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Home My WebLink About213152 09/25/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $7,956.19 y,�•io CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 213152 CHECK DATE: 9/25/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 24358 18811 79 . 00 PHYSICALS 1081 4340700 18812 65 . 00 MEDICAL FEES 1110 4340701 18813 3 , 718 . 30 MEDICAL EXAM FEES 1120 4340701 24358 18853 869 . 76 PHYSICALS 1120 4340701 24358 18897 3 , 224 . 13 PHYSICALS INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 c Carmel Clay Parks & Recreation/CARMELPARK 1411E 116th Street Terms Carmel, IN 46032 Invoice Date 09/05/2012 m Invoice# 00-18812 Date Employee Description Amount I Balance Due 08/29/12 Hammons Jennifer L. Hepatitis B Vaccination#2 $65.00 65.00 In ection Fee $0.00 $0.001 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 Purchase Description P.O.# PorF Line-bescr I S FF 7 2012 Purchas Date 2— Approval Date 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. Terms 00350364 Public Safety Medical Services 324 E. New York Street, Ste 300 Indianapolis, IN 46204 Invoice Invoice Description PO# Amount Date Number (or note attached invoice(s) or bill(s)) $ 65.00 9/5/12 18812 Medical fees gTotal 65.00 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. 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 108 - ESE PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1081-99 18812 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 20-Sep 2012 Signature $ 65.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund INVOICE t° Public Safety Medical Services = 324 E. New York Street E Suite 300 � Indianapolis, IN 46204 C Carmel Police Department/CARMEPD '�- Terms 3 Civic Square Carmel, IN 46032 Invoice Date 09/0512012 m Invoice# 00-18813 Date Employee Description Amount Balance Due 08/28/12 Rodriguez,Cristhian R. Quantiferon-Tb Blood 52.28 $52.28 CMP(Comp Metabolic Panel $20.01 $20.01 CBC(Comp Blood Count $18.12 $18.1 2 Lipid Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 &2 Blood 13.59 $13.59 08/29/12 Amos Chad B. 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/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/Intern $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Gerdt Andrew P. OnMed Pro ram $0.00 $0.00 Health R' k Appraisal(Motivation Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Flexibility Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Imp 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 Intero $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Grose,James 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 Flexibility Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.141 Treadmill-Submax $159.90 159.90 Tonomet ry(Glaucoma Test 37.64 37.64 Vital Si ns-HT WT BP P R $0.00 0.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 tY Indianapolis, IN 46204 o Carmel Police Department!CARMEPD E- 3 Civic Square Terms Carmel, IN 46032 Invoice Date 09/05/2012 m Invoice# 00-18813 Date Employee Description Amount Balance Due Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Harris Robert 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 $102.4 6 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 Tonomet Glaucoma Test 37.64 $37.64 Vital Sian -HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 7.1 PFT-Pulmonary Function Test $34.50 $34.50 AudiometrV $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Matthews Daniel 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 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 Tonometr 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 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.1 4 McIntyre,Trent A. OnMed Program 0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Com r hensive Physical Exam $102.46 102.46 Flex' Test 1 .4 1 .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-A uit 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 INVOICE 0 Public Safety Medical Services = 324 E. New York Street E Suite 300 x Indianapolis, IN 46204 G Carmel Police Department/CARMEPD 'F- 3 Civic Square Terms Carmel, IN 46032 Invoice Date 09/0512012 m Invoice# 00-18813 Date Employee Description Amount Balance Due Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Rodriguez,Cristhian R. 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 Imo Anal 14.64 $14.64 Waist/Hip Ratio .1 .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 Spillman, R. Scott OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Comoreh nsive Physical Exam $102.46 .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 Tonomet Glaucoma Test 37.64 $37.64 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/Inter 20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Total Charges > $3,718.30 Total Payments&Balance Due > $0.00 $3,718.30 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)) 09/05/12 18813 officer physicals $3,718.30 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 E. New York Street, Suite 300 Indianapolis, IN 46204 $3,718.30 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 I 18813 I 43-407.01 $3,718.30 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, September 21, 2012 Chief of Police 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 Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD f— Terms Attn: Accounts Payable 2 Civic Square Invoice Date 09/05/2012 CD Carmel, IN 46032 Invoice# 00-18811 Date Employee Description Amount Balance Due 08/15112 1 Small.Thomas D. CCS 4-Week Results $79.00 79.00 Total Charges-> $79.00 Total Payments&Balance Due > $0.00 $79.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35-2079797 date INVOICE 0 Public Safety Medical Services = 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD t Attn: Accounts Payable Terms Invoice Date 09112/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18853 Date Employee Description Amount Balance Due 09/04/12 Keaton Anthony R. 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 Treadmill-Submax $159.9 0 159.90 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 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 7. 27 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 Lenze.Theodore 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 E$27.18 102.46 Treadmill-Submax 159.90 Muscular Strength Endurance Test 27.18 Flexibilit Test $10.4 6 Bodv Fat Test- IA(Bio-Elec Imp Anal 14. 4 $14.64 Waist/Hi Ratio $3.14 $3.14 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-Di stick $3.14 $3.14 Total Charges-> $869.76 Total Payments&Balance Due-> $0.00 $869:76 Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 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 �_- Attn: Accounts Payable Terms 2 Civic Square Invoice Date 09/1912012 m Carmel, IN 46032 Invoice# 00-18897 Date Employee Description Amount Balance Due 08/31/12 Bowles,Orbie H. CCS 4-Week Results 79.00 $79.00 09/04/12 Thompson,James L. CCS 4-Week Results 79.00 $79.0 0 Stress Echo CCS 375.00 $375.00 09/12/12 Condra. K le E. Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.1 4 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 Treadmill-Submax $159.90 1 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 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 Hoover Anthony B. Com rehensive Physical 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 BQdy Fat Test-BIA(Bio-Elec imp Anal 14. 4 $14.64 Waist/Hi Ratio $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 $3.141 OnMed Program $0.00 $0.00 Health Risk Aonraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 McNab John D. EKG W/Inter 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 Comprehensive Physical Exam $102.46 $102.4 6 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 Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3,14 Chest X-Ray-P LAT Di ital 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 INVOICE r° Public Safety Medical Services 324 E. New York Street - E Suite 300 W Indianapolis, IN 46204 Carmel Fire Department/CARMEFD Terms Attn: Accounts Payable 2 Civic Square Invoice Date 09/19/2012 m Carmel, IN 46032 Invoice# 00-18897 Date Employee Description Amount Balance Due Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 Workman,William J. OnMed Pr r m Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Treadmill-Submax $159.90 $159.90 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 $3.141 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 Audi m t 14. 4 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 09/13/12 Love Joseph B. CCS 4-Week Results $79.00 $79.00 Stress Echo(CCS) $375.00 $375.00 09/14/12 Maroon. Ernie R. 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 Treadmill-Submax $159.90 $159.90 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body F t T t- IA(Bio-Elec Imp Anal 14. 4 $14.64 Waist/Hi Ratio $3.14 $3.14 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 $14.641 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Total Charges-> $3,224.13 Total Payments&Balance Due-> $0.00 $3,224.13 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) AC(_-"OUN_T.v PAYABLE VOUCHER CITY OF CARMEL All Invoice or bil! io be proj)crl !ic!1lIZCd :1iUSi ShOVY! !Und of service, vvhere perior!11ed, date-, service rendered, by whom, rai^ _gay, nun"i: cr ni ilcurs, r;>i : her Hour, nL:rlber of uniis, 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)) 18897 $3,224.13 18811 $79.00 18853 I I $869.76 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. VVARRAN T NO. ALLOWED 20_ Public Safety Medical Services IN SUM OF $ 321 East N!ew York S`reet, Ste. 300 —_ --- - - -- ----- - - --- --- Indianapolis, IN 46204 $4,172.89 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/De . WfVOICE NO. ACCT#/TITLE AMOUNT Board Members 24358 18897 43-407.01 $3,224.13 1 hereby certify that the attached invoice(s), or 24358 18811 43-407.01 $79.00 bill(s) is (are) true and correct and that the 24358 I 18853 I 43-407.01 I $869.76 materials or services itemized thereon for which charge is made were ordered and received except SEP 2 4 2912 r �tl Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund