0 0 Li id Pane! $15.00 $15.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 &2 $13.00 $13.0 0 Marcum Bradley D. CMP $15.00 $15.00 CB W Diff And Plat $12.00 $12.Q Upid Panel $15.00 $15. Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Mead David L. CMP $15.00 $15,00 CBC WIDiff And Plat $12.00 $12.00 Lipid Panel $15.00 $15.0 0 Veni uncture Fee 3.00 $3.00 HIV 1 2 13.00 $13.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 OC Indianapolis, IN 46204 o Carmel Fire Department I CARMEFD 2 Civic Square Terms m Carmel, IN 46032 Invoice Date 0712512009 Invoice 00 -11423 Date Employee Description Amount Balance Due Moriarty John F. CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 $12.0 0 Lipid Panel $15,00 $15.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13,00 $13.00 Mulford David A. CMP 15.00 $15.0 0 CBC W /Dill And Plat $12.00 $12.0 0 Lipid Panel 15.00 $15.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Nicley, Wes W. CIVIP $15.00 $15. CBC W /DiffAnd Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 &2 13.00 $13.001 Plumer Charles J. CMP $15,00 $15.00 CBC W /Dill And Plat $12.00 $12.0 0 Li id Panel $15.00 $15.0 0 Veni uncture Fee $3. D0 $3.00 HIV 1 2 $13.00 $13.0 0 Schooler, Dustin D. CMP 115.00 $15.00 CBC W /Dlff And Plat $12.00 $12.00 Lipid Panel $15.QQ $1 5.Do Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Shar. Adam C. CMP $15.00 $15,00 CBC W /Dill And Plat $12.00 $12.0 0 Lipid Panel $15.00 $15.0 0 Veni uncture Fee 3.00 $3.00 HIV 1 2 $13.00 $13,0 0 Sombke. Brad D. CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 S12,0 0 Li id Panel $15.00 $15,0 0 V ni n t r Fe .00 HIV 1 &2 $13. 1 HB SAb Quantitative Titer $35.00 $35.00 Starr GregM A. CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3,00 HIV 1 2 $13.00 $13.001 Sutton. Sean B. CMP $15.00 $15,001 CBC WlDiff And Plat $12.00 $12.00 Lipid Panel $15.00 $15.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.0 0 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 C Carmel Fire Department/ CARMEFD i 2 Civic Square Terms Carmel, IN 46032 Invoice Date 0712912009 Invoice 00 -11423 Date Employee Description Amount Balance Due Tonev, James D. CMP $15.00 15.00 CBC W /Dill And Plat $12.00 $12.00 Lipid Panel $15.00 $15.0 0 VeoipUncture Fee $3.00 HIV 1 2 $13.00 $13.00 Weddin ton Kurt L. CMP $15.00 $15.00 CBC WIDiff And Plat $12.00 $12.00 Lipid Pane! $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 113.00 $13,0 0 Whitaker Charles E. CMP $15.00 $15.0 0 CBC W /Dill And Plat $12.00 $12.0 0 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 3.00 HIV 1 2 $13.00 $13.0 0 Witsken Steven J. CMP $15.00 $15,0 0 CBC W /Dill And Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 07/22/09 Anderson D. Cory CMP $15.00 $15.0 0 CBC W /Dill And Plat $12.00 $12.00 Lipid Panel 115.00 $15,00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Baskerville Anthony A. CMP 15.00 $15.0 0 CBC W /Dill And Plat $12.00 $12.00 Lipid Panel $15. $15.00I Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Bowles Orbie H. CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 $12.00 Li id Panel $15.00 $15,00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Butts Joseph A. CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 12.00 Li id Panel $15.00 $15.00 V nipuncture Fee $3.00 ummins Frank MP $15.OQ $15.00 CBC W /DiffAnd Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Deitsch Marc W. CMP $15.00 15.00 CBC W /Dill And Plat $12.00 $12.00 Lipid Panel 15.00 15.00 INVOICE i-0 Public Safety Medical Services 324 E. New York Street E Suite 300 ix indianapolis, IN 46204 C Carmel Fire Department 1 CARMEFD F 2 Civic Square Terms Carmel, IN 46032 Invoice Date 07/29/2009 m Invoice 00- 11423 Date Employee Description Amount Balance Due Veni uncture Fee $3.00 $3.00 HIV 1 2 $13,00 $13.0 0 Edwards, Daniel E. CMP $15.00 $15.00 CBC WIDiff And Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 13.00 Harrington, Adam C. CMP 15.00 $15.00 CBC W /Dill And Plat $12.00 $12.0 0 Lipid Panel $15.00 15.00 Venipuncture Fee $3. HIV 1 2 $13.00 $13.00 Hensley, Robert P. CMP $15.00 $15.00 CBC W1DiffAnd Plat $12.00 $12.00 Li id Panel $15.00 $15.001 Veni uncture Fee $3.00 $3.00 HIV 1 2 113.00 $13.0 0 Hulett, Mark A. CMP $15.00 $15.0 0 CBC WIDiff And Plat $12.00 $12.0 0 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3,001 HIV 1 2 $13.00 $13.00 Jo hnson, Jeremy CMP $15.0 CBC W /DiffAnd Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13,00 $13.00 HB SAb Quantitative Titer $35.00 $35.D 0 Platt Jace P. CMP $15,00 $15.00 CBC WIDiff And Plat $12.00 $12.0 0 Lipid Panel 15.00 $15.0 0 Veni uncture Fes $3.00 $3.00 Reecer, Jason L. CMP 15-00 $15.0 0 Qf3 W Diiff And Plat $12.00 $12.0 Lib id Panel $15.00 $15.0 Veni uncture Fee $3.00 $3.00 HIV 1 &2 $13.00 $13.00 Robinson, Mark G. CMP $15.00 $15.00 CBC WIDiff And Plat $12.00 $12.00 Lipid Panel $15.00 $15.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 1100 $13.001 Steurv, Kent C. CMP $15.00 $15.00 CBC W /DiffAnd Plat $12.00 $12.0 0 Lipid Panel $15.00 $15.0 0 Veni uncture Fee $3.00 100 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 CD Indianapolis, IN 46204 c Carmel Fire Department CARMEFD ll� 2 Civic Square Terms Carmel, IN 46032 Invoice Date 07129/2009 Invoice 00 -11423 Date Employee Description Amount Balance Due HIV 1 &2 $13.00 $13.00 Thompson, James L. CMP $15.00 15.00 CBC W /Dill And Plat $12.00 $12.00 Li id P n l $15.00 $1 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Tierney, Scott A. CMP $15.00 $15.00 CBC Wlbiff And Plat $12.00 $12.0 0 Lipid Panel $15.00 $15,0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.0 0 Walker Christopher E. CMP $15.00 $15,00 CBC W /Dill And Plat $12.00 $12.00 Lipid Panel $15.00 $15.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Webb, Gregory A. CMP $15.00 $15.00 CBC WfDiff And Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Wendzel Jason D. CMP $15.00 $15,00 CBC W /Dill And Plat $12.00 $12.00 Li id Panel $15.00 $15.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.0 0 W ant Andrew D. CMP $15.00 $15.00 B Diff And Plat 12.00 12. Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Total Charges $4,206.00 Total Payments Balance Due $U0 $4,206.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date x INVOICE o Public Safety Medical Services w 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 m Invoice 00 -11486 Date Employee Description Amount Balance Due 08/03/09 Alverson Jonathon L. Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Health Risk Appraisal Short Form 16.00 $16.0 0 Hemoccult $5.00 $5.00 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Waist/Hi Ratio $3.00 $3.00 Flexibility Check $10.00 $10.0 0 Muscle Strength Endurance $26.00 $26.0 0 Exercise Prescri tion $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $1 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 AudiometrV $14.00 $14.0 0 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Collins Tony A. Com rehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 H ealth Risk A r i sal (Short Form) 16. 16. BIA Bio -El ec Im ed Anal $14.00 $14.00 Waist/Hi Ratio $3.00 $3.00 Flexibility Check $10.00 $10.0 0 Treadmill (PFE) $153.00 $153.00 Exercise Prescr tion $35.00 $35.0 0 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Hemoccult $5.00 $5.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W/Intero $33.00 $33. Audiometry $14.0 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Dorsch James E. Com rehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Short Form 16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Waist/Hi Ratio $3.00 $3.00 Flexibility Check $10.00 $10.0 0 Treadmill PFE 153.00 15100 Exercise Prescription $35.00 35.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 0: Indianapolis, IN 46204 C Carmel Fire Department CARMEFD f 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 m Invoice 00 -11486 Date Employee Description Amount Balance Due Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus .0 2 PFT W/Interp $33.00 $33.00 Audiorrietry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinal sis Dipstick $3.00 $3.00 Drake Carl D. Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Short Form 16.00 $16.00 Hemoccult $5.00 $5.00 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Waist/Hi Ratio $3.00 $3.00 Flexibilitv Check $10.00 $10.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 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 AudiornetrV $14.00 $14.0 0 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Fuchs Jeffery W. Comprehensive Physical $91.00 $91.00 OnMed Pro ram $0.00 $0.00 Resi)irator/Medical Review $16.00 $16. Health Risk Appraisal Short Form $16.00 $16.00 BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.0 0 Exercise Prescription $35.00 $35.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26. PFT W/Intero $33.00 $33.00 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Horner David W. Comprehensive Physical $91.00 $91.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 16.00 Health Risk Appraisal Short Form 16.00 16.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 Carmel Fire Department! CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 >n Invoice 00.11486 Date Employee Description Amount Balance Due BIA Bio -Elec Im ed Anal $14.00 $14.00 Waist/Hi Ratio $3.00 $3.00 Flexibility Check $10.00 $10,0 0 Muscle Strength Endurance $26,00 $26.00 Exercise Prescri tlon $35.00 $35.DC Treadmill PFE 153.00 $153.0 0 Hemoccult $5.00 $5.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45. 00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26. $26.0 0 PFT W/Interp $33.00 $33.00 Audiornetry $14,00 $14.0 0 ECG WI Interp $20.00 $20.00 Urinalysis Dipstick $3.00 3.00 Lux Michael T. Comprehensive Physical $91,00 $91.0 0 QnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Health Risk A raisal Short Form 16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Waist/Hi Ratio $3.00 $3.00 Flexibility Check $10.00 10.00 Muscle Stre t h Endurance $26.00 $26.00 Exercise Prescription $35.00 $35.00 Treadmill (PFE) $153.00 $153.00 Vital Signs HT WT BP P R 17.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W/Interp $33.00 $33.00 Audiometry 14.00 $14.00 ECG W1 Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 Hemo c It $5.00 S5. tindle Kevin P. Comprehen5ive Physical $91 $91.0 QnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Short Form 16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 FlexibilitV Check $10.00 $10.00 Waist/Hi Ratio 3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16,00 $16.00 Bladder Cancer Screen $45.00 45.00 Vital Si ns HT WT BP P R S7.00 7.00 1 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 X Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 m Invoice 00 -11486 Date Employee Description Amount Balance Due Vision Titmus $26.00 $26.00 PFT W /Inter 33.00 $33.00 Audiometry 14.00 $14.00 G W Intem $20. Urinalysis Dipstick $3.00 $3.00 Stroup, Scott A. Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Short Form 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 Muscle Strength Endurance $26.00 $26.00 Exercise Prescription $35.00 $35.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiornetry $14.00 $14.0 0 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Utzici, Todd T. Com rehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Res irator /Medical Review $16.00 $16.0 0 Health Risk A raisal Short Form 16.00 $16.0 0 BIA io -EI ed Anal $14.00 $14.0 0 Waist/Hi Ratio $3.00 $3.00 Flexibility Check $10.00 $10.00 Muscle Strength Endurance $26.00 $26.0 0 Exercise Prescription $35.00 $35.00 Treadmill (PFE) $153.00 $153.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiornetry $14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Di sti k $3.00 $3,00 Nutn Assessment Questionnaire $16.00 $16. Bladder Cancer Screen $45.00 $45.00 Watts, Trent E. Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Short Form 16.00 $16.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 1 INVOICE o Public Safety Medical Services 324 E. New York Street 'E Suite 300 0 Indianapolis, IN 46204 01 Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 Invoice 00 -11486 Date Employee Description Amount Balance Due 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/ Interp $20,00 $20.00 Urinalysis Dipstick $3.00 $3.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Waist/Hi Ratio $3.00 $3.00 Flexibility Check $10.00 $10.00 Treadmill (PFE) $153.00 $153.00 r ePr s ri i n $35.00 Workman William J. Com rehensive Ph sical $91.00 $91.00 OnMed Program $0.00 0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Short Form 16.00 $16.00 BIA (Bic-Elec Im ed Anal 14.00 $14.0 0 Waist/ft Ratio $3,00 $3.00 Flexibility Check $10.00 $10.0 0 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45,00 Vital Sin HT WT BP P R 7.00 $7. Vision Titmus $26.00 $26.00 PFT WfInterip $33.00 $33.00 Audiometry 14.00 $14.0 0 ECG W/ Interp $20.00 $20,00 Urinalysis Dipstick $3.00 100 08/04/09 Baskerville Anthony A. Comprehensive Physical $91.00 $91,00 Health Risk A raisal Short Form 16.00 $16.00 OnMed Program $0.00 0.00 Res irator /Medical Review $16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibilit he k 1 0 1 Waistil-liv Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire 116.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 126.0 0 PFT W/interp $33.00 $33.0 0 Audiornetry $14.00 $14.0 0 ECG W/ Interp $20,00 $20.00 Urinalysis Dipstick $3.00 $3.00 Bowles Orbie H. Comprehensive Physical $91.00 $91,00 INVOICE o Public Safety Medical Services 324 E. New York Street 'E Suite 300 W Indianapolis, IN 46204 Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 4fiO32 Invoice Date 08/1212009 Invoice 00 -11486 Date. Employee Description Amount Balance Due OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Health Risk Appraisal Short Form 16.00 $16.00 BIA i I 14.0 $14. Flexibilitv Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.00 Exercise Prescription $35.00 $35.O 0 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 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 Wl Intern $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Butts Joseph A. Com rehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Short Form 16.00 $16.0 0 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 $153.00 $153.00 Exercise Prescri tion $35.00 $35.0 0 Nutri Assessment Questionnaire $16.00 $16.00 B ladder CanQer Screen $45. $4 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/ Interp $20,00 $20.0 0 Urinal sis Dipstick $3.00 $3.00 Edwards Daniel E. Comprehensive Ph sicaf $91,00 $91.0 0 OnMed Pro ram $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Short Form 16.00 16.00 BIA Bi -EI Im e nal 14.0 $14. Flexibility Check $10.0p $10.0 0 Waist/Hi Ratio $3 .00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 Vital Signs HT WT BP P R $7.00 $7.OD Vision Titmus 26.00 26.00 INVOICE 0 Public Safety Medical Services w 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Fire Department CARMEFD E 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 m Invoice 00 -11486 Date Employee Description Amount Balance Due PFT W/Interp $33.00 $33.00 Audiornetry $14.00 $14,0 0 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Fisher Gary L. Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Health Risk Appraisal Short Form 16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 $10.00 Waist/ Ratio 0 $3 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 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 Audiornetry $14.00 $14.0 0 ECG W/ Intern $20.00 $20.00 Urinalysis Di stick $3.00 $3.00 Hamn ton Adam C. Com rehensive Physical $91.00 $91.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Short Form $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 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision T'tm s $26.00 .0 PFT W Inter $33.00 $33.00 Audiornetry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 3.00 Hensley, Robert P. Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Health Risk Appraisal Short Form 16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.001 Treadmill (PFE) $153.00 153.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08!1212009 m Invoice 00 -11486 Date Employee Description Amount Balance.Due Exercise Prescri tion $35.00 $35.00 Nutri Assessment Questionnaire $16.00 16.00 Bladder Cancer Screen $45.00 $45.0 0 Vita! Si HT WT BP P R $7.00 S7. 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 Pa ne Thomas C. Comprehensive Ph sicai $91.00 $91.0 0 Health Risk Appraisal Short Form 16.00 $16.00 OnMed Program $0,00 $0.00 Respirator/Medical Review $16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 10.00 Waist/Hi Ratio $3.00 $3.001 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.D 0 Bladder Cancer Screen $45.00 $45.00 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus 26.00 $26.0 0 PFT WAnterp $33.00 $33.DO Audiometry 14.00 $14.0 0 ECG W/ Inter 2100 $20.0 0 Urinalysis Dipstick $3.00 S3.00 Reeves Stephen J. Comprehensive Physical S91.00 $91.0 0 Health Risk A r is I Short Form $16.00 $16.0 OnMed Program $Q.QQ $0.00 Respirator/Medics{ Review $16.00 $16.00 BIA Bio -Elec Im ed Anaf $14.00 $14.00 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3,00 Treadmill (PFE $153.00 $153.00 Exercise Prescription $35.00 $35,00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45,00 $45.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vii Titmus $26.00 PFT W Inter 3100 $33. AudiometrV $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Robinson Mark G. Comprehensive Physical 91.00 $91.0 Q OnMed Program 0.00 $0.00 Respirator/Medical Review 16.00 16.00 Health Risk Appraisal Short Form 16.00 16.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department CARMEFD F 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 m Invoice 00 -11486 Date Employee Description Amount Balance Due BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.0 0 Exercise Prescription $35.00 $35.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W ter 0 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Rohr Christopher M. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Short Form 16.00 $16.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibilitv Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.0 0 E xercise Prescription $35.00 $35.0 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 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 $20.00 Urinalysis Dipstick $3.00 $3.00 W ant Andrew D. Comprehensive Ph sisal $91.00 $91.00 OnMed Pro r m $0.00 $0.0 Respirator/Medical Review $16.00 $16. Health Risk Appraisal Short Form $16.00 $16.00 BIA Bio -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 Exercise Prescription $35.00 $35.0 0 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 a INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 m W. Indianapolis, IN 46204 Carmel Fire Department 1 CARMEFD Terms 2 Civic Square Invoice Date 08/12/2009 m Carmel, IN 46032 Invoice 00 -11486 Date Employee Description :Amount Balance Due Audiometry 14.00 $14.00 ECG Wl Interp $20.00 $20.001 Urinalysis Dipstick $3.00 100 Bond r nt Jeff 3, Comprehensive Physic Health Risk Appraisal Short Form $16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 14.00 Flexibilit Check 10.00 10.00 Waist/Hi Ratio 3.00 3.00 Treadmill PFE 153.00 153.00 Exercise Prescri tion 35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16,00 Vital Signs HT WT BP P R $7,00 $7,00 Vision Titmus $26,00 $26.0 0 PFT Wllnte rip 33.00 $33.0 0 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Bladder Cancer Screen $45.00 $45.00 DeCrastas Richard A. Comprehensive Physical $91,00 $91.0 0 Health Risk Appraisal Short Form 16.00 $16,0 0 OnMed Program $0.00 $0.001 Respirator/Medical Review 16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibili Check $10.00 10.00 Waist/Hi Ratio $3.00 $3.Q0 Treadmill PFE 1 3. 153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.00 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 14.00 ECG W/ Interp $2D,00 20.00 Urinal sis Dipstick $3.00 $3.OD Bladder Cancer Screen $45.00 $45M Fa in Timothy D. Comprehensive Physical $91.00 Sgi.001 Health Risk Apuraisal (Short Form) 1 16.0 OnMed Pro ram $0.00 $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(7 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance 126.00 $26.0 0 Treadmill PFE 153.00 153.00 Exercise Prescription $35.00 $35.nn INVOICE F Public Safety Medical Services 324 E. New York Street E Suite 300 4) W Indianapolis, IN 46204 C Carmel Fire Department CARMEFD F 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 m Invoice 00 -11486 Date Employee Description Amount Balance Due Nutri Assessment Questionnaire $16.00 $16.00 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 Audiometry 14.00 $14.00 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Bladder Cancer Screen $45.00 $45.00 Kilburn Roger L. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Short Form 16.00 $16.00 OnMed Program 0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibilitv Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.0 0 Nutri Assessment Questionnaire $16.00 $16.0 0 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 W1 Intero $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Bladder Cancer Screen $45.00 $45.00 Marsh Michael A. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Short Form 16.00 $16.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 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) $153.00 $153.00 E xercise Prescription $35. $35. Nutri Assessment Questionnaire $16,00 $16.0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 AudiometrV $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Bladder Cancer Screen $45.00 $45.0 0 Orange, Douglas D. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Short Form 16.00 $16.00 OnMed Program $0.00 0.00 Respirator/Medical Review $16.00 16.00 INVOICE 0 Public Safety Medical Services t 324 E. New York Street -E Suite 300 W Indianapolis, IN 46204 0 Carmel Fire Department I CARMEFD I- 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 Invoice 00 -11486 Date Employee Description Amount Balance Due BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 sio.001 Waist/Hi Ratio $3.00 $3,001 Tr mill PFE 15.0 $153. Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26,00 PFT W /Inter 3100 3100 AudiametU $14.00 $14.0 0 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Bladder Cancer Screen $45.00 $45.00 Paddock Ronald D. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Short Form 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 Flexibility Check $10,00 $10.00 Waist/Hi Ratio $3,00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.0 0 Nutri Assessment Questionnaire 16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 Vital Signs HT WT BP P R $7.00 $7.OD Vision Titmus $26.00 $26.0 0 PFT W/Interp $33.00 133.0 0 A udiometry $4.0 14.0 ECG Wl Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Ryan. Christopher D. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Short Form 16.00 $16.00 OnMed Program $0.00 so.00l Respirator/Medical Review $16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $10.0 0 WaisUHi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescri tion $35.00 Nutri As5essme Questlonnaire $16.00 $16. 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 $14.001 ECG W/ Interp $20,00 20.00 Urinal sis Dipstick 13.00 3.00 Bladder Cancer Screen $45.00 45.00 INVOICE 0 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 08/1212009 m Invoice 00 -11486 Date Employee Description Amount Balance Due Smith Brian E. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Short Form 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 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nuth Assessment Questionnaire $16.00 $16.00 Vital Si P P R $7.00 $7. Vision Titmus $26.00 $26.00 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 Bladder Cancer Screen $45.00 $45.0 0 Vallone Frank Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Short Form 16.00 $16.0 0 OnMed Program $0.00 $0.00 Res irator /Medical Review $16.00 $16.0 0 BIA Bio- Eleclm ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $1 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.0 0 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/ Inter 20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Bl adder Cancer Screen $45.00 $45.0 Youna. Kevin M. Comurehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Short Form $16.00 $16.0 0 BIA Bio -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 Exercise Prescription $35.00 $35.0 0 Nutri Assessment Questionnaire $16.00 $16.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 x Indianapolis, IN 46204 F Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 m Invoice 00 -11486 Date. Employee Description Amount Balance Due PFT W /Inter 33.00 $33.00 Audiomet 14.00 14.00 ECG W/ Inter 20.00 20.00 Urinalysis Dbstick Bladder Cancer Screen $45.00 $45.00 Zeller, Michael J. Comprehensive Ph sical $91.00 $91.00 Health Risk Appraisal Short Form $16.00 $16.00 OnMed Program $0.00 $0,00 Respirator/Medical Review $16,00 $16.0 0 BIA Bio -Elec Im ed Anal 14.06 $14.0 0 Flexibilitv Check $10.00 $10.00 Waist /Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153,001 Exercise Prescription $35.00 S35.001 Nutri Assessment Questionnaire $16.00 $16.0 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/ Interp $20.00 $20.00 Urinal sis Dipstick $3.00 $3.00 Bladder Cancer Screen $45.00 $45.0 0 08/06/09 Bailey, Mark E. Comprehensive Physical $91.00 91.00 OnMed Pro ram $0.00 $0,00 Respirator/Medical Review $16.00 $16.00 Health Risk A2praisal Motivation 16.00 $16.00 Treadmill (PFE) $15100 $153.00 Flexibility Check $10.00 $10,0 0 Waist/Hi Ratio $100 $3.00 BIA Bio -El ec Im ed Anal $14.00 $14.00 Bladder Cancer Screen $45.00 $45.0 0 Nutri Assessment Questionnaire $16,00 $16.00 Vital Signs HT WT BP P R $7.00 7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33,00 Audiornetry $14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Di stick $3.00 $3.00 a k rville Steven P. Comprehensive Ph si E $91.00 $91. O nMed 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 $10.00 WaisUft Ratio 3.00 $3.DO BIA Bio -Elec Im ed Anal 14.00 $14.00 Bladder Cancer Screen $45.00 IZA5 .00 4 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 w Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 m Invoice 00 -11486 Date Employee Description Amount Balance Due Nutri Assessment Questionnaire $16.00 $16.00 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/ Inter 20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Exercise Prescription $35.00 $35.0 0 Haymaker, Samuel K. Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Reso iratorlMedical Review $16.00 $16.0 Health Risk Appraisal Motivation $16.00 $16.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Bladder Cancer Screen $45.00 $45.0 0 Nutri Assessment Questionnaire $16.00 $16.00 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. ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Hutchison. Brian 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 $16.0 0 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.0 0 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Muscle tren th Endurance $26.00 $26. IA Bi -Elec Imped An aly) $14.00 $14.00 Bladder Cancer Screen $45.00 $45.00 Nutri Assessment Questionnaire $16.00 $16.00 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 Mulford David A. Comprehensive Physical $91.00 $91,00 OnMed Program $0.00 $0.00 Res irator Medical Review $16.00 $16.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 o Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 0811212009 m Invoice 00 -11486 Date. Employee Description Amount Balance Due Health Risk Aonraisal f Motivation 16.00 $16.00 Treadmill (PFE) $153.00 $153.00 Flexibility Check 10.00 $10.13 0 Wais Ratio 0 Muscle Strength Endurance $26.00 $26.00 BIA Bio -Elec Im ed Anal $14.00 $14.00 Chest PN AT $60.00 $60.00 Bladder Cancer Screen 45.00 $45.0 0 Nutri Assessment Questionnaire $16.00 $16.0 0 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 Audiometry 14.00 $14.00 ECG W/ Interp $20,00 $20.00 Urinalysis Di stick $3.00 $3.00 Osborne Scott K. Com rehensive 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 Exercise Prescription $35.00 $35.0 0 Flexibility Check $10.00 10.00 Waist/Hi Ratio $3.00 $3.00 BIA Bio- El eclm ed Ana! 14.00 $14.0 0 Bladder Cancer Screen $45.00 $45.00 Nutri Assessment Questionnaire $16.00 $16.00 Vital Si ns HT WT BP P R $7.00 STDO Vision Titmus 6.00 $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.OD Peterson Vernon A. 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 $16.0 0 Treadmill (PFE) $153.00 $153.00 Flexibility Check $10.00 $10.0 0 Waist/1-1j Waist/1-1jo Ratio .D 3.00 BIA (Bio-Elec ImQed Anal 14.0 114.0 0 Exercise Prescription $35.00 $35.00 Bladder Cancer Screen $45.00 $45.00 Nutri Assessment Questionnaire $16.00 $16.00 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26,00 PFT W /Inter 33.00 $33.00 Audiometry $14.00 14.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 C Carmel Fire Department CARMEFD E 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 m Invoice 00 -11486 Date Employee Description Amount Balance Due ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Ray, Lucas M. 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 Exercise Prescription $35.00 $35.0 0 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Muscle Strenath Endurance $26.00 $26.0 0 BIA Bio -Elec Im ed Anal $14.00 $14.00 Bladder Cancer Screen $45.00 $45.0 0 Nutri Assessment Questionnaire $16.00 $16.00 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.0 0 Audiometry 14.00 $14.0 0 ECG W/ Intero $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Schooley Dustin D. Com rehensive 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 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.0 0 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Bladder Cancer Screen $45.00 $45.0 0 Nutri Assessment Questionnaire $16.00 $16.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Intero $33.00 $33.0 A udiometry 14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Sharp. Adam C. 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 $16.0 0 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 Exercise Prescription $35.00 $35.0 0 INVOICE F o Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 o Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 m Invoice 00 -11486 Date Employee Description Amount Balance Due Nutri Assessment Questionnaire $16.00 $16.00 Vital Si ns 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 $14.00 ECG W1 Interip $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Bladder Cancer Screen $45.00 $45.0 0 Sombke Brad D. Comprehensive Physical $91.00 $91.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review 116.00 $16.0 0 Health Risk Appraisal Motivation 16.00 16.00 Treadmill PFE 153.00 $153.00 Exercise Prescription $35.00 $35.00 Flexibility Check $10.00 $10,0 0 Waist/Hi Ratio $3.00 100 Muscle Strength Endurance $26.00 $26.00 BIA Bio -El ec Im ed Anal $14.00 $14.00 Bladder Cancer Screen $45.00 $45.00 Nutri Assessment Questionnaire $16.00 $16.00 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W /Inter 33.00 $33.001 Audiometry 14.00 $14.0 0 ECG W/ inter 20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Starr. Gregory A. Bladder Cancer Screen S45.00 $45.0 0 Nutri A sm nt Que tionngire $16,00 $16.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiornetry $14.00 $14.0 0 ECG 1N/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Comprehensive Physical $91.00 91.00 OnMed Program $0.00 $0.00 Res iratorlMedical Review $16.00 $16.0 0 Health Risk Aporaisal f Motivation 16.00 $16.00 Treadmill (PFE) $15 .00 $1 53.00 Flexibility Check 1 .00 $10. Waist/Hi Ratio $3.00 $3.00 BIA Bio -Elec Im ed Anal $14.00 $14.00 08/07/09 Buttler, James N. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Short Form 16.00 $16.00 OnMed Program so.00 $0.00 Respirator/Medical Review $16,00 $16.00 BIA Bio -Elec Im ed Anal 14.00 q1A .00 R 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 08/12/2009 m Invoice 00 -11486 Date Employee Description Amount Balance Due Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.0 0 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interip $33.00 $33.00 Audiomet $14.00 $14.00 E e n) $20.00 $20.0 Urinalysis Dipstick $3.00 $3.00 Contino David M. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Short Form 16.00 $16.00 OnMed Program $0.00 $0.00 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 Nutri Assessment Questionnaire $16.00 $16.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 PFT W/Interp $33.00 $33.00 Audiornetry $14.00 $14.00 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 3.00 Bladder Cancer Screen $45.00 $45.00 Gehlbach Marc A. Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Exercise Prescription $35.00 $35.0 0 Nutri Assessment Questionnaire $16.00 $1 Bladder Cancer Screen $45.00 $45.00 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 Audiornetry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Comprehensive Physical $91.00 $91.00 Health Risk Aporaisal Short Form 16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 16.00 Holden Adam D. Comprehensive Physical $91.00 1 91.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 m Indianapolis, IN 46204 o Carmel Fire Department 1 CARMEFD f 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 m Invoice 00 -11486 Date Employee Description; Amount Balance Due Health Risk ADDraisal Short Form 16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16,00 $16.0 0 BIA (Bio-Eigg Imped Anal y) $14.00 $14 Flexibilitv Check $10.00 $10.00 Treadmill (PFE $153.00 $153.00 Waist/Hi Ratio $3.00 $3.00 Nutri Assessment Questionnaire $16.00 $16.0 0 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 $20.00 Urinalysis Dipstick 13.00 $3.00 Bladder Cancer Screen $45.00 $45,0 0 Hughes, Chad L. Comprehensive Physical $91.00 91.00 Health Risk Appraisal Short Form $16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -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 $153.0 0 Exercise Prescription 135.00 $35.0 0 Nutri Assessment Questionnaire $16.00 16.00 Vital Si ns HT WT BP P R S7.00 $7.00 Vision Titmus $26.00 S26.00 PFT W/Interp $33.00 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinal sis Dipstick $3.00 $3.00 Bladder Cancer Screen $45.0D $45.00 Keaton Anthony R. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Program $0.00 $0.00 Res irator /Medical Review $16.00 $16,0 0 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 10.00 Waist/Hiip Ratio 3.00 Treadmill (PFE $15 .0 1 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W/Interp $33.00 $33.Q0 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 20.00 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 08/12/2009 m Invoice 00 -11486 Date Employee Description Amount Balance Due Urinalysis Dipstick $3.00 $3.00 Kinney, Jared N. Com rehensive Physical $91.00 $91.0 0 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 $14.0 0 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 B ladder n r Screen $45.00 $45.0 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/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Price Jose h P. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $10,0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 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 $20.00 Urinalysis Dipstick $3.00 $3.00 Reeves, Neil P. BIA Bi lec Imoed Anal y) $14.00 $14.0 Flexibility Ch k $10.00 $10.0 Treadmill (PFE) $153.00 $153.00 Waist/Hi Ratio $3.00 $3.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 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 Audiometry 14.00 $14.0 0 ECG W/ Interp $20.00 $20.0 0 Urinal sis Dipstick $3.00 $3.00 Health Risk Appraisal Short Form 16.00 $16.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 x Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 m Invoice 00 -11486 Date Employee Description Amount Balance Due OnMed Program $0.00 $0.00 Res irator /Medical Review $16.00 $16.00 Com rehensive Physical $91.00 $91.0 0 Utzia. Chad M. Comorehensive Physical 0 $91. Health Risk Appraisal Short Form $16.00 $16.00 OnMed Program $0.00 $0.00 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 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W /Inte 33.00 $33.0 0 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Bladder Cancer Screen $45.00 $45.00 Voskuhl Mark J. Comprehensive Ph sical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibilitv Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $1 153.00 Exercise Prescription $35.00 $35.00 Nuth Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 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 Wynn, Barbara M. Comprehensive Physical $91.00 $91.0 0 Health Risk Aooraisal Short Form $16.00 $16.0 0 OnMed Program 0. Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibilitv Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Bladder Cancer Screen $45.00 $45.00 INVOICE 0 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 08/12/2009 m Invoice 00 -11486 Date Employee Description Amount Balance Due Nutri Assessment Questionnaire $16.00 $16.00 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 $14.001 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Total Charges $30,101.00 Total Payments Balance Due $0.00 $30,101.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 m X Indianapolis, IN 46204 C Carmel Fire Department CARMEFD F' 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/19/2009 m Invoice 00 -11524 Date Employee Description Amount Balance Due 08/10/09 Bartrom, Brad A. 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 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) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen 45.0 $4 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 Audiomet $14.00 $14.00 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Brant. Kenneth E. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $10.0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 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 C ndra Kyle E. Com rehensive Physical 91.0 $91. Hea lth Risk r i al (Motivation) $1 .00 $16. OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 $10.00 Treadmill (PFE) $153.00 $153.00 Waist/Hi Ratio $3.00 $3.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 33.00 INVOICE t0- Public Safety Medical Services 324 E. New York Street E Suite 300 CD a: Indianapolis, IN 46204 G Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/19/2009 m Invoice 00 -11524 Date Employee Description Amount Balance Due Audiometry 14.00 $14.00 ECG W/ Interp $20.00 $20.001 Urinalysis Di stick $3.00 $3.00 Davis, James M. Com r hensive Physical $91,00 $91. Health Risk Appraisal Motivation $16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.001 Flexibility Check $10.00 $10,00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.0 0 Audiomet $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Dufek Gary J. 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 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 E xercise PrescrOti $35.00 35.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 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 $20.00 Urinalysis Dipstick $3.00 $3.00 Essex Cory C. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Program $0.00 $0.00 R it t r M dical Review $16.00 $16.0 BIA Bio -Ell ec 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 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 IY Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/19/2009 LM Invoice 00 -11524 Date Employee Description Amount Balance Due Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W/Interp $33.D0 $33.0 0 AudiometrV $14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Freer, Keith T. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 A (Bi Im Anl $14.00 $14. 0 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 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 Audiometry 14.00 $14.0 0 Urinalysis Di stick $3.00 $3.00 Martin David D. Com rehen ive Physical $91.00 $91. Health Risk Appraisal Motivation $16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Vital Sin HT WT BP P R $7.00 $7. Vision Titmus $26.00 $26.0 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 Mead. David 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 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 10.00 Waist/Hi Ratio $3.00 3.00 INVOICE F Public Safety Medical Services 324 E. New York Street E Suite 300 x Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/19/2009 m Invoice 00 -11524 Date Employee Description Amount Balance Due Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 16.00 Bladder Cancer Screen $45.00 $45.00 Vital Sions LIT WT BP P R $7.00 $7. 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 Nicley, Wes W. Comprehensive Physical $91.00 $91.00 Health Risk Aporaisal Motivation 16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 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 W/ Interp $20.00 $20.0 0 Urinal sis Di stick $3.00 $3.00 Sutton Sean B. Health Risk Appraisal Motivation 16.00 $16.0 0 C omprehensive Physical $91.00 $91.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Intern $33.00 .00 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Toney James D. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation 16.00 $16.00 OnMed Program $0.00 1 IL04 Respirator/Medical Review $16.00 16.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 0 o: Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/19/2009 m Invoice 00 -11524 Date Employee Description Amount Balance Due 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) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 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 CG W Int en) $20.00 $20. Urinalysis Dipstick $3.00 $3.00 08/11/09 Butts Renee L. 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 $16.0 0 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 Exercise Prescription $35.00 $35.001 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 Vital Si HT WT BP P R $7.00 $7. Vision Titmus $26.00 $26.00 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 Crisler, John H. 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 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility k $10.00 $10.0 Waist/Hi Ratio $3.00 $3.0 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 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 Audiometry 14.00 $14.0 0 ECG W/ Inter 20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Griffin Timothy M. I Comprehensive Physical 91.00 $91.00 Health Risk Aporaisal Motivation 16.00 $16. 00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/19/2009 m Invoice 00 -11524 Date Employee Description Amount Balance Due OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10-00 1 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 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/ Inte 20.00 $20.0 0 Urinalysis Di stick $3.00 $3.00 Howard Wendell E. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation $16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.001 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W Inter r) $33.00 1 $33.00 Audiornetry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Mead Jr. Donald R. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.001 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 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) $1 3.00 $153.0 Nutri Assessment Questionnaire $16.00 $16. Bladder Cancer Screen $45.00 $45.00 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 $20.00 Urinalysis Dipstick $3.00 $3.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department CARMEFD f 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/19/2009 m Invoice 00 -11524 Date Employee Description Amount Balance Due Medlen Michael J. 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 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.0 0 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questio i 6. $16. Bladder Cancer Screen $45.00 $45.00 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 Audiometry 14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Phillips, Craig M. Health Risk Appraisal Motivation 16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Com rehensive Physical $91.00 $91.0 0 BIA (Bio-Elec ImDed Anal y) $14.00 $14.0 0 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 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 $20.0 0 Urinalysis Dinstick Robinson Mitchell L. Com reh n ive Physical $91.00 $91. Health Risk Appraisal Motivation $16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal $14.00 $14.0 0 FlexibilitV Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.0 0 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45,00 $45.001 Vital Si ns HT WT BP P R $7.00 7.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 m W Indianapolis, IN 46204 G Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/19/2009 m Invoice 00 -11524 Date Employee Description Amount Balance Due Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.0 0 Audiornetry $14.00 $14.00 EGG W 20.0 $20.0 0 Urinalysis Dipstick $3.00 $3.00 08/13/09 Allen Brad A. 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 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 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/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Anderson D. Cory 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 $14.0 0 Flexibility Check $10.00 $10.00 Waist/Hip Ra $3.00 $3.00 Muscle Strength Endurance $26.00 $26.00 Nuth Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 Treadmill (PFE) $153.00 $153.00 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 W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Callahan, Mark Comprehensive Physical 91. 91. Hea lth Risk Appraisal Motiv tin $16.00 $16.0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Hemoccult $5.00 $5.00 BIA Bio -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 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 C Carmel Fire Department CARMEFD E 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/19/2009 m Invoice 00 -11524 Date Employee Description Amount Balance Due Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 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 Di stick $3.00 $3.00 Deitsch Marc W. Comprehensive Physical $91.00 $91.0 0 Health Risk Aooraisal Motivation 16.00 $16.00 O Pro $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.0 0 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Vital Si ns 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 $20.00 Urinal sis Dipstick $3.00 $3.00 Grimes Jeffrey A. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.00 FlexibilitV Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 B ladder Cancer Screen $45.00 $45. Hemoccult $5.00 $5.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Hepatitis B Vaccination #1 $70.00 $70.0 0 Iniection Fee $10.00 $10.0 0 Haus Joshua S. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation 16.00 $16.00 OnMed Program $0.00 $0.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 w Indianapolis, IN 46204 o Carmel Fire Department! CARMEFQ 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08!1912009 m Invoice 00 -11524 Date Employee Description Amount Balance Due Respirator/Medical Review $16.00 $16.00 BIA Blo -Elec Imiped Anal 14.00 S14.001 Flexibility Check $10.00 $10.00 i Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nuth Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.001 Vision Titmus $26,00 $26.00 PFT W/Interp $33.00 $33.0 0 Audiomet 14.00 $14.0 0 ECG W/ Interp $20,00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Miller Scott G. Comprehensive Physical $91,00 $91.00 Health Risk A raisal Motivation $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 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Vital Si ns HT WT BP P R $7.00 17,00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 33.00 Audlomet $14.00 $14.0 0 ECG W1 Inter 20.0 $20.00 Urinalysis Dipstick $3.00 $3.00 Repoert, Ian T. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation $16.00 $16.00 OnMed Program $0.00 $O.DO Respirator/Medical Review $16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 10.00 Waist/Hi Ratio $3.00 $3.DO Treadmill PFE 153.00 15100 Nutri Assessment Questionnaire $16.00 $16.0 0 B ladder Cancer Screen $45.00 $45.001 Vital Sin HT WT BP P R $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 $20.00 Urinal sis Dipstick $3.00 $3.00 Exercise Prescription 35.00 $35.OD Thompson, James L. Comprehensive Physical $91.00 $91.00 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 08/19/2009 m Invoice 00 -11524 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 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vii Titmus $26.00 PFT W/Interp $33.00 $33.00 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinal sis Dipstick $3.00 $3.00 Tierney, Scott A. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal 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 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $1 .0 1 3.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 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 Audiomet $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Di stick $3.00 $3.00 Hemoccult $5.00 $5.00 Viehe Richard E. Gomorehensive Physical $91,00 $91.0 Health Risk Aoorajsal (Motivation) 16.0 1 0 OnMed Program $0.00 $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) $153.00 $153.00 Exercise Prescription $35.00 $35.0 0 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 Ir Indianapolis, IN 46204 Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08119/2009 m Invoice 00 -11524 Date Employee Description Amount Balance Due PFT W/Interp $33.00 $33.00 Audiometry 14.00 14.00 ECG WI Inter 20.00 $20.0 0 Urinalysis Di ti k $300 $3.0c) Woodburn, Scott E. Comprehensive Physical $91.0D $91.00 Health Risk Appraisal Motivation $16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16,00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.00 Treadmill (PFE) $153.00 $153,00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45. 00 $45.0 0 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 08/14/09 Castor, Rick S. MID $15.00 $15.0 0 CBC W /Dill And Plat $12.00 $12.0 0 Lipid Panel 15.00 $15.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 8 2 1100 $13.00 Cromlich Mark A. Com rehensive Physical $91.00 91.00 He Ith Risk Apgrgi al tiv tin $16.00 $16.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $15.00 $16.00 Hemoccult $5.00 $5.00 BIA Bio -Flec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 10.00 Waist/Hi Ratio $3,00 $3.00 Treadmill (PFE $153.00 $153.00 Exercise Prescription $35,00 35.00 Nutri Assessment Questionnaire $16,00 $16.0 0 Bladder Cancer Screen $45,00 $45.00 Vital Si HT WT BP P R ST00 $7.00 Vision Titmus $26.00 26.0 PFT W/Interp $33.00 $33.00 Audiornetry $14.00 $14.00 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Giles William G. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation 16.00 16.00 OnMed Program so.00 $O.nn INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 o Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/19/2009 m Invoice 00 -11524 Date Employee Description Amount Balance Due 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 Exercise Prescription $35.00 $35.0 0 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 Hemoccult $5.00 $5.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 26. 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 Hulett. Mark A. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.00 OnMed Program $0.00 $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 Tread mill (PFE) $1 1 3.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 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 AudiometrV 1 $14.00 14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 3.00 Total Charges $16,983.00 Total Payments Balance Due $0.00 $16,983.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date INVOICE �o Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 G Carmel Fire Department CARMELFD2 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11569 Date Employee Description Amount Balance Due 08/17/09 Ca Shaw, Jeffrey A. PSA $35.00 $35.00 Conner Timothy L. PSA $35.00 $35.00 RBC Cholinesterase $45.00 $45.00 Gipson, Bruce E. PSA $35.00 $35.00 Gu el Mark E. PSA $35.00 $35.00 RBC Cholinesterase $45.00 $45.00 Maroon Ernie R. PSA $35.00 $35.00 Youna, Alan R. PSA $35.00 35.00 Total Charges $300.00 Total Payments Balance Due $0.00 $300.00 Please write invoice number on payment check. Balance due 15 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 IY Indianapolis, IN 46204 G Carmel Fire Department CARMEFD E 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11568 Date Employee Description Amount Balance Due 08/17/09 Brandt Gary D. Com rehensive 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 $16.0 0 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 $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 Vital Si ns HT WT BP P R $7.00 $7. Vision Titmus $26.00 $26.00 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 Ca shave Jeffrey A. CMP $15.00 $15.0 0 CBC W /Dill And Plat $12.00 $12.0 0 Lipid Panel $15.00 $15.0 0 Veni uncture Fee $3.00 $3.00 Conner Timothy L. CMP $15.00 $15.0 0 CBC W /Dill And Plat $12.00 $12.00 Li d Panel $15.00 $15. Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Cox Justin M. 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 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 16.0 Bladder Cancer S reen $45.00 $4 5.00 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 $20.00 Urinalysis Di stick $3.00 $3.00 Freer Keith T. CMP $15.00 $15.0 0 CBC W /Dill And Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 3.00 Frenzel Eric C. Comprehensive Physical $91.00 91.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 m x Indianapolis, IN 46204 C Carmel Fire Department CARMEFD F 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11568 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 BIA Bio- lec Im ed Anal 14.0 $14,0 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W /Inter M$2 33.00 Audiomet 14.00 ECG W/ Inter 20.00 Urinalysis Dipstick 3.00 Frost Bruce S. Com rehensive Physical 91.00 Health Risk Appraisal Motivation $16.00 $16.00 OnMed Program $0.00 $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 $3.001 Treadmill (PFE) $153.00 $153.00 Exercise Prescri ption $35.00 $35.0 0 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision T tmus $26.00 $26.0 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 Gipson, Bruce E. CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 $12.0 0 Lipid Panel $15.00 $15.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.0 0 Gu el Mark E. CMP $15.00 $15.00 CBC W D'ff And Plat $12.00 $12.0 0 Lip id Panel $15.00 $15.0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Haboush. David G. 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 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 C Carmel Fire Department CARMEFD F 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11568 Date Employee Description Amount Balance Due Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.00 Exercise Prescription $35.00 $35.0 0 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 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 i met 14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Lenze Theodore A. 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 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 Muscle Strength Endurance $26.00 $26.0 0 Treadmill PFE 153.00 $153.00 Nutri Assessment ue tionn ire $16.00 $16. Bladder Cancer Screen $45.00 $45.00 Vital Si ns 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 $20.00 Urinalysis Dipstick $3.00 $3.00 Maroon Ernie R. CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 $12.0 0 Lipid Panel $15.00 $15.0 0 Veniouncture Fee $3,00 $3.0 HIV 1 2 $13.00 $13.0 Martin Richard A. 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 BIA Bio -Elec Im ed Anal 14.00 $14.00 FlexibifjtV Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire 16.00 16.00 Bladder Cancer Screen $45.00 $45.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 G Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11568 Date Employee Description Amount Balance Due Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 26.00 PFT W /Inter 33.00 $33.0 0 A udiometry 14 0 14.0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 McNeely Michael W. 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 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 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/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Steury. Kent C. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $10. Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 AudiometrV $14.00 $14.00 ECG W/ Interp $20.00 $20.00 U rinalysis Di stick $3.00 $3.0 Weaver, Virgil L. Comprehensive Physical $91-00 $91.0 0 Health Risk Appraisal Motivation $16.00 $16.00 OnMed Program $0.00 $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) $153.00 $153.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 o: Indianapolis, IN 46204 G Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11568 Date Employee Description Amount Balance Due Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 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 Weddin ton Kurt L. Comprehensive Physical $91.00 $91.00 Health Risk Aooraisal Motivation 16.00 $16.00 nM d 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 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.0 0 Nuth Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 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 $14.0 14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Witsken Steven J. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 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) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 16.0 Bladder Cancer S r en $45, $45.0 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/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Young, Alan R. CMP $15.00 $15.00 CBC W /Dill And Plat $12.00 $12.00 Lipid Panel $15.00 $15.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11568 Date Employee Description Amount Balance Due 08/18/09 Crane Barry L. Comprehensive Physical $91.00 $91.00 Health Risk Anoraisal Motivation 16.00 $16.00 OnMed Pro ram $0.00 $0.00 s irator Me is I Review $16.00 $16. BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibilitv Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.0 0 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 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 W/ Interp $20.00 $20.00 Urinal sis Dipstick $3.00 $3.00 Foster James P. 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 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 Muscle Strength Endurance $26.00 $26.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45,00 4 .0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiornetry $14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Kelsheimer, Troy W. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation 16.00 $16.001 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 BIA Bio -Elec Im ed Anal $14.00 $14. Flexibility Ch ck $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 CD Indianapolis, IN 46204 o Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11568 Date Employee Description Amount Balance Due PFT W/Interp $33.00 $33.00 Audiometry 14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Love. Joseph B. 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 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $10.00 Waist/Hip Ratio 3. .00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.001 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.0 0 AudiometrV $14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Mitchell James C. Comprehensive Physical $91.00 $91.00 Health Risk Aooraisal Motivation 16.00 $16.0 0 O nMed Pr r m $0.00 $0. Respirator/Medical Review $16.00 $16.00 BIA Bio -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 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 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 14.0 $14.0 0 ECG W1 Intern $20.00 20. Urinalysis Dipstick $3.00 $3.00 Platt Jace P. 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 $16.0 0 BIA Bio -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 Exercise Prescription $35.00 $35.0 0 Nutri Assessment Questionnaire $16.00 $16.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 Ir Indianapolis, IN 46204 C Carmel Fire Department CARMEFD F 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11568 Date Employee Description Amount Balance Due Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W Inter $33,00 0 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Hepatitis B Vaccination #1 $70.00 $70.0 0 In'ection Fee $10.00 $10.0 0 Reecer, Jason L. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.00 OnMed Program $0.00 $0.001 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 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 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 Audiometry 14.00 $14.00 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 S elbr ng, James E. Comprehensive Physical $91.00 $91.0 0 Health Risk Anpraisal Motivation 16.00 $16.0 0 OnMed Program 0. Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibilitv Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 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/ Inter $20.00 $20.0 Urinalysis Dipstick $3.00 $3.00 Walker, Christopher E. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation 16.00 $16.00 OnMed Program $0.00 $0.001 Respirator/Medical Review $16.00 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $10.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 a� Indianapolis, IN 46204 o Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/2612009 m Invoice 00 -11568 Date Employee Description Amount Balance Due Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.0 0 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 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 Audiornetry $14.00 $14.0 0 ECG W/ Intero $20.00 $20.00 Urinalysis Diostick $3.00 $3. Webb, Gregory A. 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 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.0 0 Exercise Prescription $35.00 $35.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 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 Wendzel Jason D. 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 $16.0 0 BIA Bio -Elec Im ed Anal y) $14.00 $14.0 0 F lexibility Check $10.00 $10.0 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 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/ Intero $20.00 $20.00 Urinalysis Di stick $3.00 $3.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 G Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 M Invoice 00 -11568 Date Employee Description Amount Balance Due 08/19/09 Brisco Michael D. Comprehensive Physical $91.00 $91.00 Health Risk A raisal Motivation 16.00 $16.00 OnMed Program $0.00 $0.00 Re si)irator/Medical Review $16. $16.0 BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.00 Exercise Prescription $35.00 $35.0 0 Treadmill (PFE $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.001 Vital Signs HT WT BP P R $7.00 $7.00 PFT W/Interp $33.00 $33.00 Audiornetry $14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Ca shave Jeffrey A. 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 $16.0 0 BIA Bio -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 Exercise Prescription $35.00 $35.0 0 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiornetry $14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Cummins Frank C. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -El ec Im d Anal 14.00 $14. Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 m tY Indianapolis, IN 46204 C Carmel Fire Department CARMEFD F 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11568 Date Employee Description Amount Balance Due 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 Gu el Mark E. 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 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $10.00 W i i Ratio 00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 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 Audiometry 14.00 $14.0 0 ECG W/ Inter 20.00 $20.0 0 Urinalysis Di stick $3.00 $3.00 Marcum Bradley D. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Program $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 Muscle Strength Endurance $26.00 $26.0 0 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire 16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 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 Audiomet $14.00 $14.001 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Mason Bryan L. 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 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 35.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 Q) Indianapolis, IN 46204 G Carmel Fire Department CARMEFD f 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11568 Date Employee Description Amount Balance Due Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 PFT W/Interp $33.00 $33.00 Audiornetry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Moriarty, John F. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio- Eleclm 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 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiornetry $14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Plumer, Charles J. Comprehensive Physical $91.00 $91.0 0 Health Risk Anpraisal Motivation 16.00 $16.00 OnMed Pro ram $0.00 $0.00 Re it t r Medi al Review $16.00 $16.0 BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibilitv Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Exercise Prescription $35.00 $35.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 Vital Signs HT WT BP P R $7.00 $7.001 Vision Titmus $26.00 $26.00 PFT W/Interlp $33.00 $33.0 0 Audiometry 14.00 $14.0 0 CG W/ Inter 20.0 $20. Urinalysis Dipstick $3.00 $3.00 Reynolds, Shawn J. 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 $16.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 $10.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 a> x Indianapolis, IN 46204 G Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11568 Date Employee Description Amount Balance Due Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 Vital Si ns 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 Di stick $3.00 $3.00 Whitaker, Charles E. Comorehensive Physical $91. $91. Health Risk Appraisal Motivation $16.00 $16.00 OnMed Program $0.00 $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) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W /Inter 33.00 $33.0 0 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Youna, Andrew S. Comprehensive Physical $91.00 $91.0 0 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 $14.0 0 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $1 .00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 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 08/20109 Frye, Steven R. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Pro ram $0.00 0.00 Respirator/Medical Review 16.00 16.00 INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 CD W Indianapolis, IN 46204 G Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11568 Date Employee Description Amount Balance Due BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.0 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 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 AudiometrV $14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Johnson Jeremy S. 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 BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibilitv Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.001 Bladder Cancer Screen $45.00 $45.00 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 Inter $20.00 $20.0 Urinalysis Dipstick $3.00 $3.00 VanVoorst. Robert J. 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 $16.001 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 Muscle Strength Endurance $26.00 $26.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16. Bladder Ca ncer Screen $45.00 $45.0 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 08/21/09 1 Conner TimothV L. Comprehensive Physical $91.00 $91.00 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 08/26/2009 m Invoice 00 -11568 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 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 FlexibilitV Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.0 0 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus 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 Edwards Steven L. Comprehensive Physical $91.00 $91.0 0 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 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Mu scle Stren th Endurance $26.00 $26.0 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 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 Audiomet $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Di stick $3.00 $3.00 Holubik Steven W. Comprehensive Physical $91.00 $91.00 Health Risk Aooraisal (Motivation) $16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -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 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W /Inter 33.00 $33.001 Audiomet 14.00 14.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 m X Indianapolis, IN 46204 o Carmel Fire Department CARMEFD E 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11568 Date Employee Description Amount Balance Due ECG W/ Intem $20.00 $20.00 Urinalysis Di stick $3.00 $3.00 Maroon Ernie R. Comprehensive Physical $91.00 $91.0 0 Health Risk Ai)i)raisal Motivation $16.00 $1 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibilit Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 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 $100 $3.00 McNab John D. 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 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 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 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/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Young, Alan R. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 IA Bio -EI c ImPed Anal y) $14.00 $14.0 0 Flexibility Check $10. $10.0 0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 33.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 a> X Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 m Invoice 00 -11568 Date Employee Description Amount Balance Due Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 3.00 Total Charges $21,255.00 Total Payments Balance Due $0.00 $21,255.00 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. Public Safety Medical Services ALLOWED 20 IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $75,040.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# 1 Dept. INVOICE NO. ACCT #ITITLE AMOUNT Board Members 1120 11568 43- 407.01 $21,255.00 1 hereby certify that the attached invoice(s), or 1120 11569 43- 407.01 $300.00 bills) is (are) true and correct and that the 1120 11524 43- 407.01 $16,983.00 materials or services itemized thereon for 1120 11486 43- 407.01 $30,101.00 1120 11423 43- 407.01 $4,206.00 which charge is made were ordered and 1120 11424 43- 407.01 $1,980.00 received except 1120 11487 43- 407.01 $180.00 1120 11525 43- 407.01 $35.00 09 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 Due Invoice Invoice Description Amount Date !Number (or note attached invoice(s) or bill(s)) 11568 $21,255.00 11569 $300.00 11524 $16,983.00 11486 $30,101.00 11423 $4,206.00 11424 $1,980.00 11487 $180.00 11525 $35.00 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 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Police Department CARMEPD t— 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08/12/2009 m Invoice 00 -11488 Date Employee Description Amount Balance Due 08/03/09 Herron James C. 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 Lvfle, Blake A. RBC Cholinesterase Done In Error 0.00 0.00 Martin Brian A. Repeat Glucose Fastin 21.00 $21.00 Total Charges $651.00 Total Payments Balance Due $0.00 $651.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days.from invoice date INVOICE oo 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 08/19/2009 m Invoice 00 -11526 Date Employee Description Amount Balance Due 08/14/09 Amos Chad B. 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 HB SAb Quantitative Titer $35.00 $35.00 Byrne. Timothy L. CMP $16.00 $16.0 0 CBC W /Dill And 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 $13.00 PSA $35.00 $35. Grose James E. 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 Harris Robert P. CMP $16.00 $16.0 0 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 PSA $35.00 $35.0 0 Ha Willi E. CIVIP $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 PSA $35.00 $35.0 0 Hedrick. Brad A. 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 $13.00 PSA $35.00 $35.00 McIntyre, Trent A. 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 Vanderbeck David R. CMP $16.00 $16.00 CBC W /Dill And Plat $13.00 $13.001 Lipid Panel $16.00 $16.00 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.0 0 White Kari E. CMP $16.00 $16.0 0 CBC W /Dill And Plat $13.00 $13.00 INVOICE oo Public Safety Medical Services 324 E. New York Street E Suite 300 i Indianapolis, IN 46204 c_ Carmel Police Department/ CARMEPD 3 Civic Square Terms m. Carmel, IN 46032 Invoice Date 08/1912009 Invoice 00 -11526 Date Employee Description Amount Balance Due Lipid Panel $16.00 $16.00 Veni uncture Fee 100 3.00 FiIV 1 &2 $13.00 1100 Total Charges 1 $711.00 Total Payments Balance Due $0.00 1 $711.00 Please write invoice number on payment check. Balance dtae 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Police Department I CARMEPD f 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2009 Invoice 00 -11570 Date Employee Description Amount Balance Due 08/17/09 Bowman,GaryA. 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 $13.00 PSA $35.00 $35.0 0 Quantiferon Tb Gold $50.00 $50.0 0 Flaming, Anna G. Hepatitis B Vaccination #2 $70.00 70.00 Injection Fee $10.00 10.00 Gerdt Andrew P. CMP $16.00 $16.0 0 BC W Diff 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 Gold $50.00 $50.0 0 Pilkin ton Scott CMP $16.00 $16.0 0 CSC W /Diff And Plat 1100 $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 Q uantiferon Tb Gold $50.00 50.00 Schmidt Brian E. CMP $16.00 $16.0 0 BC W /Diff And Plat $13.0 $13.0 0 Lipid Panel $16.00 $16.00 Veni uncture Fee $3.00 3.00 HIV 1 2 $13.00 $13.0 0 PSA $35.00 S35.00 Quantiferon Tb Gold $50.00 $50.00 Total Charges $594.00 Total Payments Balance Due $0.00 $594.00 Please write invoice number on payment check. BaIance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date Prescribed by State Board at Accounts ACCOUNTS PAYABLE VOUCHER. City Form No. 201 (Rev. 4995) 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 Servic Purchase Order No. 324 E. New York Street, Suit 300 Terms Indianapolis, IN 46204 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 8/12/09 11488 payment for officer physicals 651.00 8/19/09 11526 payment for officer physicals 711.00 8/26/09 11570 payment for officer physicals 594.00 Total 1,956.00 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 V000HER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 rndianaolis, IN 1,956.00 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 11488 407 -01 651.00 bill(s) is (are) true and correct and that the 1110 11526 407 -01 711.00 materials or services itemized thereon for 1110 11570 407 -01 594.00 which charge is made were ordered and received except August 27 20 09 A d""k J f, Signature L .27 Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund