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Home My WebLink About208012 04/10/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $3,856.10 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 208012 CHECK DATE: 4/1012012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 17499 3,727.70 MEDICAL EXAM FEES 1110 4340701 17548 128.40 MEDICAL EXAM FEES INVOICE H Public Safety Medical Services w 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department/ CARMEPD F 3 Civic Square Terms Carmel, IN 46032 Invoice Date 03/22/2012 m Invoice 00 -17499 Date Employee Description Amount Balance Due 03/14/12 Tilson. Travis C. 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 $3.1 4 HIV 1 2 Blood 13.59 $13.59 03/16112 Collins Willie H. OnMed Program $0.00 $0.0 0 Health Risk Appraisal Motivation 0.00 $0.00 Res irator /Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.4 Muscula Strenat 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 $0.00 Vision Acuity 27.18 $27.18 PFT Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/ Inte 20.91 $20.91 Urinalysis Di sti k 3.14 $3.14 M iller. I I G. OnMed Proaram $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 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 27.1 27.1 PFT Pulmonary Function Test $34.50 $34.50 Audiometry 14 14 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 Moore Scott L. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Res irator /Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test BIA Bio -Elec Imp Anal 14.64 $14.64 WaisUHi do $3.14 $3.14 Treadmill Submax $159.90 $159.90 INVOICE H 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 03/22/2012 m Invoice 00 -17499 Date Employee Description Amount Balance Due Tonomet Glaucoma Test 37.64 $37.64 Vital Si ns HT WT BP P R $0.00 Vision Ac uit 27.18 $27.1 PFT P I Test Audiometry $14.64 $14.64 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 Robbins' Todd OnMed Pro ra $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator /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 Imp Anal 14.64 $14.64 Waist/Hi Ratio 3.14 $3.14 Treadmill Submax $159. $159.90 T (Glaucoma 4 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 Audiomet $14.64 $14.64 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 Sedberry. Jeffrey T. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator /Medical Review $16.73 $16.73 C omxehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibi5tv Test $10.46 $10 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 1 $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/ Interp $20.91 $20.91 Urinalysis Di stick $3.14 $3.14 S trona, David C. OnMed Pro ram $0.00 $0.00 Health Risk Armraisal iv Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 10.46 Bod Fat Test BIA Bio -Elec Imp Anal 14.64 14.64 Waist/Hi Ratio 3.14 3.14 Treadmill Submax 159.90 159.90 INVOICE F 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 03/22/2012 m Invoice 00 -17499 Date Employee Description Amount Balance Due 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 $14.641 EKG W/ Intero $20.91 $20.91 Urinalysis Di stick $3.14 $3.14 Tilson Travis C. onmed Pro`ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator Medic I Review $16.73 $16.73 Comi)rehens Physical 1 02.46 $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 Tonomet Glaucoma Test 37.64 $37.64 Vital Si ns HT WT BP P R $0.00 $0.0 0 Vision Acuity 27.18 $27.18 PFT Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/ Intern $20.91 $20.911 Urin I is Dipstick $3.14 $3.14 W ieaman. Chad R. OnMed P 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 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 Acuity 27.18 $27.18 Audiometry 14.64 $14.64 EKG W/ Inter 20.91 $20.91 U rinalysis $3.14 $3 Total Charges $3;727.70 Total Payments Balance Due $0.00 $3,727.70 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)) 03/22/12 17499 officer physicals $3,727.70 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 $3,727.70 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 I 17499 I 43- 407.01 I $3,727.70 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 Wednesday, March 28, 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 X Indianapolis, IN 46204 o Carmel Police Department CARMEPD H 3 Civic Square Terms Carmel, IN 46032 Invoice Date 03/28/2012 m Invoice 00 -17548 Date Employee Description Amount Balance Due 03/19/12 Stein Amy J. Quantiferon Tb Blood 52.28 $52.28 CMP (Comp Metabolic Panel 20.01 $20.01 CBC Com p 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 $128.40 Total Payments Balance Due $0.00 $128.40 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 ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 7995) 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 Indpls, IN 46204 Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 3/28/12 17548 officer physical 128.40 Total 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 St Suite 300 Indianapolis, IN 46204 128.40 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 17548 407 -01 128.40 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 april 2, 2012 Signature Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund