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Home My WebLink About205576 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $4,424.68 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 205576 CHECK DATE: 1/17/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 16783 3,876.46 MEDICAL EXAM FEES 1120 4340701 16844 75.00 MEDICAL EXAM FEES 1110 4340701 16845 473.22 MEDICAL EXAM FEES INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 x Indianapolis, IN 46204 0 Carmel Police Department CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 01/05/2012 m Invoice 00 -16845 Date Employee Description Amount Balance Due 12120/11 McNair Harland J. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.00 Flexibility Test $10.20 $10.2 0 Body Fat Test BIA Bio -Elec Imp Anal 1428 $14.28 Waist/Hi Ratio $3.06 $3.06 PSA Prostate S ecific A Blood 35.70 $35.70 Veni uncture $3.06 $3.06 et ry (Glaucoma Test 36.72 Vital Si ns HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 PFT Pulmonar Function Test $33.66 $33.66 Audiometry $14.28 $14.28 EKG W/ Inter 20.40 $20.40 Urinal sis Dipstick $3.06 3.06 Total Charges $473.22 Total Payments Balance Due $0.00 $473.22 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 01/05/12 16845 officer physicals $473.22 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 $473.22 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 16845 43- 407.01 $473.22 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Thursday, January 12, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE F o Public Safety Medical Services :t 324 E. New York Street E Suite 300 4) M Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 01/05/2012 m Invoice 00 -16844 Date Employee Description Amount Balance Due 12/13/11 Mulford David A. Fitness For Duty Exam (Initial) Level 1 75.00 75.00 Total Charges $75.00 Total Payments Balance Due $0.00 $75.00 Please write invoice number on payment check. Balance due 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 Fire Department CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 12/22/2011 m Invoice 00 -16783 Date Employee Description Amount Balance Due 12/12/11 Cox Jordan R. Chart Review/Completion $82.60 $82.60 Indiana PERF Exam $185.64 $185.64 Tb Skin Test $7.14 $7.14 Applicant Blood Panel PERF $117.10 $117.10 Drug Screen 7 GC /MS W /MRO $40.80 $40.80 Veni uncture $3.06 $3.06 Chest X -Ra PA/LAT Di ital $61.20 $61.20 Vital Sians HT WT BP P R $0.00 $0.0 0 Vision Acuity 26.52 $26.52 Vision Color Ishihara 26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.6 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinal sis Dipstick $3.06 $3.06 Tonomet (Glaucoma Test $36.72 $36.72 Farmer, Christopher J. Chart Review/Completion $82.60 $82.60 Indiana PERF Exam $185.64 $185.64 Tb Skin Test $7.14 $7.14 Applicant Blood Panel PERF $117.10 $117.10 Drug Screen 7 GUMS W /MRO $40.80 $40.80 Veni uncture $3.06 $3.06 Chest X -Ray PA/LAT (Digital) 61.20 61.20 V S HT WTBPP R M$26.52 Vision Acuit $26.52 Vision Color Ishihara $26.52 PFT Pulmona Function Test $33.66 Audiomet $14.28 EKG W/ Interp $20.40 1 $20.40 Urinalysis Dipstick $3.06 $3.06 Tonomet Glaucoma Test 36.72 36.72 Larawa Justin M. Chart Review/Completion 82.60 0.00 Indiana PERF Exam 185.64 0.00 Tb Skin Test 7.14 0.00 A licant Blood Panel PERF 117.10 0.00 Dr r n 7 MS W MRO 4 0 Veni uncture $3.06 $0.00 Chest X -Ra PA/LAT Di ital $61.20 $0.00 Vital Si ns HT WT BP P R $0.00 $0.00 Vision Acuit $26.52 $24.06 Vision Color Ishihara $26.52 26.52 PFT Pulmona Function Test $33.66 $33.66 Audiometr $14.28 $14.28 EKG W/ Inter $20.40 20.40 Urinal sis Di stick 3.06 3.06 Tonomet Glaucoma Test 36.72 36.72 12/13/11 Heavner Joel S. Chart Review /Com letion 82.60 82.60 INVOICE I o Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 Carmel Fire Department CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 12/22/2011 m Invoice 00 -16783 Date Employee Description Amount Balance Due Indiana PERF Exam $185.64 $185.64 A licant Blood Panel PERF $117.10 $117.1 0 Druct Screen 7 GC /MS W /MRO $40.80 $40.80 Veniouncture $3.06 $3 Tb Skin Test $7.14 $7.14 Vital Si ns HT WT BP P R $0.00 $0.00 Vision Acuity E$26.52 $26.52 Vision Color Ishihara $26.52 PFT Pulmonar Function Test 33.66 Audiomet 14.28 EKG W/ Inter $20.40 Urinalysis Dipstick $3.06 $3.06 Tonometr Glaucoma Test 36.72 $36.72 Heinlein Robert A. Chart Review/Completion $82.60 $82.60 Indiana PERF Exam $185.64 $185.64 ADDlicant Blood Panel PERF $117.10 $117.1 Drug Screen (7 GUMS W /MRO $40.80 $40.80 Veni uncture $3.06 $3.06 Chest X -Ray PA /LAT (Digital) $61.20 $61.20 Tb Skin Test $7.14 $7.14 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity $26.52 $26.52 Vision Color Ishihara $26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Tonomet ry (Glaucoma Testl $36.72 $36.72 Thomas. Nathan C. Chart Review/Completion $82.60 $82.60 Indiana PERF Exam $185.64 $185.64 Applicant Blood Panel PERF $117.10 $117.10 Drug Screen 7 GC /MS W /MRO $40.80 $40.80 Veniouncture $3.06 $3.06 Chest X -Ray PA/LAT (Digital) $61.20 $61.20 Tb Skin Test $7.14 $7.14 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 Vision Color Ishihara 26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiometry $14.2 14.2 EKG W/ Interp $20.40 $20.40 Unnalvsis Dipstick $3.06 $3.06 Tonometr Glaucoma Test $36.72 $36.72 Thompson, James L. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Com rehensive Ph sical Exam $99.96 $99.96 INVOICE t o Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Fire Department CARMEFD H Terms 2 Civic Square Carmel, IN 46032 Invoice Date 12/22/2011 m Invoice 00 -16783 Date Employee Description Amount Balance Due Treadmill Submax $156.00 $156.00 Muscular Strength Endurance Test $26.52 $26.52 Flexibility Test $10.20 $10.20 Bodv Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Chest X -Ray PA /LAT (Digital) $61.20 $61.20 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity $26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiometry 14.28 $14.28 G W Intero 20.40 20.40 Urinal sis Dipstick $3.06 $3.06 12/14/11 Cox. Jordan R. Tb Read $0.00 $0.00 Laraway, Justin M. Tb Read $0.00 $0.00 12/22/11 Patient Payment $82.60 cr 12/22/11 Patient Payment $185.64 cr 12/22/11 Patient Payment $7.14 cr 12/22/11 Patient Payment $117.10 cr 12/22/11 Patient Payment $40.80crl 12/22/11 Patient Payment $3.06 cr 12122/11 Patient Payment $61.20cr 12/22/11 Patient Payment $2.46 cr Total Charges $4,376.46 Total Payments Balance Due $500.00 $3,876.46 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 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)) 16844 $75.00 16783 $3,876.46 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 N ALLOWED 20 Public Safety Medical Services IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $3,951.46 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. I ACCT #!TITLE I AMOUNT Board Members 1120 16844 43- 407.01 j $75.00 1 hereby certify that the attached invoice(s), or 1120 16783 43 407.01 $3,876.46 bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except JAN 1 2012 0 I-J 4 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund