MRO review and the employer report

The laboratory produces a result. The Medical Review Officer (MRO) 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 employer representative (DER), and the lighter finalisation path used by labs running Reference Lab mode.

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What you’re looking at

Open the order from the queue — it will be at Reported to MRO. The review lives on its Workflow tab, which shows only the form for the stage the specimen has reached. Lab Result Summary is where you start: a Lab Result Status badge, a Positive Drugs row listing each confirmed analyte by code and name, and an SVT Validity badge where specimen validity testing produced one. Where the laboratory has not reported, the status reads Pending and there is nothing to review.

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Check the CCF for flaws

Select Open MRO Review — MRO Review opened — and two checklists appear. The difference between them decides whether the test survives. CCF Fatal Flaw Check lists the six flaws that end a test: the specimen ID on the CCF does not match the label; the 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 (non-OMB approved); 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.” CCF Correctable Flaw Check covers “Test reason not checked on CCF Step 1”, “Employer name/address incomplete on CCF Step 1”, “Collection date/time missing from CCF Step 3”, “Specimen volume not documented” and “MRO name or address missing from Step 1”. 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 or text), the Outcome (no answer, left message, reached or refused) and any Notes; each logs with Contact attempt logged. 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, each with the product’s own one-line meaning: 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 Cancellation Reason *: Fatal Flaw, Split Specimen Failed to Reconfirm, MRO Decision, Specimen Unavailable or Other. MRO Comments holds anything the fields do not. Saving gives MRO verification saved.

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Certify and report to the DER

Fill in DER Report Details: 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. Reporting gives Result reported to DER. The employer report then opens under DOT Drug Test — Verified Result, with four cards: Positive For (the verified positive analytes, where there are any), Order Details (Specimen ID, DOT Agency, Test Reason, Report Date, Report Method), DER Details and FMCSA Clearinghouse (“Reporting Required” yes or no, and “Reported At” or a Pending badge). Download Report (PDF) produces the copy for the employer’s file, showing 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. Result Summary shows a single badge:

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Custom panels

Reference Lab mode also reveals a Custom Panels card under Settings › Lab Workflow, alongside Lab Report Branding, with two tabs: Analytes ({n}) — Code, Name, Category, Urine (S/C) and Oral Fluid (S/C), each pair being the screen and confirmation cutoff for that matrix — and Panels ({n}). 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, and refuses to save with Name is required or Pick at least one analyte.

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Who can do this

Role decides whether the order opens. Permission decides whether you may sign anything out — and signing out is a separate grant from everything before it. A Lab Manager does not hold Verify and authorise results by default — that comes from the access tier, not the administrative role. Without it Finalize Lab Report is greyed out and its tooltip says so: Needs authorisation — signing results out is reserved for your verifying scientist or Lab Director. Ask them to allow “Verify and authorise results” for you. A QC Officer is review-only by design.

• Enforcement is opt-in, per person. Someone never saved in the permissions sheet is unrestricted, and the sheet warns “Saving starts enforcing”.
• A denied action is recorded; an allowed one is not. Where a figure is not yours to see it renders hidden or as a dash, never as a zero.

See Permissions.

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Check it worked

• The order shows its verified result, and the Chain of Custody tab carries the MRO and reporting 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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Common issues

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FAQ