211432 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $10,472.73
y�•'o CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 211432
CHECK DATE: 7/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 24358 18475 6, 269 . 09 PHYSICALS
1110 4340701 18476 1, 068 . 16 MEDICAL EXAM FEES
1120 4340701 24358 18515 249 . 43 PHYSICALS
1110 4340701 18516 2, 886 . 05 MEDICAL EXAM FEES
INVOICE
H Public Safety Medical Services
w 324 E. New York Street
E Suite 300
M Indianapolis, IN 46204
C Carmel Police Department/CARMEPD
�- 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/25/2012
m Invoice# 00-18516
Date Employee Description Amount Balance Due
07/16/12 Mabie.Michael 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
Li id Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.1 4
PSA-Prostate Specific A Blood 36.59 $36.59
07120112 Byrne, Timothy L. OnMed Program $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
Quantiferon-T BI $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
Flexibility Test $10.46 $10.4 6
Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64
Waist/Hi Ratio $3.14 $3.14
Treadmill-Submax $159.90 $159.90
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 j$20.91 64 $14.64
EKG W/Inter .91 20.91
Urinalysis-Dipstick .14 $3.14
In ection Fee .46 10.46
Td Tetanus Diphtheria)Vacc $20.91
Gauthier Edward B. OnMed Pro ram $0.00 $0.00
Health Risk Appraisal Motivation 0.00 so.001
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 AnalO $14.64 $14.64
Waist/Hi Ratio $3.14 $3.14
Tonomet Glaucoma Test $37.64 $37.64
Vital Signs-HT WT BP P R $0.00 $0.00
Vision-Acuity 27.18 $27.18
PFT-Pulmonary Function Test $34.50 $34.50
Audiometry 14.64 $14.64
EKG W/Interp $20.91 $20.91
Urinal sis-Dipstick $3.14 $3.14
Harris Sarah E. OnMed Program $0.00 $0.00
Health Risk Appraisal Motivation 0.00 $0.00
Respirator/Medical Review $16.73 $16.73
INVOICE
Fo Public Safety Medical Services
w 324 E. New York Street
E Suite 300
Indianapolis, IN 46204
C Carmel Police Department/CARMEPD
Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 07/25/2012
m Invoice# 00-18516
Date Employee Description Amount Balance Due
Comprehensive Physical Exam $102.46 $102.46
Flexibilitv Test $10.46 $10.4 6
Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64
Waist/Hip 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/Interp $20.91 $20.91
Urinalysis-Dipstick $3.14 $3.14
In ection Fee $10.46 $10.4 6
Td Tetanus Diphtheria)Vacc $20.91 $20.91
Lovitt.Richard A. OnMed Program $0.00 $0.00
Health Risk Appraisal Motiv tion .0
Respirator/Medical Review $16.73 $16.73
Comprehensive Physical Exam $102.46 $102.46
Flexibility Test $10.46 $10.46
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-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-Dipstick $3.14 $3.14
Mabie Michael L. 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/Interlp $20.91 $20.91
Urinal sis-Dipstick $3.14 $3.14
OnMed Pro ram $0.00 $0.00
Health Risk Appraisal Motivation 0.00 $0.00
Respirator/Medical Review 1 .7 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
Morrow.Scott A. OnMed Program $0.00 $0.00
Health Risk Appraisal Motivation 0.00 $0.00
Respirator/Medical Review $16.73 16.73
INVOICE
F Public Safety Medical Services
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 07/25/2012
m Invoice# 00-18516
Date Employee Description Amount Balance Due
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 $0.00
Vision-Acuity 27.18 $27.18
PFT-Pulmonary Function Test $34.50 $34.50
Audiornetry $14.64 $14.64
EKG W Inter 1 $20.91
Urinalysis-Dipstick $3.14 $3.14
Injection Fee $10.46 $10.46
Td Tetanus Diphtheria)Vacc $20.91 $20.91
Total Charges-> 1 $2,886.05
Total Payments&Balance Due-> $0.00 1 $2,886.05
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35-2079797 date
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
= Indianapolis, IN 46204
o Carmel Police Department/CARMEPD
F- Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 07/18/2012
m Invoice# 00-18476
Date Employee Description Amount Balance Due
07/10/12 Amos Chad 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
Broadnax Matthew L. Quantiferon-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 BI ood) $13.59 $13.59
Collins,Larry J. 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
Harris Robert P. Quantiferon-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
Venipuncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
PSA-Prostate Specific A Blood $36.59 $36.59
Ha maker William 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 $13.591
PSA-Prostate Specific A Blood 36.59 $36.59
S illman R. Scott Quantiferon-Tb Blood 52.28 $52.28
CMP(Como Metabolic Panel 20.01 $20.01
C o Blood Count) $18.12 $18.12
Li id Panel Blood $21.26 $21.26
Veni uncture $314 $3.14
HIV 1 &2 Blood $13.59 $13.59
PSA-Prostate Specific A Blood 36.59 $36.59
Vanderbeck. David R. 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-Prostate Specific A Blood 36.59 36.59
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
� Indianapolis, IN 46204
C Carmel Police Department/CARMEPD
f' Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 07/18/2012
m Invoice# 00-18476
Date Employee Description Amount Balance Due
Total Charges-> $1,068.16
Total Payments&Balance Due-> $0.00 $1,068.16
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
$3,954.21
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 18476 43-407.01 $1,068.16 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1110 18516 43-407.01 $2,886.05
materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday, July 26, 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))
07/18/12 18476 officer physicals $1,068.16
07/25/12 18516 officer physicals $2,886.05
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
0 Public Safety Medical Services
w 324 E. New York Street
E Suite 300
� Indianapolis, IN 46204
C Carmel Fire Department I CARMEFD
Attn: Accounts Payable Terms
2 Civic Square Invoice Date 07/18/2012
m
Carmel, IN 46032 Invoice# 00-18475
Date Employee Description Amount Balance Due
07/10/12 Baskerville Anthony 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
Lipid Panel Blood 21.26 $21.26
Veni uncture $3.14 $3,14
HIV 1 &2 Blood 13.59 $13.59
Buttler,James N. 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
Venipuncture $3.14 $3.14
Deitsch,Marc 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
Force Jason S. CMP Com Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.1 2
Lipid Panel Blood 21.26 $21.26
Veni un ture $3.14 $3.14
uantiferon-Tb Blood 52.28 $52.28
Foster.James P Qi ntif on-Th $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
Cholinesterase-RBC&Plasma Blood 47.05 $47.05
Holubik Steven W. Quantiferon-Tb Blood 52.28 $52.28
CMP Com Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.1 2
Li id Panel Blood 21.26 $21.26
V ni ncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
PSA-Prostate Specific A Blood $36.59 $36.59
Hughes,Chad L. 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
Mason Bryan L. O.antiferon-Tb Blooa 52.28 $52.28
CMP Corn Metabolic Panel 20.01 $20.01
INVOICE
Fo Public Safety Medical Services
= 324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
o Carmel Fire Department/CARMEFD
�- Attn: Accounts Payable Terms
2 Civic Square Invoice Date 07/18/2012
m
Carmel, IN 46032 Invoice# 00-18475
Date Employee Description Amount Balance Due
CBC(Como Blood Count 18.12 $18.12
Li id Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2 BI 13.
PSA-Prostate Specific A Blood $36.59 $36.59
Robinson Mitchell L. 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
Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
Steele Jeffrey A. Quantiferon-Tb Blood H52.28 52.28
CMP Com Metabolic Panel 20.01 20.01
CBC Com Blood Count 18.12 $18.12
Lipid Panel(Blood) 21.2 21
Veni uncture $3.14 $3.14
PSA-Prostate Specific A Blood $36.59 $36.59
Thordarson.Erik M. 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
Wendzel Jason D. Quantiferon-Tb Blood 52.28 $52.28
CMP Corn Metabolic Panel 20.01 $20.01
CBC Com Blood Count 18.12 $18.1 2
Lipid Panel Bl d 212
Veni uncture $3.14 $3.14
Woodburn Scott 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
07/11/12 Alverson Jonathan 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
Li id Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 (Blood) 1 1 .
PSA-Prostate Specific A Blood $36.59 $36.59
Contino David M. 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
INVOICE
�o Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
C Carmel Fire Department/CARMEFD
t- Attn: Accounts Payable Terms
Invoice Date 07/18/2012
2 Civic Square
m
Carmel, IN 46032 Invoice# 00-18475
Date Employee Description Amount Balance Due
Dorsch James 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 ecifc A Blood 36.59 36.59
Ellison Christo her M. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC (Coma-Blood Count 18.12 $18.12
Lipid Panel BI ood) $21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
Love Joseph 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 q$52.28.14 3.14
HIV 1 &2 Blood .59 13.59
PSA-Prostate Specific A Blood .59 36.59
Lux Michael T. Quantiferon-Tb Blood 52.28 CMP Com Metabolic Panel 0.01 20.01
B m Blood Count) $18.12 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
Maroon,Ernie R. 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 M36.59 3.14
HIV 1 &2 Blood 13.59
PSA-Prostate S ecific A Blood 36.59
Web Gr A. u n i ron-T B 2 CMP Com Metabolic Panel $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
Cholinesterase-RBC&Plasma Blood 47.05 $47.05
Workman William J. Quantiferon-Tb Blood 52.28 $52.281
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
INVOICE
to- Public Safety Medical Services
«. 324 E. New York Street
m
Suite 300
W Indianapolis, IN 46204
C Carmel Fire Department/CARMEFD
t- Attn: Accounts Payable Terms
Invoice Date 07/18/2012
2 Civic Square
m
Carmel, IN 46032 Invoice# 00-18475
Date Employee Description Amount Balance Due
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate S ecific A Blood 36.59 $36.59
07/12/12 Anderson Donovan C. Quantiferon-Tb Blood 52.28 $52.28
P m r)Metabolic Panel) $20.01
CBC Corn 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
Bailey,Mark E. Quantiferon-Tb Blood 52.28 $52.28
CMP Com 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 B lood) $13.59 $13.59
PSA-Prostate Specific A Blood $36.59 $36.59
Brant Kenneth 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 $3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate Specific A Blood 36.59 $36.59
Brisco. Michael D. Quantiferon-Tb Blood 52.28 $52.28
CMP Com Metabolic Panel 20.01 $20.01
CBC(Como Blood Count 18.12 18.12
i id Panel(Blood) 21.2 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
Davis James M. Quantiferon-Tb Blood $52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 $18.1 2
Lipid Panel Blood 21.26 $21.26
Veni uncture 3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate S ecific A Blood 36.59 $36.59
Freer Keith T. Quantiferon-Tb Blood 52.28 $52.28
MP(Corno(Corn Metabolic P I 1
CBC(Comp Blood Count $18.12 $18.12
Lipid Panel Blood $21.26 $21.26
Veni uncture $3.14 $3.14
PSA-Prostate Specific A Blood $36.59 $36.59
Frenzel Eric C. Quantiferon-Tb Blood 52.28 $52.281
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Comp Blood Count 18.12 18.12
INVOICE
� Public Safety Medical Services
= 324 E. New York Street
E Suite 300
w Indianapolis, IN 46204
C Carmel Fire Department/CARMEFD
Attn: Accounts Payable Terms
2 Civic Square Invoice Date 07/1812012
Carmel, IN 46032
Invoice# 00-18475
Date Employee Description Amount Balance Due
Lipid Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.14
Frye,Steven 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 $3.14
HIV 1 &2 Blood 13.59 $13.59
Cholinesterase-RBC&Plasma Blood 47.05 $47.051
Harrington,Adam C. Quantiferon-Tb Blood 52.28 $52.28
CMP(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
Hutchison Brian P. 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
Veni uncture $3.14 $3.1 4
HIV 1 &2 Blood 13.59 $13.59
Knott Bruce A. Quantiferon-Tb Blood 52.28 $52.28
P(Comp.Metabolic Panel) 2 .0
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
Mead David L. 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 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Prostate S ecific A Blood 36.59 $36.59
Mori rt y.John F. Quantifemn-T (Blood) .2 2
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
PSA-Prostate Specific A Blood 36.59 $36.59
Re nolds Shawn J. Quantiferon-Tb Blood 52.28 $52.28
CMP fComp 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
INVOICE
r° 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 07/18/2012
m Carmel, IN 46032 Invoice# 00-18475
Date Employee Description Amount Balance Due
HIV 1 &2 Blood 13.59 $13.59
Schooler,Dustin D. Quantiferon-Tb Blood 52.28 $52.2 8
CMP Com Metabolic Panel 20.01 $20.01
Blood CBC(Comi) unt) $18.12 $18.1 2
Lipid Panel Blood $21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2 Blood 13.59 1 $13.59
Sharp,Adam C. 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
Small Thomas D. Quantiferon-Tb Blood 52.28 $52.28
P(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
VanVoorst Robert 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
Lipid Panel Blood 21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2 Blood 13.59 $13.59
PSA-Pr t to Specific (Blood) 9
Cholinesterase-RBC&Plasma Blood $47.05 $47.05
Young,Andrew 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 Pane( Blood $21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 &2 Blood 13.59 E13.59
Total Charges-> $6,269.09
Total Payments&Balance Due-> $0.00 $6,269.09
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35-2079797 date
INVOICE
0 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
Invoice Date 07/25/2012
2 Civic Square
m
Carmel, IN 46032 Invoice# 00-18515
Date Employee Description Amount Balance Due
07/12/12 Thompson,James L. Fit For Duty Exam Follow U Level 2 $179.38 $179.38
07/17/12 Thompson,James L. Tb Skin Test $7.32 $7.32
Chest X-Ray-PA/LAT(Digital) $62.73 $62.73
07120112 Ca shave Jeffrey A. Repeat Blood Panel N/C-Error At Lab 0.00 $0.00
PSA-Prostate Specific A Blood 0.00 0.00
Total Charges-> $249.43
Total Payments&"Balance Due-> $0.00 $249.43
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
$6,518.52
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 18475 43-407.01 j $6,269.09 ( hereby certify that the attached invoice(s), or
1120 18515 43-407.01 $249.43 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 3 0 2012
Fire Chief
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))
18475 $6,269.09
18515 $249.43
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