Prior to the transmission of test results to the employer, both positive and negative test results shall be reviewed and verified by a medical review officer (MRO) qualified under subsection 59A-24.008(1), F.A.C. The MRO is permitted to use a language interpreter to assist in communicating the results of drug tests with employees and job applicants. Such language interpreters are subject to the confidentiality provisions of Section 112.0455(11), F.S. After the results have been reviewed and verified by the MRO, the test result is reported to the employer.

1. (1) Qualifications of Medical Review Officers.

   1. (a) Persons serving as medical review officers shall be medical or osteopathic physicians duly licensed in the state in which he or she practices medicine.
   2. (b) The MRO shall have knowledge of substance abuse disorders, laboratory testing procedures, chain of custody procedures, collection procedures, and have the appropriate knowledge regarding pharmacology and toxicology of illicit drugs and medical training to interpret and evaluate an individual’s drug test result together with the individual’s medical history or any other biomedical information.
   3. (c) Medical review officers shall be certified as medical review officers by the American Association of Medical Review Officers, American Society of Addiction Medicine or the Medical Review Officer Certification Council.
   4. (d) The MRO shall be employed by or contracted by the employer and shall not be employed or contracted by a drug testing laboratory performing drug free workplace testing under Section 112.0455, F.S. The drug testing laboratory is permitted to assist the employer in locating qualified medical review officers.
   5. (e) An employer shall not serve as the MRO for his or her own employees and job applicants.

2. (2) Responsibilities of Medical Review Officer. The MRO shall evaluate the drug test result(s), which is reported out by the laboratory, to verify by checking the chain of custody form that the specimen was collected, transported, and analyzed under proper procedures, as specified in these rules, and to determine if any alternative medical explanations caused a positive test result. This determination could include conducting a medical interview with the individual, review of the individual’s medical history, or the review of any other relevant bio-medical factors. The MRO shall review all medical records made available by the tested individual. The MRO shall not consider the results of samples that are not obtained or processed in accordance with these rules.

   1. (a) Negative Results. To verify that a negative test result was properly analyzed and handled according to these rules, the MRO shall:

      1. Receive and review the test result(s) from the laboratory;

      2. Verify the laboratory report by checking the chain of custody form for required signatures, procedures, and information;

      3. Ensure that the donor’s specimen identification number on copy 2 of the laboratory test report and on copy 4 of the chain of custody form which was sent to the MRO by the collection site accurately identifies the donor with the negative test result; and,

      4. Notify the employer in writing of the negative test result no more than 7 working days after the specimen was received by the laboratory, and appropriately file Copy 2 and 4 of the chain of custody form under confidential procedures for a period of 2 years.

      5. Within 24 hours of notification of the employer of a negative test result, notify the testing laboratory that the negative test result has been submitted to the employer.

   2. (b) Positive Results. To verify that a positive test result was properly analyzed and handled according to these rules, the MRO shall:

      1. Receive and review the test result(s) from the laboratory;

      2. Verify the laboratory report by checking the chain of custody form for required signatures, procedures, and information;

      3. Ensure that the donor’s specimen identification number on Copy 2 of the laboratory test report and on Copy 4 of the chain of custody form which was sent to the MRO by the collection site accurately identifies the donor with the positive test result;

      4. Notify the employee or job applicant of a confirmed positive test result, within 3 days of receipt of the test result from the laboratory, and inquire as to whether prescriptive or over-the-counter medications could have caused the positive test result;

      5. Within 5 days of notification to the donor of the positive test result, provide an opportunity for employee or job applicant to discuss the positive test result and to submit documentation of any prescriptions relevant to the positive test result;

      6. Review any medical records provided by the employee or job applicant, or authorized by the employee or job applicant and released by the individual’s physician, to determine if the positive test result was caused by a legally prescribed medication. If the donor does not have prescribed medication, the MRO shall inquire about over-the-counter medications which could have caused the positive test result. The donor shall be responsible for providing all necessary documentation, (i.e., a doctor’s report, signed prescription, etc.) within the 5 day period after notification of the positive test result;

      7. Notify the employer in writing of the verified test result, either negative, positive, or unsatisfactory, no more than 7 working days after the specimen was received by the laboratory, and appropriately file the chain of custody form under confidential procedures for 2 years;

      8. If the MRO determines that there is a legitimate medical explanation for the positive test result, based on the medical judgment of the MRO and accepted standards of practice, the MRO shall report a negative test result to the employer;

      9. Process any employee or job applicant requests for a retest of the original specimen, within 180 days of notice of the positive test result, at another licensed laboratory selected by the employee or job applicant. The donor requesting the additional test shall be required to pay for the costs of the retest, including handling and shipping expenses. The MRO shall contact the original testing laboratory to initiate the retest; and,

      10. The MRO shall not declare a confirmed positive as verified, until the MRO receives Copy 2 of the chain of custody form from the drug testing laboratory and Copy 4 from the collection site.

3. (3) Chain of Custody Procedures. A strict chain of custody procedure, initiated at the time of specimen collection, is mandatory for the validation of any test result. The MRO shall be responsible, before reporting either positive or negative test result(s) to the employer, to review all signatures, procedures, and information as required on the chain of custody form to determine that the specimen was under authorized control both before and during laboratory analysis. If proper chain of custody procedures have not been followed, the MRO shall declare the test result as unsatisfactory, due to an unacceptable chain of custody procedure.
4. (4) Verification for Opioids. Before a positive test for opioids is verified, the MRO shall determine that there is clinical evidence in addition to the urine, blood, oral fluid or hair test, of illegal use of any opium, opiate, or opium derivative (e.g., morphine/codeine). This requirement does not apply if the GC/MS confirmation test for opioids confirms the presence of 6-monoacetylmorphine.
5. (5) Reanalysis Authorized. Should any question arise as to the accuracy or validity of a test result which has been collected and analyzed in accordance with these rules, the MRO may order a reanalysis of the original sample at any licensed laboratory licensed under these rules.
6. (6) Scientifically Unsatisfactory Results. The MRO, based on a review of the chain of custody form, quality control data, multiple samples and other pertinent results, is permitted to determine that the result is scientifically unsatisfactory for further action and may request the donor to provide another sample or request a reanalysis of the original sample before making such decision. The MRO is permitted to request that the reanalysis be performed by the same laboratory or, that an aliquot of the original specimen be sent to another licensed laboratory. The laboratory shall assist in this review process as requested by the MRO and shall make available appropriate personnel to provide consultation as required by the MRO. The MRO shall report all findings based on the unsatisfactory specimen, as required by this rule chapter, but shall not include any personal identifying information in such reports.

7. (7) Contacting Donors Who Test Positive.

   1. (a) If the MRO is unable to contact a donor who tested positive within 3 working days of receipt of the test results from the laboratory, the MRO shall contact the employer and request that the employer direct the donor to contact the MRO as soon as possible. If the MRO has not been contacted by the donor within 2 working days from the request to the employer, the MRO shall verify the report as positive.
   2. (b) As a safeguard to employees and job applicants, once a MRO verifies a positive test result, the MRO may change the verification of the result if the donor presents information to the MRO which documents that a serious illness, injury, or other circumstance unavoidably prevented the employee from contacting the MRO within the specified time frame and if the donor presents information concerning a legitimate explanation for the positive test result.
   3. (c) If the donor declines to talk with the MRO regarding a positive test result, the MRO shall validate the result as positive and annotate such decline in the remarks section.

8. (8) Identification of Donor. Prior to providing an employee or job applicant with the opportunity to discuss a test result, the MRO shall confirm the identity of the employee or job applicant. At a minimum, to confirm the identity of the donor, the MRO shall ask the donor to respond with the following information:

   1. (a) If the request is in person, the MRO shall request a picture identification.

   2. (b) If the request is over the telephone, the MRO shall request:

      1. An employee identification number or social security number;

      2. Date of birth;

      3. Employer’s name; and,

      4. Work telephone number.

9. (9) Information for Donor. Once the donor’s identification has been established, and before any additional information is solicited from the donor, the MRO shall:

   1. (a) Inform the donor that the MRO is an agent of the employer whose responsibility is to make a determination on test results and report them to the employer;
   2. (b) Inform the donor that medical information revealed during the MRO’s inquiry will be kept confidential; unless the donor is in a safety sensitive or special risk position and the MRO believes that such information is relevant to the safety of the donor or to other employees. Any additional release of information shall be solely pursuant to a written consent form signed voluntarily by the donor, except where such release is compelled by a hearing officer or a court of competent jurisdiction pursuant to an appeal, or where deemed appropriate by a professional or occupational licensing board in a related disciplinary proceeding.
   3. (c) Outline the rights and procedures for a retest of the original specimen by the donor.
   4. (d) If the donor voluntarily admits to the use of the drug in question without a proper prescription, the MRO shall advise the donor that a verified positive test report will be sent to the employer.

10. (10) Verification Signature. After the MRO reviews the chain of custody forms from the laboratory and the collection site (Copy 2 from the laboratory and Copy 4 from the collection site) and, in the case of a positive test result, has contacted the donor who tested positive, the MRO shall:

    1. (a) On Copy 2 of the chain of custody form, mark the appropriate box if the verified result is positive or negative and if positive, write in for which drug(s). If the test was not performed or the test was canceled, mark the appropriate box. The reason for the cancellation or non-performance of the test shall be explained in the remarks section.
    2. (b) On Copy 2 of the chain of custody form, sign and date the verification of the final test result.
    3. (c) Prepare and sign a verification letter to the employer revealing the final verified test result. Copies of the laboratory report form or chain of custody are not suitable for this purpose.

Rulemaking Authority 112.0455(13)(a) FS. Law Implemented 112.0455 FS. History–New 6-28-91, Formerly 10E-18.008, Amended 5-1-96, 3-11-98, 2-3-05, 4-6-26.