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Effective Date: 
7/2014

Documents

Instructions

Updated: 11/2002

Purpose

To help field staff document Drug and Alcohol Treatment/Group Living Arrangement (D&A/GLA) information that

  • logs Authorized Representative (AR) and facility information,
  • acknowledges the facility AR understands their responsibilities, and
  • acknowledges the facility AR's receipt of required facility use forms and information.

Procedure

When to Prepare

The Texas Works advisor completes parts A, B, and C of Form H1846 anytime a new AR represents a facility. Parts A and C are completed at every certification and recertification.

Number of Copies

Complete one original and one copy.

Transmittal

Provide the original to the facility.

Form Retention

File a copy in the facility's case file.

Detailed Instructions

The form is self-explanatory.