MRO review and the employer report

The laboratory produces a result. The Medical Review Officer produces the verified result — the only thing an employer is ever told. This page covers that review, the report that reaches the employer’s designated representative (DER), and the lighter finalisation path used by labs running Reference Lab mode. Open the order from the queue; the review lives on its Workflow tab, at the stage the specimen has reached.

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Open the review

The Lab Result Summary card shows what the laboratory found. Select Open MRO Review to start; everything below is on that review.

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Check the CCF for flaws

Two checklists, and the difference between them decides whether the test survives.

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Fatal flaws

The CCF Fatal Flaw Check lists the six flaws that end a test:

• the specimen ID on the CCF does not match the label
• the tamper-evident seal is broken or missing on the primary specimen
• the collector signature is missing from CCF Step 3
• the donor signature is missing and the collector did not note a refusal
• the wrong custody and control form was used
• the primary specimen was not received

Ticking any of them raises Fatal Flaw Identified — “The selected flaw(s) are fatal. This test must be cancelled and cannot be used for any employment-related action. Select ‘Cancelled — Fatal Flaw’ as the verified result.” There is no way to rescue a fatally flawed test. Cancel it and let the employer arrange a recollection.

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Correctable flaws

The CCF Correctable Flaw Check covers a missing test reason, incomplete employer information, a missing collection date and time, undocumented volume, and a missing MRO name or address. These are recoverable — go back to the collector for a memorandum for record rather than cancelling.

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Contact the donor

Before verifying anything other than a negative, you must give the donor the chance to explain. The Donor Contact Log starts empty — No contact attempts recorded. Use Add Attempt for each one, recording the method (phone, email, text), the outcome (no answer, left message, reached, refused) and any notes. This log is the evidence that a good-faith effort was made, so record the attempts that failed as carefully as the one that worked.

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Record the verified result

Verified Result offers eight outcomes: For everything else, a legitimate explanation is available. Record it with Donor provided a legitimate medical explanation, then Documentation reviewed and verified once you have actually seen the documentation. Where you are cancelling, choose the reason: Fatal Flaw, Split Specimen Failed to Reconfirm, MRO Decision, Specimen Unavailable or Other. Use MRO Comments for anything the record needs that the fields do not hold.

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Certify and report to the DER

Fill in the DER Report Details card: Employer *, DER Name *, DER Phone *, DER Email, Report Method *, plus a fax number and report notes where they apply. Then tick the MRO certification: “By checking this box, I certify that I have reviewed this result per 49 CFR Part 40 and HHS Mandatory Guidelines, that I have contacted the donor (or made a good-faith effort to do so), and that my verified result determination is accurate and complete.” Without it you are stopped with MRO must certify before saving or MRO must certify before reporting.

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What the employer sees

The employer report opens under the banner DOT Drug Test — Verified Result and carries four cards: Download Report (PDF) produces the copy for the employer’s file; it shows Preparing… while it builds.

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Reference Lab mode: finalize and send

A lab running Reference Lab — Intake to Report Only has no MRO module — you produce the report and an external MRO reviews it. The finalisation path lives on the order itself.

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Read the result summary

Result Summary shows a single badge: Negative — Dilute means: “All analytes below their confirmation cutoffs, but the specimen shows dilution markers (low creatinine / specific gravity). MRO may request a recollection.” It is a negative, but not a clean one, and the MRO decides what happens next.

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Finalize the report

The Finalize Lab Report card says what finalizing does: “Finalizing locks the result and marks the order complete. After that you can download a branded PDF report to fax/email to the external Medical Review Officer.” If the button is disabled, its tooltip explains why: Needs authorisation — signing results out is reserved for your verifying scientist or Lab Director. Ask them to allow “Verify and authorise results” for you. See Permissions. Once finalized the order carries a Finalized badge — and Sent to MRO once it has been emailed — with Download PDF, Download Word, Send to MRO, Print and Regenerate beside an inline preview. Before the first PDF exists the preview reads No PDF preview available yet. Click Download PDF above to generate the report.

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Send it to the external MRO

Send to MRO opens a sheet — “Deliver the finalized PDF report directly to the external Medical Review Officer.” It has an Email tab and a Fax tab. On the Email tab, fill in MRO email *, optionally MRO name (optional) (“Used in the email greeting”) and CC (optional) (“Comma-separated for additional recipients.”), then check the Subject and add a Message to MRO (optional). On success the toast reads Lab report sent to MRO.

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Custom panels

Reference Lab mode also reveals a Custom Panels card under Settings › Lab Workflow, alongside Lab Report Branding. It has two tabs — Analytes ({n}) and Panels ({n}). The analyte table lists Code, Name, Category, Urine (S/C) and Oral Fluid (S/C), where each pair is the screen and confirmation cutoff for that matrix. The panel editor takes a Name * (its own example is “Non-DOT 10-Panel + Fentanyl”), a description, a specimen type and a DOT-regulated toggle, then lets you pick from both the built-in and your custom analytes. It refuses to save with Name is required or Pick at least one analyte.

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Check it worked

• The order shows its verified result, and the Chain of Custody tab carries MRO Verified and Reported to DER events under Reporting.
• The employer report opens under DOT Drug Test — Verified Result with the correct Specimen ID and DOT Agency.
• Download Report (PDF) produces a PDF, not a small file that opens as text.
• In Reference Lab mode, the order carries Finalized and — after sending — Sent to MRO.

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If something goes wrong