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Home My WebLink About211013 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