HomeMy WebLinkAbout225090 10/08/2013 CITY OF CARMEL, INDIANA VENDOR: 365641 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL
ig o CARMEL, INDIANA 46032 HEALTH INFORMATION MANAGEMENT CHECK AMOUNT: $173.25
p; ON 00 2001 W 86TH STREET CHECK NUMBER: 225090
INDIANAPOLIS IN 46260
CHECK DATE: 10/8/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4358200 64261 173 .25 SPECIAL INVESTIGATION
I
St. Vincent Hospitals Invoice No
Indianapolis,Carmel & Fishers 64261
2001 W. 86th Street
Indianapolis, IN 46260
( 317 ) 338-2216 Tax ID:35-0869066
Date: 09/25/2013
To: Hamilton County Prosecutor's Office
Carmel Police Department
3 Civil Square
Carmel, IN 46032
Attn: David Henry
i3-iAH3
Patient: Ronald Monday
Request No Invoice No Medical Record No Date Received Date Sent
M156560 64261 0002296684 09/25/2013 09/25/2013 Pages/Time Charges
Photocopy 583 173.25
To ensure payment is posted
correctly please include copy of
our invoice and send Attn : Health
Information Management Department
Sales Tax 0.00
Total Billed $173.25
Amount Paid 0.00
Document Date
Start End Description Balance $173.25
08/16/2013 09/05/2013 Abstract, Orders, Progress N. Nursing Notes
To ensure proper posting of payment, please send Attn: Health Information Management
I
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))
09/25/13 64261 investigation 13-42893 $173.25
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
St. Vincent Hospital
Health Information Management
IN SUM OF $
2001 W. 86th Street
Indianapolis, IN 46260
$173.25
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 64261 43-582.00 I $173.25
I hereby certify that the attached invoice(s), or
I I
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, October 03, 2013
41ZI Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund