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211917 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 y1,�•0 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $43,146.33 `o CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 211917 CHECK DATE: 8/14/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 24358 18565 21, 093 . 14 PHYSICALS 1110 4340701 18566 164 . 99 MEDICAL EXAM FEES 1120 4340701 24358 18616 21, 736 . 80 PHYSICALS 1110 4340701 18617 151 . 40 MEDICAL EXAM FEES F ' INVOICE F0° Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis,,IN 46204 C Carmel Fire Department/CARMEFD �- Terms Attn: Accounts Payable Invoice Date 08/08/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due 07/30/12 Anderson,Donovan C. 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 Muscular Strength Endurance Test $27.18 $27.18 FlexibilitV Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 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 Benbow,Kip S. OnMed Program $0.00 $0.00 Health Risk Appraisal(Motivation) 0.00 $0.00 Respirator/Medical Review $16.73 $16.731 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Imo Anal 14.64 $14.64 W is Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Chest X-Rav-PA 1 View $52.28 $52.28 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 $14.641 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.141 Cromlich.Mark A. OnMed Program $0.00 $0.00 Health Risk Aooraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.731 Comorgh.Qnsive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 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 $159.901 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/Intero $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 INVOICE 0 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 2 Civic Square Invoice Date 08/08/2012 m Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due Essex Cory C. 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 $102.4 Muscular Strength Endurance Test $27.18 $27.18 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 Chest X-Ray-PA 1 View 52.28 $52.28 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.181 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Inter 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.1 4 Frenzel,Eric C. 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 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal y) $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.1 8 PFT-P Im n Function Te t $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Len Theodore A. 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 t13 3.14 HIV i &2 Blood 13.59 McNeely, Michael W. OnMed Program $0.00 Health Risk A raisal Motivation 0.00 R it for/Medical Review $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R 0.00 $0.00 INVOICE o Public Safety Medical Services ~ 324 E. New York Street Suite 300 a: Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD Attn: Accounts Payable Terms 2 Civic Square Invoice Date 08/08/2012 m Invoice# 00-18616 Carmel, IN 46032 Date Employee Description Amount Balance Due Vision-AcuitV $27.18 $27.18 PFT-PulmonarV Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Mulford David A. OnMed Program $0.00 $0.0 0 Health Risk Anpraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Comprehensive Physical Exam 102.46 $102.46 Muscular Strencith Endurance Test $27.18 $27.181 Flexibilitv Test $10.46 1 $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 $159.9 0 Vital Signs-HT WT BP P R $0.00 $0.0 0 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Sombke Brad D. OnMed Program $0.00 $0.00 Health Risk Apmaisal Motivation 0.00 $0.00 Respirator/Medical Revi w $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 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 Steur ,Kent C. Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibilitv Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-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 INVOICE 0 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 Invoice Date 08/08/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due Urinalysis-Dipstick $3.14 $3.14 OnMed Pro ram 0.00 0.0 0 Health Risk A raisal Motivation 000 0.00 R it t r Me is I Review 1 $16.73 Stroup,Scott A. OnMed Program $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 WaisUft Ratio $3.14 $3.1 4 Treadmill-Submax $159.90 $159.90 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Te t $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 1 $3.14 Sutton,Sean B. 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 Muscuiar Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA(Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.901 Chest X-Ray-PA 1 View $52.28 $52.28 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 Weaver Virgil L. OnMed Program 0.00 $0.00 Health Risk Appraisal Motivation $0.00 0.00 Res irator/Medical Review 16.73 16.73 Com rehensive Physical Exam 102.46 102.4 Flexibility Test 10.4 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 Chest X-Ray-PA 1 View $52.28 $52.28 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 INVOICE o Public Safety Medical Services ~ 324 E. New York Street E Suite 300 Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD �- Terms Attn: Accounts Payable Invoice Date 08/08/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 07/31/12 Bowles Orbie H. CCS 4-Week Referral 0.00 $0.00 Collins.Tony A. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.0 0 Respirator/Medical Review $16.73 $16.73 Comprehensive.Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bi -EI c Imp Anal $14. 4 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Chest X-Ray-PA 1 View $52.28 $52.28 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 Dorsch James E. OnMed Program $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 R it for M dic I Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA(Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.001 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/Intero $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Drake,Carl D. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation H270,18 0.00 $0.00 Respirator/Medical Review 6.73 $16.73 Comprehensive Physical Exam 2.46 102.46 Muscular Strength Endurance Test 27.1Flexibilit Test .46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Sian -HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 27.18 INVOICE F 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 0810812012 m Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due PFT-Pulmonary Function Test $34.50 $34.50 Audiornetry $14.64 $14.64 EKG W/Inter 20.91 $20.91 r I si -Dinstick $3.14 $3.14 Giles,William G. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 1 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.4 6 Bodv Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.641 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Chest X-Ray-PA 1 View 52.28 $52.28 Vital Si ns-HT WT BP P R $0.00 $0.0 0 Vision-Acuity 27.1 27.1 PFT-Pulmonary Function Test $34.50 $34.50 Audiornetry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Kinney,Jared N. 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 Muscular Strength 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 Rati 3.14 $3.14 Treadmill-Submax $159.90 $159.90 Chest X-Ray-PA 1 View $52.28 $52.28 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity E27 $27.18 PFT-Pulmonary Function Test $34.50 Audiomet $14.64 EKG W/Inter $20.91 Urinal sis-Di stick 3.14 Love.Joseph B. OnMed Program $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Cornmeh ensive Physical Exam $102.46 $102.4 6 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Bodv Fat Test-BIA Bio-Elec Im Anal ) $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Chest X-Ray-PA 1 View 52.28 $52.281 Vital Signs-HT WT BP P R $0.00 $0.00 INVOICE 0 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 Invoice Date 08/08/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due Vision-AcuitV $27.18 $27.18 PFT- PulmonarV Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Maners Jeremy B. OnMed Program $0.00 $0.0 0 Health Risk Appraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.4 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.9 0 Cholinesterase-RBC&Plasma(Blood) $47.05 $47.05 Veni uncture $3.14 $3.14 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Mowery,Anthony W. OnMed Pro r m $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.9 0 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 Audiometry 14. 4 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Small,Thomas D. CCS 4-Week(Referral) $0.00 $0.00 Smith. Brian 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 Stindle.Kevin P. OnMed Program $0.00 $0.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 � Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD �- Attn: Accounts Payable Terms 2 Civic Square Invoice Date 08/08/2012 m Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.731 Comprehensive Physical Exam $102.46 $102.4 6 Muscular tren th Endurance Test $27,18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 1 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Chest X-Ray-PA 1 View 52.28 $52.28 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/Intern $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Utzia.Chad M. OnMed Pro r m $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Ph sical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 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 Chest X-Ray-PA N View 52.28 $52.28 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test 4. 0 $34.50 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Witsken Steven J. 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 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.461 Body Fat Test-BIA Bio-Elec Imo Anal 14.64 14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Zeller.Michael J. OnMed Program $0.00 $0.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Fire Department/CARMEFD H Attn: Accounts Payable Terms Invoice Date 08/08/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.4E Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 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 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 08/01/12 Brisco Michael D. Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 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 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 Chest X-Ray-PA 1 View $52.28 $52.28 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Cummins.Frank C. OnMed Program $0.00 $0.0 0 Health Risk Appraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular tr n th Endurance Test $27.18 $27.18 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 $159.901 Chest X-Ray-PA 1 View 52.28 $52.28 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 INVOICE H Public Safety Medical Services ._ 324 E. New York Street E Suite 300 m Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD Attn: Accounts Payable Terms 2 Civic Square Invoice Date 08/08/2012 m Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due Fa in Timothy D. OnMed Pro ram $0.00 $0.00 Health Risk Apmaisal Motivation $0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Cornr)rghensive Physical Exam $102.46 $102.4 Muscular Strength Endurance Test $27.18 $27.18 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 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.501 Audiornetry $14.64 $14.64 EKG W/Intern $20.91 $20.91 Urinalysis-Di stick $3.14 $3.1 4 Freer,Keith T. OnMed Pro r m $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 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.4 6 Bodv Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 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 Au iornetry $14.64 14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick E$1 $3.14 Frost Bruce S. OnMed Pro ram $0.00 Health Risk Appraisal Motivation $0.00 Respirator/Medical Review $16.73 Comprehensive Physical Exam $102.46 Muscular Strength Endurance Test $27.18 1 $27.18 Flexibility Test $10.46 $10.4 6 Bodv Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Chet X- -PA 1 View) $52.28 $52.28 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 $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Haboush David G. I OnMed Program 0.00 0.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 m Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD F-- Attn: Accounts Payable Terms Invoice Date 08/08/2012 2 Civic Square m Invoice# 00-18616 Carmel, IN 46032 Date Employee Description Amount Balance Due Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imn Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 127 27.18 PFT-P on Function Test 4.50 Audiometry $14.64 EKG W/Inter 20.91 Urinal sis-Di stick 3.1Hulett. Mark A. 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 Muscular Stren th Endurance Test $27.18 Flexibility Test $10.46 $10.4 6 Bodv Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 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 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Hutchison Brian P. OnMed Program $0.00 $0.0 0 Health Risk Appraisal Motivation 0.00 $0.0 0 Res irator/Medical Review $16.73 $16.73 Comprehensive Ph sical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibilitv Test $10.46 $10.46 Body Fat Test-BIA(Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 34.50 Audiometry 14.64 14.64 EKG W/Inter 20.91 $20.91 Urinalysis-Dipstick 3.14 $3.14 Marcum Bradle D. OnMed Program 0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 INVOICE 0 Public Safety Medical Services r 324 E. New York Street E Suite 300 of Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD �- Terms Attn: Accounts Payable Invoice Date 08/08/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due Res irator/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 $10.4 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-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 Plumer,Charles J. OnMed Pro ram $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.0 0 Respirator/Medical Review 1 1 .7 Com rehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Inter 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Thom son James L. 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 Strength Endurance Test $27.18 $27.18 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 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function T t $34,50 $34.50 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 3.14 Young.Andrew S. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 1 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 INVOICE 0 Public Safety Medical Services 324 E. New York Street Suite 300 M Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD E- Attn: Accounts Payable Terms 2 Civic Square Invoice Date 08/08/2012 Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 WaisUft Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Chest X-Ray-PA 1 View 52.28 $52.28 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 K W l t r $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 08/02/12 Baskerville Anthony A. OnMed Program $0.00 $0.0 0 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio 3.14 3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.1 27.1 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 Butts.Joseph A. OnMed Program 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159,90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 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 Edwards Daniel E. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 INVOICE F Public Safety Medical Services 324 E. New York Street Suite 300 tY Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD F- Attn: Accounts Payable Terms 2 Civic Square Invoice Date 08/08/2012 m Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imip Anal 14.64 $14.641 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.9 0 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 AudiometrV $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Fisher Gary L. OnMed Program $0.00 $0.0 0 Health Risk Appraisal Motivation 0.00 $0.0 0 Respirator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular Stren th Endurance Test $27.18 $27.18 Flexibilitv Test $10.46 $10.4 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 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-PulmonarV Function Test $34.50 $34.50 AudiometrV $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Griffin Timothy M. No Show Fee $40.00 $40.0 0 Mead Jr. Donald R. OnMed Pro ram $0.00 $0.00 Health Risk A r i I Motivation 0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Ph sical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 FlexibilitV Test $10.46 10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Sign -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 Interip $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Nicley,Wes W. 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 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 Q) Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD �- Terms Attn: Accounts Payable 2 Civic Square Invoice Date 08/08/2012 m Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due 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 Chest X-Ray-PA 1 View 52.28 $52.28 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Robinson, Mark G. OnMed Pr ram $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Ph sical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 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 Chest X-Ray-PA 1 View 52.28 $52.28 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-PgImonary Function Test $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Rohr Christopher M. 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 $102.4 6 Muscular Strength Endurance Test $27.18 1 $27.18 Flexibility Test $10.46 $10.4 6 Body-Fat Test--BIA Bio-Elec Im Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Chest X-Ray-PA 1 View $52.28 $52.28 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 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.11 4 $3.14 S elbrin .James E. OnMed Program $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 x Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD �- Attn: Accounts Payable Terms 2 Civic Square Invoice Date 08/08/2012 m Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hip Ratio .14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-AcuitV $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiarnetry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.1 4 Steele Jeff rev A. OnMed Program $0.00 0.00 Health Risk Appraisal Motivation 0.00 0.00 Respirator/Medical Review 16.73 16.7 Com rehensive Physical Exam 102.46 102.46 Muscular Str n th Endurance Test 27.18 $27.18 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 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 Audiomet 14.64 $14.64 EKG W/Inter 20.91 $20.91 Urinal sis-Di stick 3.14 $3.14 W ant Andrew D. OnMed Program $0.00 $0.00 Health Risk Aporaisal(Motivation) $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 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 Chest X-Ray-PA 1 View $52.28 $52.28 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/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Total Charges-> $21,736.80 Total Payments&Balance Due-> $0.00 $21,736.80 Please write invoice number on payment check. Balance due 15 days from invoice date INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD �- Terms Attn: Accounts Payable Invoice Date 08/08/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18616 Date Employee Description Amount Balance Due Our Federal Employer Identification Number is 35-2079797 INVOICE 0 Public Safety Medical Services w 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD E- Terms Attn: Accounts Payable Invoice Date 08/01/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18565 Date Employee Description Amount Balance Due 07/24/12 Bondurant Jeff S. 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 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Si ns-HT WT BP P R $0.00 $0.00 Vii -Acuity 27.1 $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 Brandt Gary D. Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Imo Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 1 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.731 Com rehensive Physical Exam $102.46 $102.46 Butts Renee L. OnMed Program $0.00 $0.0 0 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.181 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 $159.9 0 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/Interip $20.91 $20.91 Urinalysis-D stick $3.14 $3.14 Crane Barry L. OnMed Pro ram 0.00 1 0.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 M Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD Attn: Accounts Payable Terms Invoice Date 08/01/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18565 Date Employee Description I Amount Balance Due Health Risk Aooraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular Strenoth Endurance t $27.18 $27.18 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 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-AcuitV $27.18 $27.18 PFT-PulmonarV Function Test $34.50 $34.50 Audionnetry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 DeLona,Michael T. OnMed Pro ram $0.00 $0.0 0 Health Risk Aimraisal(Motivation Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test j$227.18 $27.18 Flexibilit Test 46 10.4Bod Fat Test-BIA Bio-Elec Im Anal 64 14.64 Waist/Hi Ratio 14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiornetry $14.64 $14.64 EKG W Intern $2 1 $20.91 Urinalysis-Dipstick $3.14 $3.14 Holubik Steven W. No Show Fee $40.00 $40.00 Hughes,Chad L. Urinal sis-Dipstick $3.14 3.14 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 $102.461 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 14.64 Waist/Hi Ratio $3.14 3.14 Treadmill-Submax M$27.18 $159.90 Vital Signs-HT WT BP P R $0.00 Vision-Acuity $27.18 PFT-Pulmona Function Test 34.50 Audiomet 14.64 EKG W/Interp 1 $20.91 $20.91 Kelsheimer,Troy W. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 INVOICE 0 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 Invoice Date 08/01/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18565 Date Employee Description Amount Balance Due Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibilitv Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.1 4 Treadmill-Submax $159.90 $159.9 0 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 A diom 14. 4 $14.64 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Mason Bryan L. OnMed Program $0.00 $0.0 0 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Sin -HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 1 $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 Tb Skin Test $7.32 $7.32 Chest X-Ray-PA 1 View 52.28 $52.28 Medlen Michael J. 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 10246 MuK!jlgr 5trenoth Endurance Test $27,18 $27.18 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 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/Intero $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Cholinesterase-RBC&Plasma Blood 47.05 $47.05 INVOICE Foo 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 2 Civic Square Invoice Date 08/01/2012 m Carmel, IN 46032 Invoice# 00-18565 Date Employee Description Amount Balance Due Veni uncture $3.14 $3.14 Reecer Jason L. OnMed Pro ram $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 Respirator/Medical R vi w $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W Inter 20.91 $20.91 Urinalysis-Di ti k $3.14 $3,14 Chest X-Ray-PA 1 View $52.28 $52.28 Tiernev,Scott A. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Ph sical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 FlexibilitV Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Si ns-HT WT BP P R $0.00 $0.00 V' ion-Acuity 27. 27.1 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 07/25/12 Bailey,Mark E. OnMed Program $0.0o $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 Waist/Hip Ratio .14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 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 INVOICE 0 Public Safety Medical Services = 324 E. New York Street E Suite 300 � Indianapolis, IN 46204 O Carmel Fire Department/CARMEFD F- Attn: Accounts Payable Terms 2 Civic Square Invoice Date 08/01/2012 m Carmel, IN 46032 Invoice# 00-18565 Date Employee Description Amount Balance Due Baskerville Steven P. 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 Muscular Strength Endurance Test $27.18 $27.18 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 Vital Si ns-HT WT BP P R $0.00 $0.00 Vii -Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.9 1 Urinalysis-Dipstick $3.14 $3.14 Ca shave Jeffrey A. 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 Muscular Stren th Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 W ip.R@tip $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Chest X-Ray-PA 1 View $52.28 $52.28 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 Haymaker,Samuel K. OnMed Pro ram $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.731 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp 1 $20.91 20.91 Urinal sis-Di stick $3.14 3.14 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Fire Department/CARMEFD Attn: Accounts Payable Terms 2 Civic Square Invoice Date 08/01/2012 m Carmel, IN 46032 Invoice# 00-18565 Date Employee Description Amount Balance Due Martin David D. OnMed Program $0.00 $0.00 Health Risk Aimraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 mpreh nsive Ph ical Exam $102.46 $102.46 Treadmill-Submax $159.90 $159.90 Vital Si ns-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 Urinal sis-Dipstick $3.14 $3.14 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.1 4 Martin,Richard A. OnMed Program $0.00 $0.0 0 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Ph sical Exam $102.46 $102.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Inter 20.91 $20.91 Ur n I i -Dipstick $3.14 $3.14 Osborne Scott K. 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 $102.4 6 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.4 6 Bodv Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pufmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Peterson,Vernon A. 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 $102.4 6 INVOICE � 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 08/01/2012 00 Carmel, IN 46032 Invoice# 00-18565 Date Employee Description Amount Balance Due Muscular Strength Endurance Test $27.18 $27.18 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 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/Inter 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Ray,Lucas M. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.0 0 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 27.18 PFT-Pulmonary Function T t $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 R an.Christopher D. 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 Strength Endurance Test $27.18 $27.18 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 Treadmill-Submax $159.90 $159.90 Vital Si ns-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/Inter 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.1 4 Sharp.Adam C. OnMed Program $0.00 $0.0 0 Health Risk Appraisal Motivation 0.00 $0.0 0 Respirator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Flexibility Test 10.46 $10.4 6 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 Invoice Date 08/01/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18565 Date Employee Description Amount Balance Due Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Sian -HT WT SP P R 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 Vallone Frank 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 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bi -EI Im Anal 14. 4 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonar Function Test 34.50 34.50 Audiometry 14.64 14.64 EKG W/Inter 20.91 20.91 Urinalysis-Di stick 3.14 3.14 07/26/12 Bowles Orbie H. OnMed Program 0.00 0.00 Health Risk A raisal Motivation 0.00 0.00 Respirator/Medical Review 16.73 16.73 om r hen ive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 27.18 PFT-Pulmonary Function Test 34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Inter 20.91 $20.91 Urinalysis-Di stick 3.14 $3.1 4 Castor, Rick S. OnMed Program 0.0 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibilitv 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 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 08/01/2012 m Carmel, IN 46032 Invoice# 00-18565 Date Employee Description Amount Balance Due Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-PulmonarV Function Test $34.50 $34.50 AudiometrV $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Cox.Justin M. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.731 Corngrehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 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 Vital Sign -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/Inter 20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Cholinest er e BC&P (Blood) 47. 47. Veni uncture $3.14 $3.14 Foster James P. 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 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Imo Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.9 0 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 $3.1 4 Haus.Joshua S. 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 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 10.46 Body Fat Test-BIA Bio-Elec Im Anal 14.64 14.64 INVOICE t0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Fire Department/CARMEFD Attn: Accounts Payable Terms 2 Civic Square Invoice Date 08/01/2012 m Invoice# 00-18565 Carmel, IN 46032 Date Employee Description Amount Balance Due Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Chest X-Ray-PA 1 View 52.28 $52.28 Vital Sions-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 1 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3,14 $3.14 Howard Wendell E. 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 Muscular Stren th Endurance Test $27.18 $27.18 Flexibility Test 10.46 $10.4 6 Body t Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Intern $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Payne.Thomas C. OnMed Program $0.00 $0.0 0 Health Risk A raisal Motivation $0.00 $0.0 0 Res irator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.9 0 CCS 4-Week Referral 0.00 $0.00 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/Inter 20.91 $20.91 Urinalysis-Dbstick $3.14 $3.1 4 Phillips,Craig M. Cholinesterase-RBC&Plasma Blood $47.05 $47.05 Veni uncture $3.14 $3.14 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 $102.461 Muscular Strength Endurance Test $27.18 $27.181 INVOICE to- Public Safety Medical Services 324 E. New York Street Suite 300 Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD Attn: Accounts Payable Terms Invoice Date 08/01/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18565 Date Employee Description Amount Balance Due 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 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 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinal sis-Di stick $3.14 $3.14 Reeves, t h n J. OnMed Progrgm $0.00 0 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 FlexibilitV Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax 159.90 $159.90 Vital 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 A diom t 14. 4 $14.64 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Reppert, Ian T. OnMed Program $0.00 1 $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 Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.461 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.9 0 Vital Signs-HT WTBPPR $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 Small Thomas D. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation) $0.00 Respirator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibilitv Test $10.46 $10.4 6 INVOICE Io 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 08/01/2012 m Carmel, IN 46032 Invoice# 00-18565 Date Employee Description Amount Balance Due Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax 159.90 $159.90 Chest X- -PA 1 View) .2 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34,50 $34.501 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Wendzel Jason D. OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Te t $10.46 $10.4 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 AudiometrV $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.1 4 07/27112 Alverson Jonathan L. OnMed Pro ram $0.00 $0.00 Health Risk Agpraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Inter 20.91 20.91 Urinalysis-Dipstick $3.14 $3.14 Edwards Steven L. 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 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 INVOICE ►-o Public Safety Medical Services 324 E. New York Street m Suite 300 0� Indianapolis, IN 46204 G Carmel Fire Department/CARMEFD E- Attn: Accounts Payable Terms 2 Civic Square Invoice Date 08/01/2012 m Carmel, IN 46032 Invoice# 00-18565 Date Employee Description Amount Balance Due Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 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 Fuchs.Jeffery W. OnMed Program $0.00 $0.00 Health Risk Armraisal Motivation 0.00 $0.00 Respirator/Medical R vi w $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Inter 20.91 $20.91 Urinalysis-Dipstick $3.14 $3,14 Gipson,Bruce E. 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 Muscular Strength Endurance Test $27.18 $27.18 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 Chest X-Ray-PA 1 View 52.28 $52.28 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Ac it y $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 $3.1 4 Hensley. Robert P. OnMed Program t$27.18 0.00 Health Risk Appraisal Motivation 0.00 Respirator/Medical Review 16.73 Comprehensive Physical Exam 102.46 Muscular Strength Endurance Test 27.18 Flexibility Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Imp Anal y) $14.64 INVOICE F 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 08/01/2012 m Carmel, IN 46032 Invoice# 00-18565 Date Employee Description Amount Balance Due Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Si ns-HT WT BP P R $0.00 $0.0 0 Vision-.Aci it y $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 Horner,David W. 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 Strength Endurance Test $27.18 $27.18 Flexibilit T st $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 is Hi Ratio 3 14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 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 Lux.Michael T. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Com reh nsive Physical Exam $102.46 $102.46 Muscular Strencith Endurance Test $27.18 $27.18 Flexibilitv Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.641 EKG W/Interp 20.91 $20.91 Urinalysis-Di stick 3.14 $3.14 Reeves Neil P. OnMed Pro ram $0.00 $0.0 0 Health Risk A r i I(Motivation) $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.4 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 INVOICE to 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 08/01/2012 m Carmel, IN 46032 Invoice# 00-18565 Date Employee Description Amount Balance Due Chest X-Ray-PA 1 View 52.28 $52.28 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 Audiomet 14.64 14.64 EKG W/Inter 20.91 20.91 Urinalysis-Di stick 3.14 3.14 Voskuhl Mark J. OnMed Program 0.00 0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Compreh nsive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Chest X-Ray-PA 1 View 52.28 $52.28 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/Inter 20.91 $20.91 Urinalysis-Di ti k $3.14 $3.14 Watts,Trent E. 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 Muscular Strength 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 $3.14 Treadmill-Submax $159.90 $159.90 Chest X-Ray-PA 1 View 52.28 $52.28 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.1 7.1 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 Cholinesterase-RBC&Plasma Blood 47.05 $47.05 Veni uncture $3.14 $3.14 Young,Alan R. OnMed Program $0.00 $0.0 0 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 102.46 Muscular Strength Endurance Test 27.18 $27.18 INVOICE �o Public Safety Medical Services 324 E. New York Street E Suite 300 d w Indianapolis, IN 46204 o Carmel Fire Department!CARMEFD �- Attn: Accounts Payable Terms 2 Civic Square Invoice Date 08/01/2012 m Carmel, IN 46032 Invoice# 00-18565 Date Employee Description Amount Balance Due Flexibility Test $10.46 $10.46 Bod y Fat Tes -BIA Bio-Elec Im Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.1 4 Treadmill-Submax $159.90 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 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Young, Kevin M. OnMed Program $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.461 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 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 Char es-> $21,093.14 Total Payments&Balance Due-> $0.00 $21,093.14 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 $42,829.94 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members T 24358 18616 43-407.01 j $21,736.80 1 hereby certify that the attached invoice(s), or 18565 43-407.01 $21,093.14 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 AUG 13 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 4n invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by nrhom, 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)) 18616 $21,736.80 18565 $21,093.14 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 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 08/01/2012 m Invoice# 00-18566 Date Employee Description Amount Balance Due 07/24/12 Hedrick Brad A. 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 Total Charges-> $164.99 Total Payments&Balance Due-> $0.00 $164.99 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. Public Safety Medical Services ALLOWED 20 IN SUM OF $ 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $164.99 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/T'ITLE AMOUNT Board Members 1110 18566 43-407.01 $164.99 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Friday, August 10, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No.201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 08/01/12 18566 officer physicals $164.99 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 INVOICE �o Public Safety Medical Services 324 E. New York Street E Suite 300 Q Indianapolis, IN 46204 O Carmel Police Department/CARMEPD �- 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08/08!2012 m Invoice# 00-18617 Date Employee Description Amount Balance Due 07/31/12 Dewald Gregory 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 PSA-Prostate Specific A Blood $36.59 1 $36.59 Total Charges-> $151.40 Total Payments&Balance Due-> $0.00 $151.40 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 E. New York Street, Suite 300 Indianapolis, IN 46204 $151.40 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 I 18617 I 43-407.01 I $151.40 1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Friday, August 10, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No.201 (Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 08/08/12 18617 officer physical $151.40 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