175866 08/06/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
0 1 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $2,707.00
INDIANAPOLIS IN 46204
CHECK NUMBER: 175866
CHECK DATE: 8/6/2009
DEPA ACC OUNT P O NUMBER INVOICE NUMBE AMOUNT DESCRIPTION��
1110 .4340701 11387 2,431.00 MEDICAL EXAM FEES
1110 4340701 11425 276.00 MEDICAL EXAM FEES
.a'
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
o Indianapolis, IN 46204
C Carmel Police Department I CARMEPD
E- Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 07/22/2009
tm Invoice 00 -11387
Date Employee Description Amount Balance Due
07/16/09 Broadnax. Matthew L. Comprehensive Physical $91.00 $91.00
OnMed Program $0.00 $0.00
Health Risk Appraisal (Motivation) $16.00 $16.00
Respirator/Medical Review $16.00 $16.00
Waist/Hi Ratio $3.00 $3.00
Flexibility Check $10.00 $10.0 0
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 /Inter 33.00 $33.00
Audiometry 14.0 $14.00
ECG W/ Interp $20.00 $20.00
Urinalysis Dipstick $3.00 $3.00
Tonometry $36.00 $36.00
Collins. Larry J. 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
CMP $16.00 $16.0 0
CBC W /Dill And Plat $13.00 $13.00
Lipid Panel $16.00 $16.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.0 0
HB SAb Quantitative Titer $35.00 $35.00
PSA $35.00 $35.00
Waist/Hi Ratio $3.00 $3.00
Flexibilitv Check $10.00 $10.00
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 $33.0 0
Audiometry 14.00 $14.0 0
ECG W/ Interp $20.00 $20.00
Urinalysis Di tick $3.00 $3.00
Tonometry $36.00 $36.0
Hemoccult $5.00 $5.00
Lovitt. Richard A. Comprehensive Physical $91.00 $91.00
OnMed Program $0.00 $0.00
Health Risk Appraisal (Motivation) $16.00 $16.00
Respirator/Medical Review $16.00 $16.00
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/Interlp $33.00 $33.00
Audiometry 14.00 $14.00
ECG W/ Intern $20.00 20.00
INVOICE
o Public Safety Medical Services
324 E. New York Street
'E Suite 300
tY Indianapolis, IN 46204
G Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/22/2009
to Invoice 00 -11387
.Date 'Employee Description Amount Balance Due
Urinalysis Di stick $3.00 $3.00
Tonometry $36.00 $36.00
Waist/Hi Ratio $3.00 3.00
Flexibility Check $10.00 $10.0 0
Treadmill (PFE) $153.00 $153.00
Mabie. Michael L. 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
HB SAb Quantitative Titer $35.00 $35.00
PSA $35.00 $35.00
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
Audiometry $14.00 $14.00
ECG W/ Interp $20.00 $20.00
Urinalysis Dipstick $3.00 $3.00
Tonometry $36.00 $36.00
Comprehensive Physical $91.00 $91.00
OnMed Program $0.00 $0.00
Respirator/Medical Review $16.00 $16.0 0
Health Risk Appraisal Motivation $16.00 $16.00
Hemoccult $5.00 $5.00
Waist /Hi Ratio $3.00 $3.00
Flexibility Check $10.00 $10.0 0
Treadmill (PFE) $153.00 $153.00
Morrow Scott A. Comprehensive Physical $91.00 $91.0 0
OnMed Proaram $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
Waist/Hi Ratio $3.00 $3.00
Flexibility Check $10.00 $10.00
Treadmill PFE 153.00 $153.00
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
ECG W/ Intero $20. 20.0
Urinalysis Dipstick $3.00 $3.00
Tonornetry $36.00 $36.00
Total Charges $2,431.00
Total Payments Balance Due $0.00 $2,431.00
Please write invoice number on payment check.
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 Police Department I CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 07122!2009
m Invoice 00 -11387
Date Employee Description Amount I Balance Due
Our Federal Employer Identification Number is 35- 2079797
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
tY Indianapolis, IN 46204
p Carmel Police Department! CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 07129I2009
m Invoice 00.11425
Date Employee Description Amount Balance Due
07/20/09 Flaming Anna G. Hepatitis B Vaccination #1 $70.00 $70.00
In ection Fee $10.00 $10.0 0
Harris Sarah E. Re eat Quantiferon $50,00 $50.0 0
Kin on, David M. HB SAb Quantitative Titer $35.00 $35.00
CMP $16.00 $16.00
CBC WfDiff And Plat $13.00 $13.0 0
Li id Panel 16.00 $16.00
Veni uncture Fee $3.00 $3.00
HIV 1 &2 $13.00 $13.0 0
uantiferon Tb Gold $5o.00 $50,00
Total Charges $276.00
Total Payments Balance Due $0.00 $276.00
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797 date
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
Public Safety Medical Services Purchase Order No.
324 E. New York street, Suite 300 Terms
Indianapolis, IN 46204 Date Due
invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
7/22/09 11387 payment for officer physicals 2.431.00
7/29/09 1 11425 payment for officer physicals 276.00
Total 2,707.00
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety MEdical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
2,707.00
ON ACCOUNT OF APPROPRIATION FOR
police general ufnd
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 11387 407 -01 2,431 .00 bill(s) is (are) true and correct and that the
1110 11425 407 -01 276.00 materials or services itemized thereon for
which charge is made were ordered and
received except
July 30 20 09
r
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund