216166 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
0 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $5,605.12
.o CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 216166
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 R4340701 25572 19399 1, 017 . 98 PHYSICALS
1110 R4340701 25572 19444 164 . 99 PHYSICALS
1110 R4340701 25572 19493 4 , 422 . 15 PHYSICALS
INVOICE
40 Public Safety Medical Services
324 E. New York Street
E Suite 300
X Indianapolis, IN 46204
o Carmel Police Department/CARMEPD
f- 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 12/13/2012
m Invoice# 00-19399
Date Employee Description Amount Balance Due
12/03/12 Barlow,James C. Veni uncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
PSA-Prostate Specific A Blood 36.59 $36.59
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
Clark Sr. Todd C. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panei $20.01 $20.01
CBC Com Blood Count 18.12 $18.12
Li id Panel(Blood) 21.2 1.2
Veni uncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
PSA-Prostate Specific A Blood 36.59 $36.59
Gilbert,William J. 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
Quantiferon-Tb Blood $52.28 $52.28
Klein Marc A. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Comip Blood Count 18.12 $18.1 2
Lipid Panel(Blood) 21. 21 2
Veni uncture $3.14 $3.14
HIV 1 &2 Blood $13.59 $13.59
PSA-Prostate Specific A Blood 36.59 $36.59
Zellers Nancy L. 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
Zellers Timothy V. Quantiferon-Tb Blood 52.28 $52.28
CMP(Comp Metabolic Panel 20.01 $20.01
CBC(Comn Blood Count 18.12 $18.121
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
12/06/12 Leach Aaron M. Quantiferon-Tb Blood 52.28 1 $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
Total Charges-> $1,017.98
Total Payments&Balance Due-> $0.00 $1,017.98
BSu1an" d u c 17 "'ay6
from invoice date
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
IY Indianapolis, IN 46204
o Carmel Police Department/CARMEPD
E— Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 12/19/2012
m Invoice# 00-19444
Date Employee Description Amount Balance Due
12/13/12 Hobson Phillip L. 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
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
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
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 12130/2012
m Invoice# 00-19493
Date Employee Description Amount Balance Due
12/17/12 Gilbert William 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
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
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-Dipstick $3.14 $3.14
Hobson.Phillip 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
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
Tonomet Glaucoma Test $37.64 $37.64
Vital Signs-HT WT BP P R $0.00 $0.001
Vision-A uit 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 W 3.14
Jellison Ryan D. No Show Fee 40.00
Miller Adam C. Vision-Acuity 27.18
PFT-Pulmonary Function Test 4.Audiomet $14.64
EKG W/Inter $20.91
Urinal sis-Di stick $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 102.46 102.46
Treadmill-Submax 159.90 159.90
Muscular Strength Endurance Test 27.18 $27.18
Flexibility Test $10.46 10.46
Body Fat Test-BIA Bio-Elec IMD Anal v) $14.64
INVOICE
0 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 12/30/2012
m Invoice# 00-19493
Date Employee Description Amount Balance Due
Waist/Hi Ratio $3.14 $3.14
Tonomet Glaucoma Test 37.64 $37.641
Vital Si ns-HT WT BP P R $0.00 $0.00
Pirics John D. ntiferon-T (Blood) 2.2
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
Zellers Timothy V. 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
Bodv Fat Test-BIA Bio-Elec Imn Anal 14.64 $14.64
Waist/Hi Ratio .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
Audiometry $14.64 $14.64
EKG W/Interp $20.91 $20.91
Urinal sis-Dipstick $3.14 $3.14
12/19/12 Barlow.James C. OnMed Program $0.00 $0.00
Health Risk Appraisal Motivation 0.00 $0.00
Res irator/Medical Review $16.73 $16.73
Comroehensive Physical Exam $102.46 $102.46
Treadmill-Submax $159.90 $159.90
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
Tonomet Glaucoma Test V27 $37.64
Vital Signs-HT WT BP P R $0.00
Vision-Acuity 27.18
PFT-Puimonar Function Test 34.50 Audiomet 14.64
EKG W/Interp $20.91 $20.91
Urinalysis-Dipstick $3.14 $3.14
Clark Sr. Todd C. 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
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
Vital Signs-HT WT BP P R $0.00 $0.00
Vision-Acuity 27.18 $27.18
INVOICE
0 Public Safety Medical Services
w 324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
o Carmel Police Department/CARMEPD
F- Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 12/30/2012
m Invoice# 00-19493
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
Urinalysis-Dipstick $3.14 $3.14
Leach Aaron M. OnMed Program $0.00 so.00l
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
Flexibility Test $10.46 $10.46
Body Fat Test-BIA Bi -Ele Im Anal 14. 4 $14.641
Waist/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/Inter 20.91 $20.91
Urinalysis-Dipstick $3.14 $3.14
McNair Harland J. OnMed Program $0.00 $0.00
Health Risk Appraisal Motivation 0.00 $0.00
Res irator/Medical Review $16.73 $16.73
m 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-Dipstick 3.14 3.14
Pirics,John D. OnMed Pro ram $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 $159.90 $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
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
H Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
o Carmel Police Department/CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 12130/2012
00 Invoice# 00-19493
Date Employee Description Amount Balance Due
EKG W/Inter 20.91 $20.91
Urinalysis-Dipstick $3.14 $3.141
Zellers Nancy L. OnMed Pro ram $0.00 $0.00
Health Risk A s I(Motivation) $0.00 $0.0
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 y) $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 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
Total Charges-> $4,422.15
Total Payments&Balance Due-> $0.00 $4,422.15
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
$5,605.12
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Prior Year Encumbered I hereby certify that the attached invoice(s), or
25572 19444 43-407.01 $164.99
Prior Year Encumbered bill(s) is (are) true and correct and that the
25572 19399 43-407.01 $1,017.98
Prior Year Encumbered materials or services itemized thereon for
25572 19493 43-407.01 $4,422.15 which charge is made were ordered and
received except
Friday, January 04, 2013
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))
12/31/12 19444 officer physicals $164.99
12/31/12 19399 officer physicals $1,017.98
12/31/12 19493 officer physicals $4,422.15
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