206401 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
CHECK AMOUNT: $3,558.51
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204
CHECK NUMBER: 206401
CHECK DATE: 2/1412012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 17080 431.20 MEDICAL EXAM FEES
1110 4340701 17139 3,127.31 MEDICAL EXAM FEES
INVOICE
Public Safety Medical Services
324 E. New York Street
E' Suite 300
W Indianapolis, IN 4$204
C Carmel Police Department CARMEPD
't 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 0210812012
C0 Invoice 00 -17139
Date Employee Description Amount Balance Due
01/30!12 Dawson Gregory F. OnMed Program $0.00 0.00
Health Risk Appraisal Motivation $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 159.90 159.90
Tonomet Glaucoma Test 37.64 $37.64
Vital Signs HT WT BP P R $0.00 so.001
V' uity $27.18 7
Audiometry $14.64 $14.64
EKG WI Inter $20.91 20.91
Urinai sis Dipstick $3.14 $3.14
Driver Charles E. OnMed Program $0.00 $0.00
Health Risk A raisa) Motivation 0.00 $0.00
Respirator/Medical Review $16.73 $16.73
Comprehensive Physical Exam $102.46 102.46
Flexibilitv Test $10,46 $10.4 6
Body Fat Test BIA Bio -Elec Imp Ana! 14.64 $14.64
Waist/Hi Ratio $3.14 $3.14
Treadmill Submax E$27.1 159.90
n me (Glaucoma T $37.64
Vital Signs HT WT BP P R $0.00
Vision Acuity $27.18
Audiometr 14.64
EKG WI Inter 20.91
Urinal sis Di stick $3.14
Fisher Charles B. Flexibilit Test 10 -46 $10.46
Body Fat Test BIA Bio -Elec Imp Anal 14.64 $14.64
Waist /Hi Ratio $3.14 $3.14
OnMed Pro ram $0.00 $0.00
Health Risk A raisa! Motivation 0.00 0.00
Res irator /Medical Review 16.73 $16.73
QomDreh!2nsiv hysical Exam $10246 1 2.46
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
Vision Acuity 27.18 27.18
Audiometry 14.64 $14.64
EKG W/ Interr 20.91 $20.91
Urinalysis Di stick $3.14 $3,14
Goodman Leland C. WaisUHip Ratio 3.14 $3,14
uantiferon Tb Blood 52.28 $52.28
CMP Com Metabolic Panel 20.01 $20.01
CBC (Comn Blood Count 18.12 18.12
INVOICE
6 Public Safety Medical Services
324 E. New York Street
F Suite 300
w Indianapolis, IN 46204
o Carmel Police Department/ CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 02!0812012
m Invoice 00 -17139
Date Employee Description Amount Balance Due
Lipid Panel Blood 21.26 $21.26
Veni uncture $3.14 $3,14
HIV 1 2 (Blood) 13.59 $13.59
Prostat2 Specific A Blood
Tonomet Glaucoma Test $37.64 $37.64
Vital Signs HT WT BP P R $0.00 $0.00
Vision Acuity 27.18 $27.18
AudjornetrV $14,64 $14.64
EKG W/ Interp $20.91 $20.91
Urinalysis Dipstick $3,14 $3.1 4
OnMed Program $0.00 $0.0 0
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 Im o Anal 14.64 $14.64
David R. Comprehensive Physical Exam $102.46 $102-4
Flexibilitv 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 $159.90
Tonometr Glaucoma Test 37.64 $37.64
Vital Signs HT WT BP P R $0.00 $0.00
Vision Acuity $27.18 $27.18
AudiornetEy $14.64 14.64
EKG W/ Inter 20:91 $2Q.91
Urinalysis Dipstick $3.14 $3.14
OnMed Program $0.00 $0.00
Health r M fv 0
Res irator /Medical Review $16.73 $16.73
Hughes, Crystal K. OnMed Program $0.0D $0.00
Health Risk Appraisal Motivation 0.00 $0.00
Respirator/Medical Review $16.73 $16.73
Comprehensive Physical Exam $102.46 $102,46
FlexibilitV Test $10.46 10.46
Body Fat Test BIA Bio -Elec ImR Anal 14.64 $14.64
Waist/Hi Ratio $3.14 $3.14
Treadmill Submax M$21.26 159.90
uantiferon Tb Blood 52.28
CMP (Como Metabolic Panel 20.01
B lood t $18-1
Lipid Panel (Blood) $21.26
Veni uncture $3.14 $3.14
HIV 1 2 Blood 1159 $13.59
Tonometr Glaucoma Test $37.64 $37.64
Vital Si ns HT WT BP P R 0.00 $0.00
Vision Acuity 27.18 27.18
Audiometr 14.64 14.64
INVOICE
H Public Safety Medical Services
324 E. New York Street
.E Suite 300
tr Indianapolis, IN 46204
C Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 02/08/2012
m Invoice 00 -17139
Date Employee Description Amount Balance Due
EKG W1 Interp $20.91 $20.91
Urinalysis Dipstick $3.14 3.14
Theis Adam G. 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
Veni uncture $3.14 $3.14
HIV 1 2 Blood 13.59 $13.59
OnMed Program $0.00 $0.00
Health Risk Anoraisal Motivation 0.00 $0.001
Resp irator Medical Review $16.73 $16.73
Comprehensive Physical Exam $102.46 $102.46
Flexibility Test $10.46 $10.4 6
Bodv Fat Test BIA Bio -Elec Imp Anal 14.64 $14.64
Waist/Hi Ratio $3.14 $3.14
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 Acuit 27.18 $27.18
Audiometry $14.64 $14.64
EKG W1 Inter 20.91 20.91
Urinal sis Dipstick $3.14 $3.14
Total Charges $3,127.31
Total Payments Balance Due $0.00 $3.127.31
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
INVOICE
0 Public Safety Medical Services
:t 324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
o Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 0210112012
m Invoice 00 -17080
Date Employee Description Amount Balance Due
01124/12 Driver Charles E. Quantiferon Tb Blood $52.28 $52.28
CMP (Comp Metabolic Panel 20.01 $20.01
CBC (Comp Blood Count 18.12 18.12
Li id Panel Blood 21.26 $21.26
Veni uncture t 3.14
PSA Prostate Specific A Blood 36.59
Henry. David R. Quantiferon Tb Blood 52.28
CMP Com Metabolic Panel 20.01
CBC Com Blood Count $18.1 2
Lipid Panel Blood 21.26 $21.26
V e n iouncture $3.14 $3.14
HIV 1 2 Blood $13.59 $13.59
01126/12 Dawson. Gregory F. CBC (Comp Blood Count $18.12 $18.1 2
Lipid Pane] Blood 21.26 $21.26
Veni uncture $3.14 3.14
PSA Prostate Specific A Blood 36.59 $36.59
Quantiferon Tb Blood 52.28 52.28
CMP Corn Metabolic Panel 20.01 $20.01
Total Charges 1 $431.20
Total Payments Balance Due $0.00 1 $431.20
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance Clue 15 days from invoice
date
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
$3,5 58.51
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO, ACCTPTITLE AMOUNT Board Members
1110 17080 43- 407.01 $431.20 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1110 17139 43- 407.01 $3,127.31
materials or services itemized thereon for
which charge is made were ordered and
received except
Friday, February 10, 2012
Chief of Police
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))
02/01/12 17080 officer physicals $431.20
02/08/12 17139 officer physicals $3,127.31
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