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Home My WebLink About205972 01/31/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $4,588.77 INDIANAPOLIS IN 46204 CHECK NUMBER: 205972 CHECK DATE: 1/31/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NU AMOUNT DESCRIPTION 1110 4340701 16903 751.77 MEDICAL EXAM FEES 1120 4340701 16953 1,350.38 MEDICAL EXAM FEES 1110 4340701 16954 164.99 MEDICAL EXAM FEES 1120 4340701 170019 46.13 MEDICAL EXAM FEES 1110 4340701 17020 2,275.50 MEDICAL EXAM FEES INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 d Indianapolis, IN 46204 o Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 01/11/2012 m Invoice 00 -16903 Date Employee Description Amount Balance Due 01/03/12 Collins. Shane P. Quantiferon Tb Blood 52.28 $52.28 CMP (Comp Metabolic Panel 20.01 $20.01 CBC (Comp Blood Count 18.12 $18.1 2 Lipid Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.1 4 HIV 1 2 Blood 13.59 $13.59 Hill Nathaniel W. Quantiferon Tb Blood 52.28 $52.28 CMP (Comp Metabolic Panel 20.01 $20.01 CBC (Comp Blood Count 18.12 $18.12 Lipid Panel Blood 21.26 $21.26 Venipuncture $3.14 $3.14 HIV 1 2 Blood $13.59 $13.59 Laker. Jeffrey W. Quantiferon Tb Blood $52.28 $52.28 CMP (Comp Metabolic Panel $20.01 1 $20.01 CBC (Comp Blood Count 18.12 $18.12 Lipid Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 2 Blood 13.59 $13.59 PSA Prostate Specific A Blood 36.59 $36.59 White II Robert E. Quantiferon Tb Blood 52.28 $52.28 CMP Com Metabolic Panel 20.01 $20.01 CBC (Comp Blood Count 18.12 $18.1 2 i id Panel 1 21 21.2 Veni uncture $3.14 $3.14 HIV 1 2 Blood $13.59 $13.59 PSA Prostate Specific A Blood $36.59 $36.59 01/05/12 Stites William R. Veni uncture $3.14 $3.14 HIV 1 2 Blood 13.59 $13.59 PSA Prostate Specific A Blood 36.59 $36.59 Quantiferon Tb Blood 52.28 $52.28 CMP (Comp Metabolic Panel 20.01 $20.01 CBC (Como Blood Count 18.12 $18.1 2 Li id Panel Blood 21.26 $21.26 Total Charges $751.77 Total Payments Balance Due $0.00 $751.77 Please write invoice number on payment check. Balance due 15 days from Our Federal Employer Identification Number is 35- 2079797 Invoice date INVOICE 4 o Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Police Department CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 01/18/2012 m Invoice 00 -16954 Date Employee Description Amount Balance Due 01/11/12 Snow. Donald C. Quantiferon Tb Blood $52.28 $52.28 CMP (Comp Metabolic Panel $20.01 $20.01 CBC (Comp Blood Count 18.12 $18.12 Lind Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 2 Blood 13.59 $13.59 PSA Prostate Specific A Blood $36.59 36.59 Total Charges $164.99 Total Payments Balance Due $0.00 $164.99 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from Invoice 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)) 01/11/12 16903 officer physicals $751.77 01/18/12 16954 officer physicals $164.99 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $916.76 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 1110 16903 43- 407.01 $751.77 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 16954 43- 407.01 $164.99 materials or services itemized thereon for which charge is made were ordered and received except Thursday, January 26, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 01/25/2012 m Invoice 00 -17020 Date Employee Description Amount Balance Due 01/16/12 Troyer. Darin M. Quantiferon Tb Blood $52.28 $52.28 CMP (Comp Metabolic Panel $20.01 $20.01 CBC (Comp Blood Count 18.12 $18.1 2 Lipid Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.1 4 HIV 1 2 Blood 13.59 $13.59 01/17/12 Hill Nathaniel W. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.4 6 FlexibiliLy T $10.46 0.4 Bodv Fat Test BIA Bio -Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.1 4 Treadmill Submax $159.90 $159.90 Tonomet Glaucoma Test 37.64 $37.64 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 27.18 $27.18 PFT Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/ Intem $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 Laker Jeffrey W. Urinalysis Di stick $3.14 $3.14 O nMed Pr m Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Body Fat Test BIA Bio -Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Tonomet Glaucoma Test 37.64 $37.64 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 27.18 $27.18 PFT Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/ Intern $20.91 $20.91 Sno w, Donald C. Viso Acuity $27.18 7.1 PFT Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.141 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Flexibility Test $10.46 $10.4 6 Body Fat Test BIA Bio -Elec Imo Anal 14.64 $14.641 Waist/Hi Ratio $3.14 $3.14 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 C Carmel Police Department CARMEPD H 3 Civic Square Terms Carmel, IN 46032 Invoice Date 01/25/2012 m Invoice 00 -17020 Date Employee Description Amount Balance Due Treadmill Submax $159.90 $159.90 Tonomet (Glaucoma Test 37.64 $37.64 Vital Si ns HT WT BP P R $0.00 $0.00 S tites, William R. OnMed Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Flexibility Test $10.46 $10.46 Body Fat Test BIA Bio -Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill Submax $159.90 $159.9 0 Tonomet Glaucoma Test 37.64 $37.64 Vital Si ns HT WT BP P R $0.00 $0.00 Vision Acuity 27.18 $27.18 PFT Pulmonary Function Test $34.50 $34.50 Aud iornet[y $14.64 $14.64 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 White II Robert E. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review 16.73 16.73 Comprehensive Ph sical Exam 102.46 $102.46 Flexibility Test $10.46 $10.4 6 Body Fat Test BIA Bio -Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill Submax $159.90 $159.90 Vital Signs HT WT BP P R $0.00 $0.00 Vision iU $27.18 $27.1 PFT Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 01/20/12 Fisher, Charles B. Quantiferon Tb Blood 52.28 $52.28 CMP Com P Metabolic Panel 20.01 $20.01 CBC (Comp Blood Count $18.12 $18.1 2 Lipid Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 2 Blood 13.59 $13.59 Total Charges j $2,275.50 Total Payments Balance Due $0.00 $2,275.50 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance Due 15 days from invoice 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)) 01/25/12 17020 officer physicals $2,275.50 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $2,275.50 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 I 17020 I 43- 407.01 I $2,275.50 1 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 Monday, January 30, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 Ir Indianapolis, IN 46204 G Carmel Fire Department CARMEFD Attn: Accounts Payable Terms 2 Civic Square Invoice Date 01/18/2012 m Carmel, IN 46032 Invoice 00 -16953 Date Employee Description Amount Balance Due 01/09/12 Malicoat Justin R. Chart Review/Completion $84.67 $84.67 Indiana PERF Exam $190.28 $190.28 Tb Skin Test $7.32 $7.32 Applicant Blood Panel PERF $120.04 $120.04 Drug Screen 7 GC /MS W /MRO $41.82 $41.82 Veni uncture 3.14 $3.14 Chest X -Ray PA/LAT (Digital) 62.73 Vital Si ns HT WT BP P R $0.00 $0.0 0 Vision Acuity 27.18 27.18 Vision Color Ishihara 27.18 $27.18 PFT Pulmonary Function est $34.50 $34. Audiometry $14.64 $14.64 EKG W/ Interp $20.91 $20.91 Urinal sis Dipstick $3.14 $3.14 Tonomet Glaucoma Test 37.64 $37.64 01/13/12 Greiner. Brandon J. Chart Review/Completion $84.67 $84.67 Indiana PERF Exam $190.28 $190.28 Tb Skin Test $7.32 $7.32 ADDlicant Blood Panel PERF $120.04 $120.04 Druo Screen 7 GC /MS W /MRO $41.82 $41.82 Veni uncture $3.14 $3.14 Chest X -Ray PA /LAT Di ital 62.73 $62.73 Vital SiQns HT WT BP P $0.00 $0.0 Vision Acuity $27.18 $27.18 Vision Color Ishihara) $27.18 $27.18 PFT Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 14.64 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 Tonometr Glaucoma Test 37.64 $37.64 Total Charges $1,350.38 Total Payments Balance Due $0.00 $1,350.38 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from 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)) 16953 $1,350.38 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $1,350.38 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. I ACCT #/TITLE I AMOUNT Board Members 1120 I 16953 I 43- 407.01 I $1,350.38 1 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 s Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 c Carmel Fire Department CARMEFD Attn: Accounts Payable Terms 2 Civic Square Invoice Date 01/25/2012 m Invoice 00 -17019 Carmel, IN 46032 Date Employee Description Amount Balance Due 01/16/12 Malicoat Justin R. Repeat GGT Blood $12.24 $12.24 Repeat Hepatic LFT's Blood $30.75 $30.75 Veni uncture $3.14 $3.14 Total Charges $46.13 Total Payments Balance Due $0.00 $46.13 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice 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)) 17019 $46.13 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. Public Safety Medical Services ALLOWED 20 IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $46.13 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 I 17019 I 43- 407.01 I $46.13 1 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 JAN 3 0 2012 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund