211013 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
y` 0 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $20,013.46
�,•2o CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
ToM`o INDIANAPOLIS IN 46204 CHECK NUMBER: 211013
CHECK DATE: 7/1712012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 18381 16, 638 . 59 MEDICAL EXAM FEES
1110 4340701 18382 2, 826 . 57 MEDICAL EXAM FEES
1120 4340701 18439 140 . 10 MEDICAL EXAM FEES
1110 4340701 18440 408 . 20 MEDICAL EXAM FEES
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
C Carmel Police Department/CARMEPD
Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 07/03/2012
m Invoice# 00-18382
Date Employee Description Amount Balance Due
06/25/12 Dietz Aaron K. OnMed Program $0.00 $0.00
Health Risk Appraisal Motivation 0.00 $0.00
Respirator/Medical Review $16.73 $16.73
Com rehensive Ph sical Exam $102.46 $102.46
Flexibility Test $10.46 $10.46
Body Fat T6st-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 7.1
PFT-Pulmonary Function Test $34.50 $34.50
Audiometry $14.64 $14.64
EKG W/Interp $20.91 $20.911
Urinalysis-Dipstick $3.14 $3.14
Flaming,Anna G. OnMed Program $0.00 $0.00
Health Risk Appraisal Motivation 0.00 $0.00
Respirator/Medical Review $16.73 $16.73
Com rehensive Physical Exam $102.46 $102.46
Muscular Strencith Endurance Test $27.18 $27.18
Flexibility Test $10.46 $10.46
Body Fat Test-BIA Bio-Elec Im 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-AcuitV $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
Frost Dwight D. Flexibility Test $10.46 $10.46
Body Fat Test-BIA Bio-Elec Imo Anal 14.64 $14.64
Waist/Hi Ratio $3.14 $3.14
antiferon-T Blood $52.28 2.2
CMP(Comp Metabolic Panel $20.01 $20.01
CBC Com p Blood Count $18.12 $18.12
Li id Panel Blood $21.26 $21.26
Veni uncture N$36.59 3.14
HIV 1 &2 Blood 13.59
PSA-Prostate Specific A Blood 36.59
OnMed Pro ram 0.00
Health Risk A raisal Motivation 0.00
Res irator/Medical Review 16.73
Com rehensive Ph sical Exam 102.46
Treadmill-Submax $159.90
INVOICE
H Public Safety Medical Services
w 324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
G Carmel Police Department/CARMEPD
H 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/03/2012
m Invoice# 00-18382
Date Employee Description Amount Balance Due
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
Audionjet 4.64 $14.64
EKG W/Interp $20.91 $20.91
Urinalysis-Dipstick $3.14 $3.14
Lon ,Scott D. 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 $10.46
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 Sians-HT WT BP P R $0.00 $0.00
Vision-Acuity $27.18 $27.18
PFT-Pulmonary Function Test $34.50 $34.50
Audiornetry $14.64 $14.64
EKG W/Interp $20.91 $20.91
Urinalysis-Dipstick 116.73.14 3.14
Martin, Brian A. OnMed Program .00 $0.00
Health Risk Appraisal Motivation .00 0.00
Respirator/Medical Review 16.73
Com rehensive Ph sical Exam .46 102.46
Flexibility Test $10.46 10.46
Body Fat Test-BIA Bio-Elec irnip Anal 14.64 $14.64
Waist/Hip Ratio $3.14 $3.141
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
PFT-Pulmonary Function Test $34.50 $34.50
Audiornetry E$20. 14.64
EKG W/Inter 20.91
Urinalysis-Di stick $3.14
Thomas Richard E. OnMed Program 0.00
Health Risk A raisal Motivation $0.00
Respirator/Medical Review $16.73 $16.73
Com rehen ive 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 $0.00
Vision-Acuity 27.18 $27.18
INVOICE
►o— 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 07103/2012
m Invoice# 00-18382
Date Employee Description Amount Balance Due
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
Total Charges-> $2,826.57
Total Payments&Balance Due-> $0.00 $2,826.57
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35-2079797 Balance due 15 days from invoice
date
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
4)
of Indianapolis, IN 46204
o Carmel Police Department/CARMEPD
E- 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/11/2012
Invoice# 00-18440
Date Employee Description Amount Balance Due
07/02/12 Gauthier Edward B. Quantiferon-Tb Blood $52.28 $52.28
CMP(Como 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
Lovitt. Richard A. Quantiferon-Tb Blood $52.28 $52.28
CMP(Como Metabolic Panel 20.01 $20.01
CBC Com Blood Count 18.12 18.12
Li id Panel Blood 21.26 $21.26
VenipuncturQ $3.14 $3.14
PSA-Prostate Specific A Blood $36.59 $36.59
07/03/12 Morrow Scott A. 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
Quantiferon-Tb Blood 52.28 52.28
CMP(Comp Metabolic Panel 20.01 32 0.01
Total Charges > $408.20
Total Payments&Balance Due-> $0.00 $408.20
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35-2079797 date
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF $
324 E. New York Street, Suite 300
Indianapolis, IN 46204
$3,234.77
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 18382 43-407.01 $2,826.57 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1110 18440 43-407.01 $408.20
materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday, July 12, 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))
07/03/12 18382 officer physicals $2,826.57
07/11/12 18440 officer physicals $408.20
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
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
a)
a� Indianapolis,-IN 46204
G Carmel Fire Department/CARMEFD
Attn: Accounts Payable Terms
2 Civic Square Invoice Date 07/03/2012
m
Carmel, IN 46032 Invoice# 00-18381
Date Employee Description Amount Balance Due
06/25/12 Ca shaw.Jeffrey A. 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 $3.14
PSA-Prostate Specific A Blood 36.59 $36.591
Collins Tony A. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.1 2
Li id Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2(Blood) $13.59 $13.591
PSA-Prostate Specific A Blood $36.59 $36.59
Condra Kyle E. 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' $3.141
HIV 1 &2 Blood 13.59 $13.59
Cholinesterase-RBC&Plasma Blood 47.05 $47.05
DeCrastos.Richard A. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC Com Blood Count 18.12 $18.12
-Lipid Panel(Blood) $21,26 21.2
Veni uncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
PSA-Prostate Specific A Blood q$21.26.59 $36.59
Drake.Carl D. Quantiferon-Tb Blood .28 52.28
CMP(Comp Metabolic Panel 0.01 $20.01
CBC(Comp Blood Count 8.12 18.12
Lipid Panel Blood $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
Edwards'Steven L. Quantiferon-Tb Blood 52.28 $52.28
MP m Metabolic Panel 20.01 $20.01
CBC Com 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 $13.591
PSA-Prostate Specific A Blood 36.59 $36.59
Fuchs Jeffery W. 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 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate S ecific A Blood 36.59 $36.59
INVOICE
o Public Safety Medical Services
= 324 E. New York Street
E Suite 300
w Indianapolis, IN 46204
G Carmel Fire Department/CARMEFD
Terms
Attn: Accounts Payable
2 Civic Square Invoice Date 07103/2012
m
Carmel, IN 46032 Invoice# 00-18381
Date Employee Description Amount Balance Due
Cholinesterase-RBC&Plasma Blood 47.05 $47.05
Quantiferon-Tb Blood 52.28 $52.28
Gehlbach Marc A. Quantiferon-Tb Blood 52.28 $52.28
MP(Como Metabolic Panel) 20. 1 $20.01
CBC(Como 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
Giles,William G. Quantiferon-Tb Blood) $52.28
CMP(Comp Metabolic Panel 20.01 $20.011
CBC(Como Blood Count 18.12 $18.12
Lipid Panel Blood $21.26 $21.26
Veni uncture $3.14 $3.1 4
Cholinesterase-RBC&Plasma Blood 47.05 $47.05
PSA-Pro t to Specific A (Blood) 6.5
Gipson,Bruce E. 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 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate Specific A Blood 36.59 $36.59
Gu el Mark E. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Como Blood Count 18.12 $18.12
Lipid Panel Blood 21.26 $21.26
Veniouncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
PSA-Prostate Specific A Blood $36.59 $36.59
Cholinesterase-RBC&Plasma Blood 47.05 $47.05
Hensley, Robert P. Quantiferon-Tb Blood 52.28 $52.28
CMP Com p 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
PSA-Prostate S ecific A Blood 36.59 $36.59
Holden Adam D. Quantiferon-Tb Blood 52.28 $52.28
CMP Com o Metabolic Panel) $2 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
Hoover Anthony B. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
INVOICE
H Public Safety Medical Services
= 324 E. New York Street
E Suite 300
CD
W Indianapolis, IN 46204
C Carmel Fire Department/CARMEFD
f- Attn: Accounts Payable Terms
2 Civic Square Invoice Date 07/03/2012
m Invoice# 00-18381
Carmel, IN 46032
Date Employee Description Amount Balance Due
CBC(Comp Blood Count 18.12 $18.1 2
Lipid Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.14
PSA-Prostate Specific A Blood 36.59 $36.59
Horner David W. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.1 2
Lind Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Pr st t ific A Q(Bloo
Hulett, Mark A. 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
PSA-Prostate Specific A Blood 36.59 $36.59
Kinney,Jared N. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.1 2
Li id Pane{ Blood 21.26 $21.26
Veni un ture $3.14 $3.1 4
HIV 1 &2 Blood $13.59 $13.59
Maners Jeremy B. 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 $3.14
HIV 1 &2 Blood M21.26 13.59
Marsh Michael A. Quantiferon-Tb Blood 52.28
CMP(Comp Metabolic Panel 20.01
CBC(Como Blood Count 18.12
Li id Panel Blood $21.26
V n' unct re $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
PSA-Prostate Specific A Blood $36.59 $36.59
McNab.John D. 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
PSA-Prostate Specific A Blood 36.59 36.59
McNair Travis L. Quantiferon-Tb Blood 52.28 52.28
CMP(Comp Metabolic Panel 20.01 20.01
INVOICE
�o 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 07/03/2012
m
Carmel, IN 46032 Invoice# 00-18381
Date Employee Description Amount Balance Due
CBC(Corn Blood Count $18.12 $18.12
Li id Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 2(Blood) 13.5 1 .
Cholinesterase-RBC&Plasma Blood $47.05 $47.05
Mitchell James 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
Mowery,Anthony W. Quantiferon-Tb Blood 52.28 $52.28
CMP Corn Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.1 2
Lind Panel Blood 21.26 $21.26
Veniouncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
Paddock, Ronald D. 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
PSA-Prostate Specific A Blood 36.59 $36.59
Price Joseph P. Lipid Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate S fi A (Blood) 0$36.59 3 .Quantiferon-Tb Blood 2.28 $52.28
CMP Com Metabolic Panel 0.01 $20.01
CBC Com Blood Count 8.12 18.12 Reeves Neil P. Quantiferon-Tb Blood 2.28 $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 $3.14
HIV 1 &2 Blood 13.59 $13.59
Cholinesterase-RBC&Plasma Blood) $47.05
Reeves Ste hen J. Quantiferon-Tb Blood 52.28 $52.28
MP(Comp Metabolic P nel $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
PSA-Prostate Specific A Blood 36.59 $36.59
Administrative Fee Your Site) $151.001
Starr.Gregory A. Quantiferon-Tb Blood 52.28 $52.281
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
of Indianapolis, IN 46204
G Carmel Fire Department/CARMEFD
E- Attn: Accounts Payable Terms
2 Civic Square Invoice Date 07/03/2012
m Invoice# 00-18381
Carmel, IN 46032
Date Employee Description Amount Balance Due
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 3.14
HIV 1 &2 Blood 13.59 13.59
PSA-Prostate S ecific A Blood 36.59 36.59
Steu . Kent C. Quantiferon-Tb Blood 52.28 52.28
CMP Com Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.12
Li id Panel Blood 21.26 $21.26
Venipuncture $3.14 $3,14
HIV 1 &2 Blood $13.59 $13.59
PSA-Prostate Specific A Blood $36.59 $36.59
Stindle Kevin 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 $3.14
HIV 1 &2 Blood 13.59 13.59
Utzi .Chad M. Quantiferon-Tb Blood H$52.28 52.28
CMP(Comp Metabolic Panel 20. 1 $20.01
CBC Com Blood Count 18.12 $18.1 2
LiDid Pan BI ood) $21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
Utzi .Todd T. 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 $3.14
HIV 1 &2 Blood H 3.59 13.59
PSA-Prostate S ecific A Blood 6.59 36.59
Voskuhl Mark J. Quantiferon-Tb Blood 52.28 52.28
CMP Com Metabolic Panel 20.01 $20.011
CB C(Co m Blood Count) 18.12 g$221.26
Lipid Panel Blood $21.26 Veni uncture $3.14 HIV 1 &2 Blood $13.59
Watts Trent E. Quantiferon-Tb Blood 52.28 52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.1 2
Li id Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate S ecific A Blood 36.59 $36.59
Cholinesterase-RBC&Plasma Blood 47.05 $47.05
INVOICE
0 Public Safety Medical Services
._ 324 E. New York Street
E Suite 300
= Indianapolis, IN 46204
C Carmel Fire Department/CARMEFD
Attn: Accounts Payable Terms
2 Civic Square Invoice Date 07/03/2012
m Invoice# 00-18381
Carmel, IN 46032
Date Employee Description Amount Balance Due
Weddinciton, Kurt L. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.1 2
Lb id Panel(Blood) 1.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
PSA-Prostate Specific A Blood q$36.59 $36.59
Cholinesterase-RBC&Plasma Blood .05 47.05
Witsken Steven J. Quantiferon-Tb Blood .28 52.28
CMP Com Metabolic Panel .01 20.01
CBC Com Blood Count .12 $18.1 2
Li id Panel Blood 21.26 $21.261
Veni uncture $3.14 $3.14
PSA-Prostate Specific A Blood 36.59 $36.59
Wynn, Barbara M. Quantiferon-Tb Blood 52.28 $52.28
CMP Co 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 1 $13.59
Young,Alan R. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.011
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 S ecific A Blood 36.59 36.59
Youna.Kevin M. Quantiferon-Tb(Blood) 2.2 2.2
CMP Com p 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
Zeller Michael J. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.1 2
Li id Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.141
HIV 1 &2 Blood 13.59 $13.59
06/26/12 Baskerville Steven P. Quanfiferon-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
PSA-Prostate Specific A Blood 36.59 $36.59
Benbow.Kip S. Quantiferon-Tb Blood $52.28 $52.28
CMP Com p Metabolic Panel 20.01 $20.01
INVOICE
to .Public Safety Medical Services
= 324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
C Carmel Fire Department!CARMEFD
F- Attn: Accounts Payable Terms
Invoice Date 07/03!2012
2 Civic Square
m
Carmel, IN 46032 Invoice# 00-18381
Date Employee Description Amount Balance Due
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
Bowles Orbie H. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel $20.01 $20.01
CBC(Como Blood Count 18.12 $18.1 2
Lipid Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.141
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate Soecific A (Blood) 3
Conner,Timothy L. 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 $3.14 $3.1 4
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate Specific A Blood 36.59 $36.59
Cholinesterase-RBC&Plasma Blood 47.05 $47.05
Crane Barry L. Quantiferon-Tb Blood $52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 181 2
Li id Panel(Blood) 21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2 Blood q$20.01.59 $13.59
PSA-Prostate Specific A Blood .59 $36.59
Cromlich Mark A. Quantiferon-Tb Blood .28 52.28
CMP(Comp Metabolic Panel 20.01
CBC(Comp Blood Count .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
PSA-Prostate Specific A Blood 36.59 $36.59
Cummins Frank C. Quantiferon-Tb Blood 52.28 $52.28
MP(Como 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
PSA-Prostate Specific A Blood 36.59 $36.59
Cholinesterase-RBC&Plasma Blood 47.05 $47.05
Essex Cory C. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Como Blood Count 18.12 $18.12
Lipid Panel Blood 21.26 $21.26
Veni uncture $3.14 3.14
INVOICE
t° 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 07/03/2012
m
Carmel, IN 46032 Invoice# 00-18381
Date Employee Description Amount Balance Due
HIV 1 &2 Blood 13.59 $13.59
Frost Bruce S. Quantiferon-Tb Blood 52.28 $52.28
CMP Com Metabolic Panel 20.01 $20.01
C m Blood n $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
PSA-Prostate Specific A Blood 36.59 $36.59
Haboush David 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 $21.261
Veni uncture $3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate S ecific A Blood 36.59 $36.59
Cholinesterase-RBC&Plasm (Blood) 47. 47.
Ha maker,Samuel K. Quantiferon-Tb Blood $52.28 $52.28
CMP(Comp Metabolic Panel $20.01 $20.01
CBC Com P 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
Keaton Anthony R. Quantiferon-Tb Blood 52.28 52.28
CMP(Como Metabolic Panel $20.01 20.01
CBC Com Blood Count $18.12 18.12
Li id Panel Blood 21.26 21.26
Vni ntr .14 .14
HIV 1 &2 Blood $13.59 $13.59
Marcum Bradley D. 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
PSA-Prostate Specific A Blood 36.59 M$47.05
Cholinesterase-RBC&Plasma Blood 47.05 Martin David D. Quantiferon-Tb Blood 52.28 CMP Com Metabolic Panel 20.01 C Com Blo ount 18.12 Li id Panel Blood $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
Martin, Richard A. 1 Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 20.01
CBC(Comp Blood Count 18.12 1 $18.12
INVOICE
too Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
O Carmel Fire Department/CARMEFD
F- Attn: Accounts Payable Terms
2 Civic Square Invoice Date 07/03/2012
m Invoice# 00-18381
Carmel, IN 46032
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
PSA-Prostate Specific A Blood 36.59 $36.59
McNeely,Michael W. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.1 2
Li id Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
Mulford David A. Quantiferon-Tb(Blood) 2.2 2.2
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
PSA-Prostate Specific A Blood 36.59 $36.59
Osborne Scott K. 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 BI ood) $13.59 $13.59
PSA-Prostate Specific A Blood $36.59 1 $36.59
Peterson Vernon A. 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
PSA-Prostate Specific A Blood 36.59 $36.59
Plumer, Charles J. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC Corn Blood Count 18.12 $18.12
Li id 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
Cholinesterase-RBC&Plasma Blood $47.05 $47.05
Ray.Lucas M. Quantiferon-Tb Blood $52.28 $52.28
CMP Corn Metabolic Panel $20.01 $20.01
CBC Corn Blood Count 18.12 $18.12
Li id Panel Blood 21.26 $21.26
Veni uncture $3.14 3.14
HIV 1 &2 Blood 13.59 $13.59
Ryan,Christo her D. Quantiferon-Tb Blood 52.28 $52.28
INVOICE
Fo 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 07/03/2012
m #
Carmel, IN 46032 Invoice 00-18381
Date Employee Description Amount Balance Due
CMP Corn Metabolic Pane) $20.01
CBC(Comp Blood Count 18.12 $18.1 2
Li id Panel Blood 21.26 $21.26
Veniouncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
Sombke Brad D. 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 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate Specific A Blood 36.59 $36.59
Stroun, Scott A. Quantiferon-Tb Blood 52.28 52.28
CMP Com Metabolic Panel 20.01 20.01
CBC(Como Blood Count 18.12 18.12
Li i Panel 21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
Sutton Sean B. 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
Thompson.James L. Quantiferon-Tb Blood 52.28 $52.28
CMP Com Metabolic Panel 20.01 $20.01
CBC Com Blood Count 18.12 $18.12
Lipid P n I(Blood) $21.26 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
Fitness For DutV Exam Initial Level 2 $179.38 $179.38
Toney.James D. 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
PSA-Prostate Specific A Blood 36.59 $36.591
Cholinesterase-RBC&Plasma(Blood) 47. 47.0
Vallone Frank 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
Vem uncture $3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate Specific A Blood 36.59 $36.59
INVOICE
F0 Public Safety Medical Services
w 324 E. New York Street
E Suite 300
� Indianapolis, IN 46204
G Carmel Fire Department/CARMEFD
f- Attn: Accounts Payable Terms
2 Civic Square Invoice Date 07/03/2012
m
Carmel, IN 46032 Invoice# 00-18381
Date Employee Description Amount Balance Due
Weaver Virgil L. 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 $3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
06/27/12 Allen.Brad A. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.1 2
Li id Panel Blood 21.26 $21.26
Venipuncture $3.14
HIV 1 &2 Blood $13.59 $13.59
Bondurant Jeff S. 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 $3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate Specific A Blood 36.59 $36.59
Brandt.Gary D. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC Com Blood Count 18.12 $18.1 2
Li id Pan I(Blood) 21.2 1.2
Veni uncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
PSA-Prostate Specific A Blood $36.59 $36.59
Cholinesterase-RBC&Plasma Blood 47.05 $47.05
Butts.Joseph A. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel $20.01 20.01
CBC(Comp Blood Count 18.12 $18.121
Lipid Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate S ecific A Blood 36.59 $36.59
Butts Renee L. Quantiferon-Tb(Blood) 2.2 2.2
CMP Com p 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
Castor Rick S. 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
PSA-Prostate S ecific A Blood 36.59 36.59
INVOICE
H 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 07/03/2012
m Invoice# 00-18381
Carmel, IN 46032
Date Employee Description Amount Balance Due
Cox Justin M. Quantiferon-Tb Blood 52.28 $52.28
CMP Corn Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.1 2
Lir)id Panel(Blood) 21. 6 $21,26
Veni uncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13:59
DeLong,Michael T. 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 $3.14
HIV 1 &2 Blood 13.59 $13.59
Edwards Daniel E. Quantiferon-Tb Blood 52.28 $52.28
CMP(Como Metabolic Panel 20.01 $20.01
CBC Corn Blood Count 18.12 18.12
Li id Panel Blo d $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
Fa in,Timothy D. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Como 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
Fisher Gary L. Quantifer on-Tb Blood 52.28 $52.281
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Corno 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
PSA-Prostate Specific A Blood $36.59 $36.59
Griffin Timoth M. 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 $3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
Grimes.Jeffrey A. Quantiferon-Tb Blood 52.28 $52.28
MP Corn Metabolic Panel) $20. 1 $20.01
CBC(Comp Blood Count $18.12 $18.12
Li id Panel Blood $21.26 $21.26
Veni uncture $3.14 $3.14
PSA-Prostate Specific A Blood $36.59 $36.59
Haus Joshua S. I Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.12
INVOICE
�o Public Safety Medical Services
324 E. New York Street
E Suite 300
Q Indianapolis, IN 46204
C Carmel Fire Department/CARMEFD
f' Attn: Accounts Payable Terms
2 Civic Square Invoice Date 07/03/2012
m
Carmel, IN 46032 Invoice# 00-18381
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
Howard Wendell E. 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 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate S ecific A Blood 36.59 $36.59
Johnson,Jeremy Quantiferon-Tb(Blood) 2.28 $52,28
CMP Com p 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
Kelsheimer,Troy W. 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 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Pro tate S ifi A Blood $36.59
Cholinesterase-RBC&Plasma Blood $47.05 $47.05
Mead Jr. Donald R. 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
PSA-Prostate Specific A Blood 36.59 $36.59
Medlen Michael J. Quantiferon-Tb Blood 52.28 $52.28
CMP(Como Metabolic Panel 20.01 $20.01
CBC Com Blood Count 18.12 $18.12
Li id Panel Blood 21.26 $21.26
Ve!]iouncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
PSA-Prostate Specific A Blood $36.59 $36.59
Nicle ,Wes 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
Veni uncture $3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
Payne,Thomas C. Quantiferon-Tb Blood 52.28 $52.28
CMP Com Metabolic Panel 20.01 20.01
CBC(Como Blood Count 18.12 18.12
INVOICE
� Public Safety Medical Services
324 E. New York Street
E Suite 300
w Indianapolis, IN 46204
G Carmel Fire Department/CARMEFD
F- Attn: Accounts Payable Terms
2 Civic Square Invoice Date 07/03/2012
m Invoice# 00-18381
Carmel, IN 46032
Date Employee Description Amount Balance Due
Lipid Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.141
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate Specific A BI .5
Phillips,Craig M. Quantiferon-Tb Blood $52.28 $52.28
CMP(Comp Metabolic Panel $20.01 $20.01
CBC Com p 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 Aq Blood 36.59 $36.59
Platt Jace P. Quantiferon-Tb Blood $52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC Corn Blood Count 18.12 $18.1 2
Li id Panel Blood 21.26 $21.26
Venipuncture $3.14 $3.14
PSA-Prostate Specific A Blood $36.59 $36.59
Reecer.Jason L. 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
PSA-Prostate Specific A Blood 36.59 $36.59
Cholinesterase-RBC&Plasma Blood 47.05 $47.05
Rermert. Ian T. Quantifer on-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC C m 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
Robinson. Mark G. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.011
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 S ecific A Blood 36.59 $36.59
Rohr Christo her M. Quantiferon-Tb Blood 52.28 $52.28
MP(Como Metabolic Panel) $2 .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
PSA-Prostate Specific A Blood 36.59 36.59
S elbrin ,James E. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 20.01
INVOICE
�o Public Safety Medical Services
.+ 324 E. New York Street
Suite 300
W Indianapolis, IN 46204
o Carmel Fire Department/CARMEFD
Attn: Accounts Payable Terms
2 Civic Square Invoice Date 07/03/2012
00
Carmel, IN 46032 Invoice# 00-18381
Date Employee Description Amount Balance Due
CBC(Comp Blood Count $18.12 $18.1 2
Lipid Panel Blood $21.26 $21.26
Veni uncture $3.14 314
HIV 1 &2 Blood $13.59 $13.59
PSA-Prostate Specific A Blood 36.59 t47
Tierney,Scott A. HIV 1 &2 Blood 13.59
PSA-Prostate Specific A Blood 36.59
Cholinesterase-RBC&Plasma Blood 47.05 Quantiferon-Tb Blood 52.28
CMP(Comp Metabolic Panel 20.01 $20.01
BC(Coml2 Blood Count) $18.12 $18.12
Lipid Panel Blood $21.26 $21.26
Veni uncture $3.14 $3.14
Viehe Richard E. 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
PSA-Prostate S ecific A Blood $36.59 $36.59
Walker Christopher E. Quantifer on-Tb Blood 52.28 $52.28
CMP Com Metabolic Panel 20.01 $20.01
CBC(Como 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
W ant.Andrew D. 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 $3.14
HIV 1 &2 Blood 13.59 13.59
PSA-Prostate S ecific A Blood 36.59 $36.59
06/28/12 Thom son James L. Fit For Dut Exam Follow U Level 2 $179.38 179.38
Total Charges-> $16,638.59
Total Payments&Balance Due-> $0.00 $16,638.59
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35-2079797 Balance Due 15 days from invoice
date
INVOICE
to 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 07/11/2012
CM Invoice# 00-18439
Carmel, IN 46032
Date Employee Description Amount Balance Due
07/05/12 Viehe Richard E. Chest X-Ray-PA/LAT(Digital) 62.73 $62.73
Tb Skin Test $7.32 $7.32
07/06/12 Plumer,Charles J. Tb Skin Test Had+Quantiferon 7.32 $7.32
Chest X-Ray-PA/LAT(Digital) 62.73 $62.73
Total Charges-> $140.10
Total Payments&Balance Due-> $0.00 $140.10
Please write invoice number on payment check. ______
Our Federal Employer Identification Number is 35-2079797 Balance due 15 days from invoice
date
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF $
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$16,778.69
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 18439 43-407.01 $140.10 1 hereby certify that the attached invoice(s), or
1120 18381 43-407.01 $16,638.59 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
JUL 16 2012
e
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
'rescribed 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
vhom, 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))
18439 $140.10
18381 $16,638.59
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