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215153 12/04/2012 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: $6,638.81 INDIANAPOLIS IN 46204 CHECK NUMBER: 215153 CHECK DATE: 121412012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 19261 2 , 864 . 76 MEDICAL EXAM FEES 1110 4340701 19306 3 , 774 . 05 MEDICAL EXAM FEES INVOICE H Public Safety Medical Services .= 324 E. New York Street E Suite 300 M Indianapolis, IN 46204 C Carmel Police Department/CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 11/20/2012 m Invoice# 00-19261 Date Employee Description Amount Balance Due 11/14/12 Bickel Joseph 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 Treadmill-Submax $159.90 $159.90 Muscular Stren 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 Tonomet Glaucoma Test 37.64 $37.64 Vital Sin -HT WT BP P R $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 Cash Steven H. 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 W i Hi Ratio $3.14 $3.14 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/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.1 4 Horner Jeffrey J. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.731 Com rehensive Physical Exam $102.46 $102.46 Treadmill-Submax $159.90 $159.90 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 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 Keith Brett A. OnMed Program $0.00 $0.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 tY Indianapolis, IN 46204 G Carmel Police Department/CARMEPD F- 3 Civic Square Terms Carmel, IN 46032 Invoice Date 1112012012 m Invoice# 00-19261 Date Employee Description Amount Balance Due Health Risk Appraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Treadmill-Submax $159.90 Flexibilitv Test $10.46 $10.46 BodV Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Tonomet Glaucoma Test 37.64 $37.64 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Inter 20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Kinkade Matthew P. No Show Fee $40.00 $40.00 McAllister,Jo n 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 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 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 WL[Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Meyer,Ryan J. Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Treadmill-Submax $159.90 $159.90 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 Tonomet Glaucoma Test 37.64 $37.64 Vital Signs-HT WT BP P R $0.00 $0.001 Vision-Acuity 27.18 $27.18 PT-P m Function Test $34.50 $34.50 AudiometrV $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 OnMed Program $0.00 $0.00 Smiley,Landry D. 1 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review. $16.73 $16.73 INVOICE o 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 11/20/2012 m Invoice# 00-19261 Date Employee Description MAnaly) $14.64 Balance Due Comprehensive Physical Exam 102.46 Treadmill-Submax $159.90 Flexibility Test 10.46 Body Fat Test-BIA Bio-Elec $14.64 Waist/Hi Ratio $3.14 $3.14 Tonomet Glaucoma Test 37.64 $37.64 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 Audiometry 14.64 $14.64 EKG W Inter Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Total Charges-> $2,864.76 Total Payments&Balance Due-> $0.00 $2,864.76 Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 Balance due 15 days from Invoice date INVOICE to- Public Safety Medical Services 324 E. New York Street E Suite 300 ix Indianapolis, IN 46204 C Carmel Police Department/CARMEPD ►- Terms 3 Civic Square Carmel, IN 46032 Invoice Date 11/28/2012 m Invoice# 00-19306 Date Employee Description Amount Balance Due 11/19/12 Carev, Luckie 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 [136.59 26 21.26 Veni uncture 14 3.14 PSA-Prostate Specific A Blood 36.59 Green Timoth J. Quantiferon-Tb Blood 28 52.28 CMP Com Metabolic Panel 01 $20.01 CBC(Comp Blood Count 18.12 $18.12 Li id Panel Blood 21.26 $21.26 Venipuncture $3.14 $3.14 HIV 1 &2 Blood $13.59 $13.59 PSA-Prostate Specific A Blood $36.59 $36.59 Jellison Ryan D. 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 $36.59 McNair Harland J. Quantiferon-Tb Blood 52.28 $52.28 CMP(Comp Metabolic Panel 20.01 $20.01 CBC(Comp Blood Count 18.12 $18.1 2 Lipid Panel Blood 21.26 $21.26 V ni n ture $3.14 HIV 1 &2 Blood $13.59 $13.59 PSA-Prostate Specific A Blood $36.59 $36.59 Miller Adam C. Quantiferon-Tb Blood 52.28 $52.28 CMP(Comp Metabolic Panel 20.01 $20.01 CBC Com p Blood Count 18.12 $18.1 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 Cholinesterase-RBC&Plasma Error 0.00 $0.00 11/20/12 Barlow Cody J. OnMed Program $0.00 $0.00 Health Risk Apbraisal(Motivation) $0 0 $0.00 Respirator/Medical Review $16.73 $16.73 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 $10.461 BodV Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Tonomet Glaucoma Test 37.64 $37.64 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 34.50 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Police Department/CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 11/28/2012 m Invoice# 00-19306 Date Employee Description Amount Balance Due Audiometry 14.64 $14.64 EKG W/Inter 20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Brady, n P. OnMed Pr oaram $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 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 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Carey, Luckie 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 Treadmill-Submax $159.90 $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 T n met I uc m Test) 37.64 7.64 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/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Graham Bruce 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 $10.46 Body Fat Test-BIA(Bio-Elec 1mg Anal $14,64 $14,64 Waist/Hi Ratio $3.14 $3.14 Tonomet Glaucoma Test $37.64 $37.64 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 1 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Inter 20.91 $20.91 INVOICE H Public Safety Medical Services = 324 E. New York Street E Suite 300 � Indianapolis, IN 46204 o Carmel Police Department/CARMEPD �- Terms 3 Civic Square Carmel, IN 46032 Invoice Date 11/28/2012 m Invoice# 00-19306 Date Employee Description Amount Balance Due Urinalysis-Dipstick $3.14 $3.14 Green Timothy 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 Treadmill-Submax $159.90 159.90 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 Tonomet Glaucoma Test 37.64 $37.64 Vital Signs-HT WT BP P R $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 Howard Lana M. 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 Flexibility Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Imo Anal 14.64 $14.64 Waist]Hio Ratio $3.14 $3.14 Tonomet Glaucoma Test $37.64 $37.64 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 OnMed Program $0.00 0:00 Health Risk Appraisal Motivation 0.00 $0.00 Klein Marc A. OnMed Program $0.00 $0.00 Health Risk Aooraisal Motivation 0.00 $0.00 Respirator/Medical R vi w $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Treadmill-Submax $159.90 $159.90 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 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 $14.641 EKG W/Inter 20.91 20.91 INVOICE o 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 11!2812012 m Invoice# 00-19306 Date Employee Description Amount Balance Due Urinalysis-Dipstick $3.14 $3.14 Total Charges-> $3,774.05 Total Payments&Balance Due-> $0.00 $3,774.05 Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF $ 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $6,638.81 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. J ACCT#/TITLE AMOUNT Board Members 1110 19261 43-407.01 $2,864.76 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 19306 43-407.01 $3,774.05 materials or services itemized thereon for which charge is made were ordered and received except /Friday, November 30, 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)) 11/20/12 19261 officer physicals $2,864.76 11/28/12 19306 officer physicals $3,774.05 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