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212347 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ti•'�j� ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $18,212.28 �.io CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 212347 CHECK DATE: 8/28/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 24358 18662 17, 125 . 62 PHYSICALS 1091 4340700 18663 65 . 00 MEDICAL FEES 1110 4340701 18664 586 . 78 MEDICAL EXAM FEES 1120 4340701 24358 18710 434 . 88 PHYSICALS INVOICE �o Public Safety Medical Services 324 E. New York Street E Suite 300 � Indianapolis, IN 46204 0 Carmel Police Department/CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08/15/2012 m Invoice# 00-18664 Date Employee Description Amount Balance Due 08/06/12 Deven ort Adam 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 Lytle,Blake A. 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 Veniouncture $3.14 $3.14 HIV 1 &2 Blood $13.59 $13.59 Paris. Mark 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 HIV 1 &2 Blood $522 13.59 PSA-Prostate Specific A Blood 36.59 08/09/12 Gerdt Andrew P. Quantiferon-Tb Blood 52.28 CMP(Comp Metabolic Panel 20.01 CBC Com Blood Count 18.12 Li I BI 1. Veni uncture $3.14 HIV 1 &2 Blood $13.59 PSA-Prostate S ecific A Blood $36.59 Total Charges > $586.78 Total Payments&Balance Due-> $0.00 $586.78 Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 Balance due 15 days from invoice date Prescribed by State Board of Accounts City Form No.201 (Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 08/15/12 18664 officer physicals $586.78 I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF $ 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $586.78 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 18664 43-407.01 $586.78 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 Thursday, August 23, 2012 \ Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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 08/22/2012 m Carmel, IN 46032 Invoice# 00-18710 Date Employee Description Amount Balance Due 08/17/12 Ellison Chhsto her M. 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 Treadmill-Submax $159.90 $159.90 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/Hi Ratio $3.14 $3.14 Vital Si ns-HT WT BP P R $0.00 $0.001 Vision it 7. .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 Total Charges-> $434.88 Total Payments&Balance Due-> $0.00 $434.88 Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 Balance due 15 days from invoice date prescribed by State Board of Accounts City Form No.201 (Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL 4n invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by Athom, 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)) 18710 $434.88 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF $ 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $434.88 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 24358 I 18710 I 43-407.01 I $434.88 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 AUG 2 .4 ant? Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE o Public Safety Medical Services .. 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Fire Department/CARMEFD Terms Attn: Accounts Payable 2 Civic Square Invoice Date 08/15/2012 m Carmel, IN 46032 Invoice# 00-18662 Date Employee Description Amount Balance Due 08/02/12 Mead Jr. Donald R. CCS 4-Week Referral 0.00 $0.00 08/06/12 Allen,Brad 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 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 $3.1 4 Treadmill-Submax $159.90 $159.90 Vital Sians-HT WT BP 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 Deitsch Marc 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 Body Test- I I I A 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-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 Griffin Timothy M. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.0 0 Res irator/Medical Review $16.73 $16.731 Comprehensive Physical $102.46 1 .4 Muscular Strength Endurance Test L]$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 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 $20.911 INVOICE H 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 08/15/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18662 Date Employee Description Amount Balance Due Urinalysis-Dipstick $3.14 $3.14 Holubik Steven W. CCS 4-Week Referral 0.00 0.00 Health Risk A raisal Motivation 0.00 0.00 R i i t Review 1 Comprehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance TejAnnal $27.18 $27.18 Flexibility Test 10.46 10.46 Body Fat Test-BIA Bio-Elec Imp $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 Audiornetry $14.64 $14.64 EKG W/Interp $20.91 $20.91 ri I -DOstick $3.14 $3.14 OnMed Program $0.00 $0.00 Johnson Jeremy 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 Vitai Si ns-HT WT BP P R $0.00 $0.00 Vii Acuity 7.1 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 Platt.Jace P. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $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/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 X Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD ►- Attn: Accounts Payable Terms 2 Civic Square Invoice Date 08/15/2012 m Carmel, IN 46032 Invoice# 00-18662 Date Employee Description Amount Balance Due Robinson Mitchell L. 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 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 Stren th Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat T A(Bio-Elec Imp A $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Repeat Quantiferon-Tb Blood 0.00 $0.00 Veni uncture $0.00 $0.00 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 Thordarson Erik M. 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 Stren th 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-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 VanVoorst Robert J. OnMed Pro ram $0.00 $0.00 Health Risk A raisal 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 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.501 Audiometry 14.64 $14.64 EKG W/Intero $20.91 $20.911 INVOICE H Public Safety Medical Services w 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 0 Carmel Fire Department/CARMEFD Terms Attn: Accounts Payable Invoice Date 08/15/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18662 Date Employee Description Amount Balance Due Urinalysis-Dipstick $3.14 $3.14 Hemoccult $0.00 $0.00 Viehe Richard E. OnMed Program 0.00 0.00 Health Risk Aopraisal(Motivation) $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 $10.4 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 $159.90 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 Urinalysis-Dipstick $3.14 $3.14 Walker Christopher 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 $10.4 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 Re eat CBC Com Blood Count g7. 0.00 Veiuc r .0 Chest X-Ray-PA 1 View $52.28 Vital Signs-HT WT BP P R $0.00 Vision-Acuity 27.18 PFT-Pulmonary Function Test 34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.1 4 Woodburn.Scott 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 Strenath Endurance Test 71 7.1 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 $27.181 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 � Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD �- Terms Attn: Accounts Payable Invoice Date 08115/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18662 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 Urinal sis-Dipstick $3.14 $3.14 08/07/12 Contino David 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 $102.46 Muscular Stren th Endurance Test $27.18 $27.18 Flexibilitv Test $10.46 $10.46 Body BIA B' - I I y) $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 DeCrastos Richard A. OnMed Pro ram $0.00 $0.00 Health Risk Aonraisal Motivation 0.00 0.00 Res irator/Medical Review $16.73 $16.73 Comi)rehensive Physical 1 2 4 102.4 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 $34.501 Audiometry 14.64 $14.64 EKG W/Inter 20.91 $20.91 Urinalysis-Di stick $3.14 $3.1 4 Gehlbach, Marc A. OnMed Pro 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 Vision-A uity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 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 Invoice Date 08/15/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18662 Date Employee Description Amount Balance Due Audiomet 14.64 $14.64 EKG W/Interip $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 CCS 4- k(Referral) $0.00 $0.00 Gu el Mark 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 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 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- o Function T est $34.50 $34.50 Audiometry t$20. $14.64 EKG W/Inter $20.91 Urinalysis-Dipstick 3.14 Holden,Adam D. OnMed Program $0.00 Health Risk Appraisal Motivation 0.00 Respirator/Medical Review $16.73 $16.731 Com rehensive 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 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 Marsh. Michael A. 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 $27.18 Flexibilitv 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-A Uit 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 INVOICE 0 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 08/15/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18662 Date Employee Description Amount Balance Due EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Mitchell James 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 $10.4 6 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill- max $159.90 1 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 Paddock Ronald D. OnMed Program $0.00 $0.00 Health Risk Appraisal 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 T $10.46 1 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/Inter 20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Price Jose oh P. OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.0 0 Resoirator/Medical Review 1 7 1 .7 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 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 $20.911 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 m a: Indianapolis, IN 46204 G Carmel Fire Department/CARMEFD I- Terms Attn: Accounts Payable Invoice Date 08/15/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18662 Date Employee Description Amount Balance Due Urinalysis-Di stick $3.14 $3.14 Smith Brian E. OnMed Pro ram g$16.73 0.00 Health Risk Appraisal Motivation 0.00 r t r I Review 1 7 Com rehensive Ph sical Exam $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 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 ri I si -Dipstick 3.14 $3.14 Webb,Gregory 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 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 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 $3.141 Weddin ton Kurt 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 $102.4 6 Muscular Strength Endurance Test L$14.64 27.18 Flexibility Test 10.46 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 Waist/Hi Ratio $3.14 Treadmill-Submax $159.90 $159.90 Hemoccult $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/interp $20.91 $20.911 Urinalysis-Dipstick $3.14 3.14 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 � Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD Terms Attn: Accounts Payable Invoice Date 08/15/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18662 Date Employee Description Amount Balance Due 08/08/12 Conner.Timothy L. OnMed Program $0.00 $0.0 0 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 $10.4 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 $0.001 Vision-Acuity 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 Davis.James 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 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 9 1 Vital Si ns-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 Urinal sis-Dipstick $3.14 $3.14 Knott Bruce A. OnMed Program $0.00 $0.00 Health Risk A Draisal 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 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 1 $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 Hemoccult $0.00 $0.00 Mead David L. OnMed Program $0.00 $0.00 INVOICE ►o- 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 08/15/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18662 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 Strenath 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 Audiornetry $14.64 $14.64 EKG W/Intery $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Moriarty,John F. OnMed Pro ram $0.00 $0.00 Health Risk r aisal(Motivation 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 Hemoccult $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 u $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Re noIds Shawn 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 $102.4 6 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 Sin -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 Schooler.Dustin D. OnMed Program $0.00 $0.001 Health Risk A raisal Motivation 0.00 $0.001 INVOICE 0 Public Safety Medical Services 324 E. New York Street Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD ~_ Attn: Accounts Payable Terms Invoice Date 08!15/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18662 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 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 1 . 4 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.11 4 $3.14 08/09/12 Buttler,James N. 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 Flexibility Test $10.46 $10.461 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 - ay-P 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 $3.14 $3.14 Ellison Christopher M. No Show Fee $0.00 $0.00 Fa in Timothy D. Chest X-Ray-PA 1 View 52.28 $52.28 Frye,Steven R. OnMed Pro ram $0.00 $0.00 Health Risk Armraisal Motivation 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 Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.141 Treadmill-Submax $159.90 $159.90 Chest X-Ra -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 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 08/15/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18662 Date Employee Description Amount Balance Due Urinalysis-Di stick $3.14 $3.14 Harrin ton Adam C. No Show Fee $0.00 $0.00 Hoffman Matthew F. OnMed Pro ram $0.00 $0.00 Health i Appraisal M iv io n) $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 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/ r 1 $20.91 Urinalysis-Dipstick $3.14 $3.14 Hulett, Mark A. Chest X-Ray-PA 1 View $52.28 $52.28 McNair.Travis 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 $10.4 6 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 3.14 Treadmill-Submax J$27.18 9.90 159.90 Vital Si s-HT WT BP P R .00 Vision-Acuity $27.18 PFT-Pulmona Function Test .50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Starr. GregorV 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 Strength Endurance Test $27.18 27.18 Flexibility Test $10.46 $10.46 Body Fat T est-BIA Bio- lec Imp Analy) 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 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 CD Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD ►_- Terms Attn: Accounts Payable Invoice Date 08/15/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18662 Date Employee Description Amount Balance Due EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Utzi .Todd T. 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 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 E$20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Wynn Barbara 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 $102.46 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 Audiornetry 14.64 $14.641 EKG W/Intem 20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 08/10/12 Freer Keith T. Chest X-Ray-PA 1 View 52.28 $52.28 Frost Bruce S. CCS 4-Week Referral 0.00 $0.00 Hutchison,Bri n P. Chest X-Ray-PA 1 View) 2 2.2 Love,Joseph B. CCS 4-Week Referral $0.00 $0.00 Ra ,Lucas M. Chest X-Ray-PA 1 View $52.28 $52.28 Ryan,Christo her D. Chest X-Ray-PA 1 View $52.28 $52.28 Thompson,James L. CCS 4-Week Referral $0.00 0.00 Total Charges-> $17,125.62 Total Payments&Balance Due-> $0.00 $17,125.62 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35-2079797 date Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s)or bill(s)) 18662 $17,125.62 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF $ 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $17,125.62 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members 24358 I 18662 I 43-407.01 I $17,125.62 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 AUG 2 7 2012 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE H Public Safety Medical Services = 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 Carmel Clay Parks &Recreation!CARMELPARK Terms 1411 E 116th Street Invoice Date 08/15/2012 m Carmel, IN 46032 Invoice# 00-18663 Date Employee Description Amount Balance Due 08/09/12 Walter Christine Hepatitis B Vaccination#2 $65.00 $65.00 Injection Fee 0.00 $0.00 Total Charges-> $65.00 Total Payments&Balance Due-> $0.00 $65.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 Balance due 15 days from invoice date RE CE�VED �R Alu5 17 2.012 Purchase S ink � rU Description p or F P.O.# 1 3 i_ ` 0 G.L.# ' Budget Line Descr � Z.� I I Z e Purchase Date — Approval ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 00350364 Public Safety Medical Services Terms 324 E. New York Street, Ste 300 Indianapolis, IN 46204 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO# Amount 8/15/12 18663 Medical fees $ 65.00 Total $ 65.00 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 Voucher No. Warrant No. 00350364 Public Safety Medical Services Allowed 20 324 E. New York Street, Ste 300 Indianapolis, IN 46204 In Sum of$ $ 65.00 ON ACCOUNT OF APPROPRIATION FOR 109 - Monon Center PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1091 18663 4340700 $ 65.00 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 23-Aug 2012 Signature $ 65.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund