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[]
[]
[]
["Discharge Assistance Project- Individual DAP PLAN (IDAPP)"]
["RFD Date",null,null," Plan Type: ",null,null,"Plan Start Date",null,null,"Plan End Date"]
["First Name",null,null,"Last Name",null,null,"Legal Status:",null,null,"ID/DD            "]
["State Hospital",null,null,"Patient ID #",null,null,"State Hospital Admission Date",null,null,"State Hospital Discharge Date"]
["DAP CSB",null,null,"CSB ID#",null,null,"Out of Region:",null,null,"Transfer Due Date",null,{"$f":"IF(OR(I8=\"Region 1\",I8=\"Region 2\",I8=\"Region 3\",I8=\"Region 3.a\",I8=\"Region 3.b\",I8=\"Region 4\",I8=\"Region 5\"),EDATE(L7,6),\"\")","v":""}]
["Insurance Plan",null,null,"Insurance Plan Type",null,null,null,"Income Type",null,"Total Amount Per Month"]
[]
[]
["Code","Core Service Category/Subcategory",null,null,"Notes",null,"Projected Months Needed","Unit Cost","Projected Annual Units","Projected Annual Cost","Projected Other Funds          (medicaid, etc.)","Self Pay ","IDAPP Cost"]
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[null,"OTHER - ",null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER  - ",null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER -",null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER",null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER",null,null,null,null,null,null,null,0,null,null,0]
[null,"TOTAL",null,null,null,null,null,null,null,{"$f":"SUM(J13:J25)","v":0},{"$f":"SUM(K13:K25)","v":0},{"$f":"SUM(L13:L25)","v":0},{"$f":"J26-SUM(K26:L26)","v":0}]
[]
[null,null,null,null,null,null,null,null,null,null,"Regional DAP",{"$f":"M26","v":0}]
[]
["Requested by:",null,null,null,null,null,"Title:",null,null,null,"Date:"]
[]
["Regional Approval:",null,"Name:",null,null,null,"Title:",null,null,null,"Date:"]
[]
["Confidentiality Notice: This document contains confidential health information that is legally privileged and intended only for the use of or by the entity named above.  Redisclosure, copying, distribution or actions taken in reliance on the contents of this document is strictly prohibited.   (version 04-25-2019)"]
[]
[]
[]
[]
[]
[]
[]
[]
["Discharge Assistance Project- Individual DAP PLAN (IDAPP)"]
["RFD Date",null,null," Plan Type: ",null,null,"Plan Start Date",null,null,"Plan End Date"]
["First Name",null,null,"Last Name",null,null,"Legal Status:",null,null,"ID/DD            "]
["State Hospital",null,null,"Patient ID #",null,null,"State Hospital Admission Date",null,null,"State Hospital Discharge Date"]
["DAP CSB",null,null,"CSB ID#",null,null,"Out of Region:",null,null,"Transfer Due Date",null,{"$f":"IF(OR(I47=\"Region 1\",I47=\"Region 2\",I47=\"Region 3\",I47=\"Region 3.a\",I47=\"Region 3.b\",I47 = \"Region 4\",I47=\"Region 5\"),EDATE(L46,6),\"\")","v":""}]
["Insurance Plan",null,null,"Insurance Plan Type",null,null,null,"Income Type",null,"Total Amount Per Month"]
[]
[]
["Code","Core Service Category/Subcategory",null,null,"Notes",null,"Projected Months Needed","Unit Cost","Projected Annual Units","Projected Annual Cost","Projected Other Funds          (medicaid, etc.)","Self Pay ","IDAPP Cost"]
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[{"$f":"IF(ISNA(VLOOKUP(B58,Dropdowns!A2:B22,2,FALSE)),\"\",VLOOKUP(B58,Dropdowns!A2:B22,2,FALSE))","v":""},null,null,null,null,null,null,null,null,0,null,null,0]
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[null,"OTHER - ",null,null,null,null,null,null,null,0,null,null,0]
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[null,"OTHER",null,null,null,null,null,null,null,0,null,null,0]
[null,"OTHER",null,null,null,null,null,null,null,0,null,null,0]
[null,"TOTAL",null,null,null,null,null,null,null,{"$f":"SUM(J52:J64)","v":0},{"$f":"SUM(K52:K64)","v":0},{"$f":"SUM(L52:L64)","v":0},{"$f":"J65-SUM(K65:L65)","v":0}]
[]
[null,null,null,null,null,null,null,null,null,null,"Regional DAP",{"$f":"M65","v":0}]
[]
["Requested by:",null,null,null,null,null,"Title:",null,null,null,"Date:"]
[]
["Regional Approval:",null,"Name:",null,null,null,"Title:",null,null,null,"Date:"]
[]
["Confidentiality Notice: This document contains confidential health information that is legally privileged and intended only for the use of or by the entity named above.  Redisclosure, copying, distribution or actions taken in reliance on the contents of this document is strictly prohibited.   (version 04-25-2019)"]

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["CSB Information",null,"Individual Identifying Information      ",null,null,"State Hospital (S.H.) Information",null,"S.H. Episode Dates",null,"DAP Dates",null,null,"DAP Plan Funding"]
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["Category","Code",null,"CSB",null,"Hospitals",null,"Medicaid","Medicare","Private Insurance ","Other ",null,null,null,null,"CSB","CODE"]
["Outpatient",310,null,"Alexandria",null,"Catawba",null,"QMB","A only",null,null,null,"No",null,null,"Alexandria",1]
["Case Management",320,null,"Alleghany Highlands",null,"CSH ",null,"Spend Down","B only",null,null,null,"Region 1",null,null,"Alleghany Highlands",3]
["Assertive Community Treatment",350,null,"Arlington",null,"ESH",null,"Pending","C only",null,null,null,"Region 2",null,null,"Arlington",5]
["Day Treatment/Partial Hospitilization",410,null,"Blue Ridge",null,"NVMHI",null,"Medicaid","D only",null,null,null,"Region 3",null,null,"Blue Ridge",67]
["Rehabilitation/Habilitation",425,null,"Chesapeake",null,"PGH",null,null,"A, B, C, D",null,null,null,"Region 3.a",null,null,"Chesapeake",9]
["Sheltered Employment",430,null,"Chesterfield",null,"SVMHI",null,null,"A, B, C",null,null,null,"Region 3.b",null,null,"Chesterfield",11]
["Ind Supported Emp",460,null,"Colonial",null,"SWVMHI",null,null,"A, B, D",null,null,null,"Region 4",null,null,"Colonial",13]
["Group Supported Emp",465,null,"Crossroads",null,"WSH",null,null,"A, C, D",null,null,null,"Region 5",null,null,"Crossroads",15]
["Highly Intensive Residential\n    • Nursing Home",501,null,"Cumberland Mt.",null,null,null,null,"A, B",null,null,null,null,null,null,"Cumberland Mt.",17]
["Highly Intensive Residential\n    • ICF",501,null,"Danville-Pittsylvania",null,null,null,null,"A, C",null,null,null,null,null,null,"Danville-Pittsylvania",19]
["Highly Intensive Residential    \n  • Substance Use Detox",501,null,"Dickenson County",null,null,null,null,"A, D",null,null,null,null,null,null,"Dickenson County",20]
["Highly Intensive Residential    \n  • Other",501,null,"District 19",null,null,null,null,"B, C, D",null,null,null,null,null,null,"District 19",53]
["Intensive Residential\n    • Group Home",521,null,"Eastern Shore",null,null,null,null,"B, C",null,null,null,null,null,null,"Eastern Shore",21]
["Intensive Residential\n    • Substance Use Rehabilitation",521,null,"Fairfax-Falls Church",null,null,null,null,"B, D",null,null,null,null,null,null,"Fairfax-Falls Church",23]
["Supervised Residential\n    • Supervised Apartments",551,null,"Goochland-Powhatan",null,null,null,null,"C, D ",null,null,null,null,null,null,"Goochland-Powhatan",25]
["Supervised Residential\n    • ALF",551,null,"Hampton-Newport News",null,null,null,null,null,null,null,null,null,null,null,"Hampton-Newport News",27]
["Supervised Residential\n    • Sponsor Home",551,null,"Hanover",null,null,null,null,null,null,null,null,null,null,null,"Hanover",29]
["Supervised Residential\n    • Emergency Shelter",551,null,"Harrisonburg-Rockingham",null,null,null,null,null,null,null,null,null,null,null,"Harrisonburg-Rockingham",31]
["Supportive Residential\n    • PSH",581,null,"Henrico",null,null,null,null,null,null,null,null,null,null,null,"Henrico",33]
["Supportive Residential\n    • In-Home Supports",581,null,"Highlands",null,null,null,null,null,null,null,null,null,null,null,"Highlands",35]
["Assessment & Evaluation",720,null,"Horizon",null,null,null,null,null,null,null,null,null,null,null,"Horizon",7]
[null,null,null,"Loudoun",null,null,null,null,null,null,null,null,null,null,null,"Loudoun",37]
[null,null,null,"MPNN",null,null,null,null,null,null,null,null,null,null,null,"MPNN",39]
[null,null,null,"Mount Rogers",null,null,null,null,null,null,null,null,null,null,null,"Mount Rogers",41]
[null,null,null,"New River Valley",null,null,null,null,null,null,null,null,null,null,null,"New River Valley",43]
[null,null,null,"Norfolk",null,null,null,null,null,null,null,null,null,null,null,"Norfolk",45]
[null,null,null,"Northwestern",null,null,null,null,null,null,null,null,null,null,null,"Northwestern",47]
[null,null,null,"Piedmont",null,null,null,null,null,null,null,null,null,null,null,"Piedmont",51]
[null,null,null,"Planning District One",null,null,null,null,null,null,null,null,null,null,null,"Planning District One",49]
[null,null,null,"Portsmouth",null,null,null,null,null,null,null,null,null,null,null,"Portsmouth",55]
[null,null,null,"Prince William ",null,null,null,null,null,null,null,null,null,null,null,"Prince William ",57]
[null,null,null,"Rappahannock Area",null,null,null,null,null,null,null,null,null,null,null,"Rappahannock Area",59]
[null,null,null,"Rappahannock-Rapidan",null,null,null,null,null,null,null,null,null,null,null,"Rappahannock-Rapidan",61]
[null,null,null,"Region Ten",null,null,null,null,null,null,null,null,null,null,null,"Region Ten",63]
[null,null,null,"Richmond",null,null,null,null,null,null,null,null,null,null,null,"Richmond",65]
[null,null,null,"Rockbridge Area",null,null,null,null,null,null,null,null,null,null,null,"Rockbridge Area",69]
[null,null,null,"Southside",null,null,null,null,null,null,null,null,null,null,null,"Southside",71]
[null,null,null,"Valley",null,null,null,null,null,null,null,null,null,null,null,"Valley",73]
[null,null,null,"Virginia Beach",null,null,null,null,null,null,null,null,null,null,null,"Virginia Beach",75]
[null,null,null,"Western Tidewater",null,null,null,null,null,null,null,null,null,null,null,"Western Tidewater",77]