> ## Documentation Index
> Fetch the complete documentation index at: https://help.clinikehr.com/llms.txt
> Use this file to discover all available pages before exploring further.
# DOT and workplace drug testing
> How your lab runs federally regulated workplace drug testing — the four workflow modes, the specimen lifecycle, and where each step happens.
export const Path = ({steps = []}) =>
{steps.map((s, i) =>
{i > 0 ?
›
: null}
{s}
)}
;
export const Availability = ({editions = ['all'], plans, roles, note}) => {
const list = editions.includes('all') ? ['clinic', 'pharmacy', 'lims'] : editions;
return
Available in
{list.map(e =>
{EDITION_LABELS[e] || e}
)}
{plans ? Plan : null}
{plans ? {plans} : null}
{roles ? Who : null}
{roles ? {roles} : null}
{note ? {note} : null}
;
};
Workplace drug testing is not clinical lab work with different paperwork. It is a regulated chain that a lawyer may read years later, and every stage of it — who held the specimen, which seal was intact, which cutoff a value was measured against, who certified the result — has to survive that reading. ClinikEHR's DOT-LIMS module is built around that chain rather than around the result.
This section covers the whole lifecycle for a diagnostic centre running Department of Transportation and SAMHSA-regulated testing, and the lighter reference-lab variant for labs that only receive and report.
## Choose how your lab runs
The module has four shapes, set once by an owner or manager. The card is titled **Lab Workflow** and explains itself: "Determines which laboratory module is shown to your staff. Switching modes does not delete any data — orders remain in their original workflow."
| Mode | What it gives you |
| ------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| **Standard Clinical Lab** | "In-house lab orders for clinical care. No DOT-specific workflow." The DOT entries are hidden from the sidebar entirely. |
| **DOT / SAMHSA — Full Workflow** | "End-to-end federal workplace drug testing: collection → laboratory → MRO review → DER reporting." |
| **Reference Lab — Intake to Report Only** (carries a **New** badge) | "For laboratories that receive sealed specimens from external collection sites and produce a PDF report for an external MRO. Hides collection, MRO, and DER modules." |
| **Both — Standard + DOT Full Workflow** | "Clinics that do both in-house clinical lab work and DOT testing on-site." |
Choose a mode, then select **Save Workflow Mode** — **Reset** puts the card back as you found it. On success you get **Lab workflow updated — Reload your DOT-LIMS pages to see the new mode.**
Switching modes does not migrate orders already in flight. They stay in the workflow they were raised under and finish there. Anyone with a DOT-LIMS page already open must reload before the new mode reaches their screen.
Reference Lab mode renames the navigation rather than removing it: **DOT Testing** becomes **Lab Intake** and **DOT History** becomes **Intake History**. The full detail of that mode, including the intake order form, is on [Reference lab mode](/lims/dot/lab-intake-mode).
## The lifecycle
In full DOT mode a specimen moves through five stages, each owned by a different person and each writing its own custody event.
| Stage | Who does it | Where it happens |
| ----------------------------- | ----------------------------------------------- | --------------------------------------------------------------------- |
| Collection and the CCF | Collector at the collection site | [Collect a specimen and complete the CCF](/lims/dot/collection) |
| Accessioning and seal check | Accessioning clerk at the full lab | [Accession an incoming specimen](/lims/lab/accessioning) |
| Initial immunoassay screen | Bench technician | [Screen and confirm a specimen](/lims/dot/screening-and-confirmation) |
| GC-MS / LC-MS/MS confirmation | Bench technician, certified by the lab director | [Screen and confirm a specimen](/lims/dot/screening-and-confirmation) |
| MRO review and the DER report | Medical Review Officer | [MRO review and the employer report](/lims/dot/reports) |
In Reference Lab mode the first and last stages fall away: the specimen arrives already sealed and already documented, and the finished report goes to an external Medical Review Officer as a PDF.
## The rule the whole module exists to enforce
An unconfirmed screen is **never** reported as Positive. Per HHS Mandatory Guidelines an analyte cannot be designated **Positive** without GC-MS or LC-MS/MS confirmation. If you finalize a specimen that was screened but not confirmed, ClinikEHR raises the **SAMHSA Compliance Check** dialog and the report lists those analytes as **Non-Negative** (presumptive screen result) with a footnote citing § 40.97. Reporting a presumptive screen as a positive costs someone their job on evidence that would not stand up.
Two further rules are enforced for you and worth knowing before you meet them:
* **Methamphetamine needs amphetamine alongside it.** 49 CFR § 40.97(b)(3): methamphetamine above its cutoff with amphetamine below the linkage threshold **cannot** be reported as confirmed positive, and ClinikEHR downgrades it to Negative.
* **Some drugs can never be verified Negative.** 49 CFR § 40.151(f): THC, PCP and 6-acetylmorphine cannot be verified as Negative by the MRO regardless of any prescription or medical explanation the donor provides.
## Seals and the chain of custody
Every handoff is recorded. The **Laboratory Accession** card asks for an **Accession Number \***, a **Received Date & Time \***, and the condition of both seals — **Primary Specimen Seal (Bottle A) \*** and **Split Specimen Seal (Bottle B) \*** — as Yes/No answers. Answering "no" to either makes **Seal Condition Notes \*** required, and a broken seal raises a confirmation before the order can proceed. **Bottle B Storage Location** records where the split went, in enough detail that a colleague can retrieve it ("Freezer A-2, Rack 3, Position 7").
The **Chain of Custody** tab groups every event into **Specimen Intake**, **Laboratory Analysis**, **Reporting** and **Post-Report**. Each event shows a **Seal Intact** or **Seal Broken** pill, the released-by → received-by handoff, any notes, its timestamp and the elapsed time since the previous event. Full detail on [Accession an incoming specimen](/lims/lab/accessioning).
## The people the module talks about
In drug testing the person tested is the **donor**, not the patient — that is the word the CCF, the collector and the MRO all use, and it is the word the forms use. Elsewhere in your lab they are patients as usual.
## Where to go next
The five-step custody and control form, temperature, volumes, seals and shipping. Full DOT mode only.
Cutoffs for urine and oral fluid, specimen validity testing, and why a non-negative screen is not a positive.
Fatal and correctable flaws, donor contact, verified results, and the report that reaches the employer.
Receive a sealed specimen from an external collection site and produce a branded PDF for an external MRO.
Accession numbers, seal checks and reading the chain of custody.
The queue every drug-testing specimen sits on between stages.