Welcome to the NDASA Excelling as a Medical Review Officer (MRO) Staff Member/ Assistant Course, developed with the mission of raising the level of professional standards within the drug and alcohol testing industry.

This course will provide you with the information and tools to successfully perform the functions of an MRO Staff Member/Assistant.

The course covers these topics:

  • Drug testing in the workplace
  • Governance of drug testing
  • The drug testing process
  • The MRO role
  • The MRO Staff/Assistant’s role
  • Industry standards for MRO Staff/Assistants
  • Personal characteristics of a successful MRO Staff/Assistant
  • MRO Staff/Assistant methodology
  • What the MRO Staff/Assistant can and can not do
  • Communicating as an MRO Staff/Assistant
  • How to manage challenges and issues in the testing process


  • To provide background knowledge of the drug testing industry to allow the MRO Staff/Assistant to effectively assist an MRO, who is the “gatekeeper” of laboratory drug test results
  • To establish standards for MRO Staff/Assistants throughout the drug testing industry.
  • To provide a practical methodology for the MRO Staff/Assistant to work effectively to meet the demands of industry standards.
  • To provide real-world, functional tips for successful performance in the role of MRO Staff/Assistant.
  • MROCC Certification
  • This course will provide you with the information and tools to perform the functions of an MRO Staff/Assistant successfully. The course enables you to become certified through the Medical Review Officer Certification Council (MROCC). Upon completion of the NDASA course, please contact MROCC regarding certification.
Regulatory StandardExaminationDeliverablesIndustry Applicability
FederalUniversal skills setMulti-industry
40 CFR Part 40 – SubpartsFinal Examination – 90% to pass.Knowledge of the DOT regulationsDOT-regulated sector  
NDASA CertificationRegulated by federal, state or local mandates
Private sector


Several assumptions are built into this MRO Staff/Assistant course:

  • Although the course refers most often to DOT regulations and procedures because they remain the gold standard in the industry, it also discusses federal employee testing and non-DOT testing. Although the DOT regulations do not mention “MRO Assistant”, there are multiple references to what an MRO’s staff is permitted to do. The MRO Staff/Assistant needs to know the type of testing procedures that apply in a given situation.
  • For simplicity, the course most often refers to “the MRO” as if he or she were a single individual, but that term could mean an MRO organization or another situation where there is more than one physician in the office who reviews drug test results.
  • The term “collection site” may also refer to an individual collector who is contracted to perform collections. This course does not include much information about alcohol testing, because the MRO’s role in alcohol testing is limited.
  • Although much discussion centers on urine and oral fluid drug testing, we understand that the majority of principles and procedures discussed also apply to hair testing, saliva testing, or sweat patch testing, for non DOT/non HHS situations only.
  • The course emphasizes workplace testing, but similar principles and procedures apply to drug testing within the schools, court-ordered testing, as well as personal drug testing. Although the recipient of the test results will most often be the employer or the Designated Employer Representative (DER), in certain situations reporting may be to other entities such as schools or courts.
  • This is not a medical course to teach the classifications, effects, and pharmacology of drugs and alcohol. Aside from defining basic medical terms, it intentionally leaves out the technical and scientific information pertaining to the Medical Review Officer responsibilities. It is not the role of the MRO Staff/Assistant to interpret drug test results.
  • The course does not discuss any non-negative on-site testing that is not confirmed at a laboratory or any testing that is not done under strict chain of custody. These methods are not standardized or recommended by the industry.


Upon completion of this course, students will be prepared to take the Medical Review Officer Certification Council (MROCC) MRO Staff/Assistant online examination. With successful completion of the MROCC examination, the student will be awarded a three-year MROCC MRO Staff/Assistant certification. Visit the MROCC website to purchase and take the exam.

MRO Staff/Assistant Resource Library Who's Who in the Drug Testing Industry Drug Testing in the Workplace Governance of Drug Testing Overview of DOT Regulations Pertaining to Medical Review Officers HIPPA and the MRO Staff/Assistant Introduction to the Drug Testing Industry Understanding the Urine Specimen Collection Process Urine Specimen Collection Procedures Understanding the Oral Fluid Specimen Collection Process Oral Fluid Collection Procedures Lab Processes and the MRO Special Testing Situations – Direct Observation Urine Special Testing Situations – Shy Bladder Collection Special Testing Situations – Dry Mouth Special Testing Situations – Correctable Flaws Special Testing Situations – Fatal Flaws MRO Review of Alternate Specimens for Drug Testing MRO Review of Alcohol Tests Drug Testing Laboratories Laboratory Testing Methods Historical Perspective and Current Role of the MRO MRO Training and Certification The Value of the MRO Staff/Assistant Position The Role of the MRO Staff/Assistant MRO Staff/Assistant Standards Qualities of a Successful MRO Staff/Assistant MRO Staff/Assistant Methodology – The CCF MRO Staff/Assistant Methodology – The Lab Report MRO Staff/Assistant Methodology – Document Review MRO Staff/Assistant Methodology – Irregularities and Errors MRO Staff/Assistant Methodology – Preparation for MRO Review MRO Staff/Assistant Methodology – Facilitating the MRO/Donor Interview MRO Staff/Assistant Methodology – Gathering Information for the MRO MRO Staff/Assistant Methodology – Contact with Donor & Employer MRO Staff/Assistant Methodology – Record Keeping & Review MRO Staff/Assistant Methodology – Process Summary for Negative Test Results MRO Staff/Assistant Methodology – Process Summary for Non-Negative Results Limitations of the MRO Staff/Assistant Role MRO Staff/Assistant Duties in Special Testing Situations – Shy Bladder MRO Staff/Assistant Duties in Special Testing Situations – Split Specimen MRO Staff/Assistant Duties in Special Testing Situations – Non-DOT MRO Staff/Assistant Duties in Special Testing Situations – School Settings Donor Communication Issues DER and C/TPA Communications Managing Common Laboratory Issues The MRO and the FMCSA Clearinghouse Releasing and Test Result Information Final Examination and Next Steps