> ## 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.

# MRO review and the employer report

> Check the CCF for flaws, contact the donor, record a verified result, and release the report to the employer's designated representative.

export const AuditNote = ({action = 'This action'}) => <div className="ck-callout ck-callout--info" role="note">
    <p className="ck-callout__body">
      {action} is written to your workspace's audit log with your name, the
      record touched and the time — a HIPAA requirement, and one you can review
      yourself under <strong>Audit Log</strong>. See{' '}
      <a href="/platform/security/audit-log">Audit log</a>.
    </p>
  </div>;

export const StillStuck = ({topic}) => <div className="ck-callout ck-callout--note" role="note">
    <p className="ck-callout__body">
      <strong>Still stuck{topic ? ` with ${topic}` : ''}?</strong>{' '}
      Check <a href="/platform/help/troubleshooting">Troubleshooting</a> first —
      it covers the failures we see most often. If that does not resolve it,{' '}
      <a href="/platform/help/contact-support">contact support</a> and include
      your workspace name and the time the problem happened, so we can find the
      matching entry in your audit log.
    </p>
  </div>;

export const TaskHeader = ({before, time, after}) => <div className="ck-task">
    {before ? <div className="ck-task__cell">
        <div className="ck-task__title">Before you start</div>
        <p className="ck-task__body">{before}</p>
      </div> : null}

    {time ? <div className="ck-task__cell">
        <div className="ck-task__title">Takes about</div>
        <p className="ck-task__body">{time}</p>
      </div> : null}

    {after ? <div className="ck-task__cell">
        <div className="ck-task__title">When you're done</div>
        <p className="ck-task__body">{after}</p>
      </div> : null}
  </div>;

export const Path = ({steps = []}) => <span className="ck-path">
    {steps.map((s, i) => <span key={i} className="ck-path__step">
        {i > 0 ? <span className="ck-path__sep" aria-hidden="true">
            ›
          </span> : null}
        {s}
      </span>)}
  </span>;

export const Availability = ({editions = ['all'], plans, roles, note}) => {
  const list = editions.includes('all') ? ['clinic', 'pharmacy', 'lims'] : editions;
  return <div className="ck-avail" role="note" aria-label="Feature availability">
      <span className="ck-avail__label">Available in</span>

      {list.map(e => <span key={e} className={`ck-pill ck-pill--${e}`}>
          {EDITION_LABELS[e] || e}
        </span>)}

      {plans ? <span className="ck-avail__label">Plan</span> : null}
      {plans ? <span className="ck-pill ck-pill--plan">{plans}</span> : null}

      {roles ? <span className="ck-avail__label">Who</span> : null}
      {roles ? <span className="ck-pill ck-pill--role">{roles}</span> : null}

      {note ? <span className="ck-avail__note">{note}</span> : null}
    </div>;
};

<Availability editions={['lims']} plans="All plans" roles="MRO review is for the Medical Review Officer. Finalizing a report needs “Verify and authorise results”." />

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.

<Path steps={['Sidebar', 'DOT Testing']} />

Open the order from the queue; the review lives on its **Workflow** tab, at the stage the specimen has reached.

<TaskHeader before="A specimen with lab results reported to MRO, and the CCF paperwork to hand" time="10 minutes, plus however long the donor takes to answer the phone" after="A verified result, a certified MRO review, and a report released to the DER" />

## 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.

## Check the CCF for flaws

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

### 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.

### 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.

## 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.

## Record the verified result

**Verified Result** offers eight outcomes:

| Result              | Means                                                       |
| ------------------- | ----------------------------------------------------------- |
| **Negative**        | Nothing reportable                                          |
| **Negative-Dilute** | Negative, but the specimen was dilute                       |
| **Positive**        | Confirmed positive, with no legitimate medical explanation  |
| **Positive-Dilute** | Confirmed positive on a dilute specimen                     |
| **Adulterated**     | "Specimen contains a substance not expected in human urine" |
| **Substituted**     | The specimen was not consistent with human urine            |
| **Invalid**         | "Results cannot be reported — retest required"              |
| **Cancelled**       | "Fatal flaw or other reason requiring cancellation"         |

<Warning>
  **Cannot Verify as Negative — 49 CFR § 40.151(f).** ClinikEHR raises this when it applies: "\{drugs} cannot be verified as Negative by the MRO regardless of any prescription or medical explanation provided by the donor. These substances have no legitimate DOT-recognized medical use." It covers THC, PCP and 6-AM. A prescription, a state medical card, a physician's letter — none of them turn one of these into a negative, and verifying it as one is a misreport with a person's livelihood attached.
</Warning>

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.

## 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**.

## What the employer sees

The employer report opens under the banner **DOT Drug Test — Verified Result** and carries four cards:

| Card                    | Contents                                                                 |
| ----------------------- | ------------------------------------------------------------------------ |
| **Positive For**        | The verified positive analytes, where there are any                      |
| **Order Details**       | Specimen ID, DOT Agency, Test Reason, Report Date, Report Method         |
| **DER Details**         | Who it was reported to, and how                                          |
| **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; it shows **Preparing…** while it builds.

<AuditNote action="Opening or exporting a donor's verified result" />

## 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.

### Read the result summary

**Result Summary** shows a single badge:

| Badge                        | Means                                                              |
| ---------------------------- | ------------------------------------------------------------------ |
| `POSITIVE`                   | Confirmed above the confirmation cutoff                            |
| `NEGATIVE`                   | Nothing above cutoff, specimen valid                               |
| `NEGATIVE — DILUTE`          | See below                                                          |
| `PENDING CONFIRMATION`       | Non-negatives are waiting on GC-MS / LC-MS/MS                      |
| `NON-NEGATIVE (PRESUMPTIVE)` | Screened non-negative and finalized without confirmation           |
| Validity status              | Adulterated, substituted or invalid from specimen validity testing |

**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.

### 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](/platform/team/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.**

### 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.

<Note>
  The **Fax** tab carries a **Soon** badge. Send by email, and use your own fax line for a recipient who will only take fax.
</Note>

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**.

## Custom panels

Reference Lab mode also reveals a **Custom Panels** card under Settings › Lab Workflow, alongside **Lab Report Branding**.

<Path steps={['Settings', 'Lab Workflow', 'Custom Panels']} />

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**.

<Note>
  A custom analyte only appears in a panel once it has a **confirmation** cutoff defined for that matrix. An analyte with a screen cutoff but no confirmation cutoff will look configured and still be missing from the picker — this is the single most common custom-panel trap.
</Note>

## 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**.

## If something goes wrong

<AccordionGroup>
  <Accordion title="I cannot save the review">
    The MRO certification box is required: **MRO must certify before saving** or **MRO must certify before reporting**. It is an attestation, so the MRO reviewing the case has to tick it themselves.
  </Accordion>

  <Accordion title="Negative is not available as a verified result">
    A drug covered by 49 CFR § 40.151(f) — THC, PCP or 6-AM — is on the positive list. No medical explanation makes those negative. If you believe the laboratory result is wrong, that is a split-specimen retest question, not a verification one.
  </Accordion>

  <Accordion title="The FMCSA Clearinghouse card shows Pending">
    The report has been produced but the Clearinghouse submission has not been recorded yet. Complete it through the Clearinghouse itself; the card reflects the state, it does not submit for you.
  </Accordion>

  <Accordion title="Finalize Lab Report is greyed out">
    You do not hold "Verify and authorise results". The tooltip names the grant to ask for — see [Permissions](/platform/team/permissions).
  </Accordion>

  <Accordion title="The downloaded report is tiny or will not open">
    Try **Regenerate**, then **Download PDF** again. If it fails a second time, [contact support](/platform/help/contact-support) with the specimen ID and the time you tried.
  </Accordion>

  <Accordion title="My custom analyte is missing from the panel picker">
    It has no confirmation cutoff for that specimen type. Add the confirmation value on the **Analytes** tab and it appears.
  </Accordion>

  <Accordion title="The order never offers an MRO review stage">
    Your lab is on **Reference Lab — Intake to Report Only**, which hides collection, MRO review and DER reporting by design. Finalize and send to the external MRO instead — see [Reference lab mode](/lims/dot/lab-intake-mode).
  </Accordion>
</AccordionGroup>

<StillStuck topic="an MRO review or an employer report" />