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Home My WebLink About212745 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $7,365.65 INDIANAPOLIS IN 46204 CHECK NUMBER: 212745 CHECK DATE: 9/1212012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 18711 2, 458 . 60 MEDICAL EXAM FEES 1120 4340701 24358 18759 487 . 16 PHYSICALS 1110 4340701 18760 4 , 419 . 89 MEDICAL EXAM FEES INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department/CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08/22/2012 m Invoice# 00-18711 Date Employee Description Amount Balance Due 08/13/12 Schmidt 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 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 08/16/12 Collins Larry J. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.731 m r hen b 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 1 $159.90 Tonomet Glaucoma Test 37.64 $37.64 'Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Inter 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Deven ort,Adam 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 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 Tonometr Glaucoma Test 37.64 $37.64 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pjjlaonary Function Test $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Hep B Titer SAb-Quantitative Blood 36.59 $36.59 Veni uncture $3.14 $3.14 Dewald Gregory 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 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 a) W Indianapolis, IN 46204 C Carmel Police Department/CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08/22/2012 00 Invoice# 00-18711 Date Employee Description Amount Balance Due Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Tonomet Glaucoma Test 37.64 $37.64 Vital Sians-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Hedrick Brad 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 $102.46 Flexibility Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hit)Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Tonomet Glaucoma Test $37.64 $37.64 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 20.91 Urinalysis-Dipstick $3.14 $3.14 Paris Mark J. OnMed Program $0.00 $0.00 Health Risk Apnraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Comwehensive Physical Exam $102.46 $102.46 Flexibility Test $10.46 $10.46 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill-Submax $159.90 $159.90 Tonomet Glaucoma Test 37.64 $37.64 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/Inter 20.91 $20.91 Urinalysis-Di stick $3.14 3.14 Total Charges-> $2,458.60 Total Payments&Balance Due-> $0.00 $2,458.60 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35-2079797 date INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 a) w Indianapolis, IN 46204 G Carmel Police Department/CARMEPD �- 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08/28/2012 m Invoice# 00-18760 Date Employee Description Amount Balance Due 08/20/12 Bowman Gary A. Quantiferon-Tb Blood $52.28 $52.28 CMP(Comp Metabolic Panel 20.01 $20.01 CBC(Comp Blood Count 18.12 $18.1 2 Lipid Panel Blood 21.26 $21.26 Veni uncture 114 $3.14 HIV 1 &2 Blood 13.59 $13.59 PSA-Prostate Specific A Blood 36.59 $36.59 Grose James E. Veni uncture $3.14 $3.14 HIV 1 &2 Blood 13.59 $13.591 Quantiferon-Tb Blood $52.28 $52.28 P(Como Metabolic Panel) 20. 1 $20.01 CBC(ComP Blood Count $18.12 $18.12 Lipid Panel Blood $21.26 $21.26 Locke, Robert E. CMP(Comp Metabolic Panel 20.01 $20.01 CBC(Comp Blood Count 18.12 $18.12 Lipid Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 &2 Blood 13.59 $13.59 PSA-Prostate Specific A Blood 36.59 $36.59 uantiferon-Tb Blood 52.28 $52.28 McIntyre,Trent A. Quantiferon-Tb Blood 52.28 $52.28 CMP Com Metabolic Panel 20.01 $20.01 CBC(Como Blood Count) $18.12 $18.1 Lipid Panel Blood $21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 &2 Blood 13.59 $13.59 Rush Michael T. Quantiferon-Tb Blood 52.28 $52.2B CMP(Comp Metabolic Panel 20.01 $20.01 CBC(Comp Blood Count 18.12 $18.1 2 Li id Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.141 HIV 1 &2 Blood 13.59 $13.59 08123112 Bowman Gary A. OnMed Pro ram $0.00 $0.00 Health Risk Aooraisal Motivation 0.00 $0.00 Res-pirator/Medical Review 1 .7 16.7 Comprehensive Physical Exam $102.46 $102.46 Flexibility Test K159.90 $10.46 Bod Fat Test-BIA Bio-Elec Imp Anal 14.64 Waist/Hi Ratio 3.14 Treadmill-Submax $159.90 Tonomet Glaucoma Test 37.64 $37.64 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Intero $20.91 20.91 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 08/28/2012 m Invoice# 00-18760 Date Employee Description Amount Balance Due Urinalysis-Di stick $3.14 $3.14 Broadnax Matthew L. Com rehensive Physical Exam g$14.64 102.46 Flexibility Test 10.46 Body F Test-BA i - I Imp n l 1 4 Waist/Hi Ratio $3.14 Treadmill-Submax $159.90 $159.90 Tonomet Glaucoma Test 37.64 $37.64 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-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-Di stick $3.14 $3.14 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Resnirator/Medical Review 1 .7 1 .7 Haymaker,William 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 Flexibilitv Test 10.46 10.46 BodV Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hip Ratio 3.14 $3.141 Treadmill-Submax $159.90 $159.90 Tonomet Glaucoma Test 37.64 $37.64 Vital 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 Locke Robert E. 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 $102.4 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 $159.90 $159.90 T nom t (Glaucoma T 37.64 $37.64 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity $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 Lytle. Blake A. I OnMed Program $0.00 $0.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street �. Suite 300 d W. Indianapolis, IN 46204 C Carmel Police Department/CARMEPD I- 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08/28/2012 m Invoice# 00-18760 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 Flexibilitv Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.1 4 Treadmill-Submax $159.90 $159.90 Tonomet Glaucoma Test 37.64 $37.64 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 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 Rush. Michael 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 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 Treadmill-Submax $159.90 $159.9 0 T n et (Glaucoma Test) $37.64 $37.64 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiornetry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Schmidt Brian E. Waist/Hi Ratio $3.14 $3.14 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 Treadmill-Submax $159.90 $159.90 Tonomet Glaucoma Test $37.64 $37.64 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.181 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 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 Vanderbeck David R. OnMed Pro ram $0.00 $0.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 CD Indianapolis, IN 46204 C Carmel Police Department/CARMEPD E- Terms 3 Civic Square Carmel, IN 46032 Invoice Date 08/28/2012 m Invoice# 00-18760 Date Employee Description Amount Balance Due Health Risk ADoraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 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 Tonomet Glaucoma Test 37.64 $37.64 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 34.50 Audiornetry $14.64 $14.64 EKG W/Interip $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 08/24/12 Matthews Daniel M. guantiferon-Tb Blood 52.28 $52.281 P(Corno Metabolic Panel) $20.01 $20.01 CBC Com p Blood Count $18.12 $18.12 Lipid Panel Blood $21.26 $21.26 Veni uncture $3.14 $3.14 Total Charges-> $4,419.89 Total Payments&Balance Due-> $0.00 $4,419.89 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 $6,878.49 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 18711 43-407.01 $2,458.60 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 18760 43-407.01 $4,419.89 materials or services itemized thereon for which charge is made were ordered and received except Friday, September 07, 2012 ,-5--!,5.e 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)) 08/22/12 18711 officer physicals $2,458.60 08/28/12 18760 officer physicals $4,419.89 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 Fire Department/CARMEFD F- Attn: Accounts Payable Terms Invoice Date 08/28/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18759 Date Employee Description Amount Balance Due 08/21/12 Freer Keith T. Chest X-Ray(Comparison) 0.00 $0.00 Harrington,Adam C. 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 $16.73 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/Hip 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-A uit 27.18 27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 Total Charges > 1 $487.16 Total Payments&Balance Due-> $0.00 $487.16 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 $487.16 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members 24358 I 18759 I 43-407.01 I $487.16 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 SEP 1 0 2012 < Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No.201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 18759 $487.16 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