Promoting and Preserving
the Highest Quality of
Standards Among MROs
and Their Teams.

DEFINITION OF A MEDICAL REVIEW OFFICER

A Medical Review Officer (MRO) is a licensed physician who is responsible for receiving and reviewing laboratory results generated by an employer's drug testing program and evaluating medical explanations for non-negative drug test results.

The MRO acts as an independent and impartial "gatekeeper" and advocate for the accuracy and integrity of the drug testing process. The MRO provides quality assurance review of the drug testing process for the specimens under his or her purview, determines if there is a legitimate medical explanation for laboratory confirmed positive, adulterated, substituted and invalid drug test results, and ensures the timely reporting of test results and other information to employers and protects the confidentiality of the drug testing information.

MRO responsibilities

The MRO has the following responsibilities:

• Review all positive, adulterated, rejected for testing, invalid, and substituted test results;
• Ensure that specimens reported as negative and (for urine) negative/dilute are properly reviewed and reported to the agency’s designated representative. Staff under the direct, personal supervision of the MRO may review and report negative and (for urine) negative/dilute test results to the agency’s designated representative. The MRO must review at least 5% of the negative results reported by staff to ensure the MRO staff are properly performing the review process. This review should include all specimens that required corrective action;
• Discuss potential invalid results with the HHS-certified laboratory to determine whether further testing at another HHS-certified laboratory is warranted;
• Complete action on a report from an HHS-certified laboratory or IITF by


• Reviewing the information on the MRO copy of the Federal Custody and Control Form (CCF) that was received from the collector and the report received from the laboratory or IITF;
• Interviewing the donor when required (e.g., to verify the existence of prescribed medication that could explain the result and/or to collect evidence of the prescription and subsequent dispensing of that prescription);
• Making a determination regarding the result; and
• Reporting the verified result to the federal agency.
• Maintain all records in accordance with the appropriate federal agency requirements;
• Conduct a medical evaluation of the donor or a review of the examining physician’s findings and determine “refusal to test” or “cancelled test” when a collector reports that the donor was unable to provide a specimen and an alternate specimen (i.e., another authorized specimen type, urine, or oral fluid) was not collected;
• Monitor the frequency of errors and notify responsible parties to take corrective action to prevent recurrence;
• Review the results of Federal agency blind samples and perform the initial investigation into discrepant results; and
• Request additional testing (as allowed) to help in the determination of a final result for a donor specimen.

More detailed information about the Medical Review Officer field is available at the links below:

MROCC MRO Competencies
DOT 49 CFR Part 40: Procedures for Transportation Workplace Drug and Alcohol Testing Programs
SAMHSA: Medical Review Officer Guidance Manual for Federal Workplace Drug Testing Programs

INITIAL CERTIFICATION

The MROCC Initial Certification examination is open to those physicians who have had appropriate MRO training from an MROCC-approved MRO training course sponsored by ACOEM, AOCOPM, or AAMRO. To apply for the initial certification examination a physician must:

• have graduated from a medical school or school of osteopathic medicine
• hold a valid and unexpired medical license (MD or DO) to practice within the U.S., its territories, a province of Canada, Mexico, or a country in which the physician resides and practices. If any license is limited, suspended, or revoked, the applicant must notify MROCC in writing upon submission of their application. All adverse actions resulting in limitations, suspension, or revocation will be reviewed by MROCC on an individual basis. No approval of an application will be granted until the review has been completed.
• have completed, within the past 12 months, an MROCC-approved MRO training course sponsored by ACOEM, AOCOPM or AAMRO.

RECERTIFICATION

MROCC Recertification examination is open to physicians who are (or were previously) certified by MROCC or AAMRO. DOT requires MROs to complete retraining and pass a recertification examination every five years. To apply for the recertification examination a physician must:

• have current or previous certification by MROCC or AAMRO
• hold a valid and unexpired medical license (MD or DO) to practice within the U.S., its territories, a province of Canada, Mexico, or a country in which the physician resides and practices. If any license is limited, suspended, or revoked, the applicant must notify MROCC in writing upon submission of their application. All adverse actions resulting in limitations, suspension, or revocation will be reviewed by MROCC on an individual basis. No approval of an application will be granted until the review has been completed.
• have completed approved MRO retraining in the 5 years preceding the examination (training used previously to fulfill the requirements to get certified/recertified as an MRO cannot be reused). The retraining requirement may be fulfilled by either the MROCC Self-Study CME activity or an MROCC-approved MRO training course.

EXAM DATES

There are both online and onsite MRO Certification and Recertification examination offerings. The online examination is offered year round and can be taken on the date/time of the examinee's choosing. Onsite exams are paper based and administered following select onsite courses. Course registration is separate and is completed through the course sponsor.

MROCC APPROVED TRAINING:

ACOEM and AOCOPM offer onsite MRO training courses. Additionally, they both also offer online recorded MRO training courses that are available throughout the year. Both online and onsite courses are acceptable training for Initial Certification and Recertification. Current course/examination opportunities are as follows:

ONLINE TRAINING OFFERINGS

ACOEM COURSE

FORMAT: Online Recorded Course
COURSE: Medical Review Officer Online Course
CREDITS: ACCME designates this activity for a maximum of
18.5 AMA PRA Category 1 Credits™.
PHONE: (847) 818-1800
WEBSITE: https://acoem.org/Learning/MRO-Resources
FEE: Contact provider directly for fees.

AOCOPM COURSE

FORMAT: Online Recorded Course
COURSE: Medical Review Officer Training Course
CREDITS: The AOA designates this activity for a maximum of
14.25 AOA 1-A Credits and 14.25 AMA PRA Category 1 Credits™
PHONE: (800) 558-8686
WEBSITE: https://aocopm.memberclicks.net/opam-workshop-mro
FEE: Contact provider directly for fees.

ONSITE TRAINING OFFERINGS

ACOEM MRO TRAINING COURSE

Location: Schaumburg, IL
Course Dates: October 04, 2025 - October 05, 2025
Exam Date: October 05, 2025
Exam Time: 2:00PM CT to 5:00PM CT
Sponsor: ACOEM
Course website: Registration opening summer 2025

COURSE CONTACT INFORMATION

ACOEM COURSE

CONTACT: Nikki Hoffman
PHONE: (847) 818-1800
WEBSITE: https://acoem.org/Learning/MRO-Resources

AOCOPM COURSE

CONTACT: Ronda LeBoeuf
PHONE: (800) 558-8686
WEBSITE: https://www.aocopm.org/

MROCC FEES

MROCC examination and CME fees are as follows:

INITIAL CERTIFICATION:

• $525 INITIAL CERTIFICATION EXAM: Online/Onsite examination following completion of approved MRO training course through ACOEM, AOCOPM, or AAMRO (Course fee/registration separate)

RECERTIFICATION:

• $525 RECERTIFICATION EXAM ONLY: Online/Onsite examination following completion of approved MRO training course through ACOEM, AOCOPM, or AAMRO (Course fee/registration separate)
• $695 RECERTIFICATION EXAM AND SELF-STUDY CME ACTIVITY: 25 Hour MROCC Self-Study CME Activity and Recertification Examination ($170 for 25 Hours of CME; $525 for online/onsite recertification exam). Cost of 6th edition MRO Manual used in the self-study CME activity is separate and purchased through OEM Press).

MROCC CME ACTIVITY ONLY:

• $170 15 Hour MROCC Self-Study CME/Self-Assessment Activity (does not include recertification examination)

PROFESSIONAL PRINTED CERTIFICATE:

• $37 Professional printed certificate

CERTIFICATION AND RECERTIFICATION

MROCC certification is DOT and SAMHSA recognized and approved. The examinations are based on 49 Code of Federal Regulations (CFR Part 40) and the MRO Competencies. As mandated by the Department of Transportation, MRO certification is valid for five years, at which time recertification is required to remain within DOT compliance and in the directory of currently certified MROs.

MROCC EXAMS

State-of-the-art psychometric procedures are employed for scoring and the determination of the minimum passing level. Scores are determined and reported based upon the total number of items answered correctly. There is no penalty for guessing. Passing scores are not determined on the basis of subcategory scores.

All MROCC MRO certification/recertification examinations are $525. MRO training courses, self study CME activity, and MRO Manual are separate costs. Details on the specific examination options are listed below.

ONLINE EXAMINATIONS

INITIAL CERTIFICATION (Physicians who are being certified as an MRO for the first time)

• Available to physicians who have completed an MROCC-approved MRO training course within the last 12 months
• Convenient, online platform accessible from any computer
• Immediate pass/fail decision upon submission
• Open book format
• Consists of 110 multiple choice questions
• Examinees have up to 3 hours to complete
• Must be taken in one sitting (no logging on/off)
• Two free retests are allowed
• $525 Initial certification exam

RECERTIFICATION (Physicians who are or have been previously certified as an MRO by MROCC or AAMRO)

• Available to physicians who have submitted the MROCC 25 Hour Self-Study CME activity OR completed an MROCC-approved MRO training course within the last 5 years
• Convenient, online platform accessible from any computer
• Immediate pass/fail decision upon submission
• Open book format
• Consists of 100 multiple choice questions
• Examinees have up to 30 days to complete once the exam is started
• Log on/off privileges
• Two free retests are allowed
• Great, no-travel option for recertification when combined with the MROCC 25 Hour Self-Study CME Activty
• $525 Recertification exam only
• $695 Recertification exam and self-study CME activity

ONSITE PAPER EXAMS

INITIAL CERTIFICATION (Physicians who are being certified as an MRO for the first time)

• Available to physicians who have completed an MROCC-approved MRO training course within the last 12 months
• Consist of 110 multiple choice questions
• Allow 3 hours for completion
• Are closed book format
• Have results available within 4-5 weeks of the examination
• Are proctored, paper/pencil examinations
• Are administered in conjunction with approved MRO training courses
• Two free retests are allowed
• $525 Initial certification exam

RECERTIFICATION (Physicians who are or have been previously certified as an MRO by MROCC or AAMRO)

• Available to physicians who have submitted the MROCC 25 Hour Self-Study CME activity OR completed an MROCC-approved MRO training course within the last 5 years
• Consist of 110 multiple choice questions
• Allow 3 hours for completion
• Are closed book format
• Have results available within 4-5 weeks of the examination
• Are proctored, paper/pencil examinations
• Are administered in conjunction with approved MRO training courses
• Two free retests are allowed
• $525 Recertification exam

EXAMINATION PREPARATION

Physicians preparing for MROCC certification and recertification examinations are strongly encouraged to utilize a variety of resources including, but not limited to, the following:

• Any training materials/syllabus from any training courses attended
• MROCC MRO Manual 6th edition (OEM Press Website)
• MRO Regulations, Office of Drug and Alcohol Policy and Compliance (ODAPC) Title 49: Transportation, Part 40 - Procedures for Transportation Workplace Drug and Alcohol Testing Programs
• HHS Mandatory Guidelines for Federal Workplace Drug Testing Programs
• Benzodiazepine Metabolism Chart
• Opioid Metabolism Chart
• Exam Bibliography and Examination Blueprint (pdf)
• MRO Competencies Document (pdf)
• Sample Exam Questions

ADDITIONAL EXAMINATION PREPARATION

Prior to taking an MROCC examination, it is the responsibility of the registrant to have read and to understand MROCC's policies on cheating and certificate revocation.

• MROCC Cheating Policy (pdf)
• MROCC Revocation Policy (pdf)
• Code of Ethical Conduct (pdf)

ONLINE EXAM RESULTS

Examination results are given immediately upon submission. If you receive a pass result, you can expect to receive an email from MROCC within 5 days with instructions on accessing your official verification and ordering a professionally printed certificate. If you do not pass the examination and have not utilized your free retests, you will receive an email with information on the retest within 48 hours of receiving your examination results.

ONSITE PAPER EXAM RESULTS

Examination results are sent out by email within 4-5 weeks of taking the examination. If you pass the examination, an official verification of certification and online pdf certificate will be available at that time by logging into your MROCC record. If you do not pass the examination and have not utilized your free retests, you will receive an email with information on the retest within 48 hours of receiving your examination results.

CME Certificates

If you completed the 25 Hour Self-Study CME activity, the CME certificate will be available through the website after successful completion of the examination. Once the exam is completed and your results and CME have been processed, MROCC will send an email with instructions on accessing the CME Certificate. You can expect your results and CME to be processed within 5 days of completion.

MROCC RETEST POLICY

While we hope that everyone who takes the examination will pass it; we know realistically that there are many factors which can interfere with performance. In recognition of these possible complicating factors, the MROCC Board has adopted a policy on retests.

Initial Certification Retests

The retest policy permits the examination to be taken two additional times for free within 12 months of completion of the MRO course. An email with information on logging into the retest is sent out within 48 hours of the failure notice. If you do not pass the examination after using your free retests, a new registration with examination fee will be required before attempting the examination again. Completion of a new MRO course will be necessary if it has been more than 12 months since completion of the course.

If you have already completed your retest opportunities, please log into your record at https://www.mrocc.org/app_choices.cfm and select "I used my retests and need to register for another exam" to complete your application and pay the examination fee.

Recertification Retests

The retest policy permits the examination to be taken two additional times for free within a 12 month period from the date of registration for recertification. An email with information on logging into the retest is sent out within 48 hours of the failure notice. If after two retests, you have not passed the recertification examination, a new registration and examination fee will be required before attempting the examination again.

If you have already completed your retest opportunities, please log into your record at https://www.mrocc.org/login.cfm and select "Recertify Now" to complete your application and pay the examination fee.

Review Prior to Retesting

Weaknesses and strengths within each of the MRO competencies are included as part of your examination results.  Examinees who do not pass the examination, should review these areas to determine where to focus their studying prior to taking the retest. In addition to any other materials you may review, it is recommended that you study the DOT MRO Regulations as 50% of the exam is comprised of questions on the Regulations. The Regulations also include sections on Collections and Procedures. The Exam Bibliography and Blueprint should also be reviewed as it includes information on the different subject areas of the examination.

THE ONLINE EXAM

If you are taking the examination online, a quick review of the screenshots below may help to navigate the examination a little more easily. Click on an image below to enlarge it.

STARTING THE EXAM (click image to enlarge)...

AGREEMENT OF INTEGRITY (click image to enlarge)...

EXAM INSTRUCTIONS (click image to enlarge)...

INITIAL EXAM QUESTION (click image to enlarge)...

RECERTIFICATION EXAM QUESTION (click image to enlarge)...

WHAT TO EXPECT

Once you have registered/paid for the examination, you can expect the following:

• An immediate email receipt for your credit card payment.
• Once MROCC has processed your registration, a confirmation email will be sent within 48 hours that includes instructions and logon information for online examinees. Those taking the onsite paper-based examination will receive an email confirming the date and location of the examination.
• Upon submission of your online examination, results are available immediately. Onsite paper-based examinees can expect a results notification email within 4-5 weeks of the examination.
• If the examination is not passed and you have retest opportunities remaining, an email will be sent within 48 hours allowing access to your retest.
• If you receive a pass result, you can expect to receive an email from MROCC within 5 days with instructions on accessing your official verification and online pdf certificate. It will also include instructions for ordering a professionally printed certificate.
• Once the exam is successfully completed and your results and CME have been processed, MROCC will send an email with instructions on accessing the CME Certificate. You can expect your results and CME to be processed within 5 days of completion.

Begin the Exam Registration

To begin the registration process, please select from the choices below.

TEAM MEMBER DEFINITION

The MRO can be assisted by one or more staff. An MRO Team Member performs administrative functions and does not perform any portion of the interview between the MRO and donor. The administrative functions typically include receipt and sorting of test forms, presenting non-negative and fatally flawed files to the MRO for review, and distribution of reports to clients. Some MRO Team Members also call donors, confirm their identity, and then transfer the calls to the MRO.

Some MRO Team Members are also involved in the corroboration of medical explanations that donors may present to the MRO. An MRO Team Member should be detail-oriented, well organized, and reliable. Under the U.S. Department of Transportation (DOT) drug and alcohol testing procedures, the MRO must supervise the MRO Team Member. This supervision must include personal oversight of that team member's work; personal involvement in evaluating, hiring, and firing the team member, line authority over the team member for decisions, direction, and control; and regular contact and oversight concerning drug testing program matters. The MRO's supervision and control cannot be superseded by or delegated to anyone else with respect to test result review and other functions performed by the MRO Team Member.

BENEFITS OF CERTIFICATION

This three-year certification, awarded upon successful completion of approved training and passing of the MRO Team Member online examination, acknowledges competency in those practical skills the MRO Team Member applies in fulfilling his or her professional responsibilities within the workplace drug testing arena. An MROCC-Certified MRO Team Member provides assurance to the MRO, the employer, and the donor that duties are performed in a consistent and professional manner, ensuring integrity and confidentiality throughout the entire drug testing process.

INITIAL CERTIFICATION

MRO Team Member certification is valid for three years. Initial MRO Team Member certification is open to non-physician team members who assist and are directly supervised by a certified MRO.

MRO Team Member initial certification candidates are required to:

• Complete an MRO Assistant training course sponsored by ACOEM, ALCOPRO, DATAC, or SAPAA. The course must have been completed within the 24 months preceeding registration for certification.
  -- OR --
  Training Waiver: Individuals who have a minimum of three year's experience as an MRO Team Member may waive the training course requirement with a letter of recommendation from a currently certified MRO. The letter must be from an MRO who has worked with the team member for a minimum of one year, and has knowledge of his or her competency as an MRO Team Member.
• Take and Pass the current MRO Team Member certification examination

Documentation of MRO Assistant training course must be submitted at the time of registration. Certificate of course completion or registration confirmation/receipt from the course provider is acceptable.

RECERTIFICATION

MRO Team Member recertification is offered to those who currently hold or previously held MRO Team Member (or MRO Assistant) certification. MRO Team Member certification/recertification is valid for three years. Candidates for MRO Team Member recertification are required to:

• Submit a letter of recommendation from the supervising MRO attesting to the Team Member's competency
• Read MRO Team Manual: MROCC'S Guide for MROs and MRO Team Members available from OEM Press, and complete/submit the Self-Assessment tool with their registration.
  OR
  Alternate Training: Recertifying MRO Team Members may substitute the self-assessment by attending any of the available MRO Assistant training courses sponsored by ACOEM, ALCOPRO, DATAC, or SAPAA
• Take and Pass the current MRO Team Member certification examination

Completed Self-Assessment tool or documentation of approved MRO Assistant training course must be submitted at the time of registration, along with the letter of recommendation from the supervising MRO.

APPROVED TRAINING

While MROCC does not offer MRO Team Member/Assistant training, the following organizations offer courses throughout the year. Please use the contact information below to obtain information regarding training opportunities:

• American College of Occupational and Environmental Medicine (ACOEM)
  ACOEM website  Phone: 847.818.1800
• ALCOPRO
  ALCOPRO website  Phone: 800.227.9890
• The Drug & Alcohol Testing Association of Canada (DATAC)
  DATAC website  Phone: 866.324.7093
• National Drug & Alcohol Screening Association (NDASA - note: DATIA is now part of NDASA)
  NDASA website  Phone: 888.316.3272
• The Substance Abuse Program Administrators Association (SAPAA)
  SAPAA website  Phone: 800.672.7229

CERTIFICATION AND RECERTIFICATION

The online exam is offered to individuals who have completed appropriate MRO Assistant training or have at least three years of confirmed experience. The exam consists of multiple choice items, distributed by content area according to the examination blueprint, and intermingles recall (recognition), simple interpretation (analysis), and problem solving (evaluation) type questions. Examinees have up to 30 days to complete once the exam is started.

EXAM DETAILS

• Offered throughout the year
• Convenient online platform
• 12 months to begin exam after registration
• 30 Days to complete exam once started
• $50 Retest within 12 months of registration
• Log on/off privileges
• Consists of 40 multiple choice questions
• Open book format
• Immediate Pass/Fail determination
• Certification is valid for a full 3 years
• Validates your training and experience

MROCC FEES

MROCC fees are as follows:

• $125 Online Initial Certification Examination (Course fee/registration separate)
• $100 Online Recertification Examination (Course fee/registration separate)
• $50 Examination Retest
• $17 Professional-printed Certificate

Refund requests for online exams cannot be honored once the exam has been scheduled, regardless of whether or not it has been accessed. Please understand this in advance of registering.

EXAMINATION PREPARATION

Team Members preparing for MROCC Team Member certification and recertification examinations are strongly encouraged to utilize a variety of resources including, but not limited to, the following:

• Any training materials/syllabus from any training courses attended
• MRO Team Manual: MROCC'S Guide for MROs and MRO Team Members available from OEM Press
• MRO Regulations, Office of Drug and Alcohol Policy and Compliance (ODAPC) TITLE 49: TRANSPORTATION, PART 40 - PROCEDURES FOR TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS
• MRO Team Member Competencies
• Sample Exam Questions

ADDITIONAL EXAMINATION PREPARATION

Prior to taking an MROCC examination, it is the responsibility of the registrant to have read and to understand MROCC's policies on cheating and certificate revocation.

• MROCC Cheating Policy
• MRO Team Member Revocation Policy

ONLINE EXAM RESULTS

You will receive your online examination results immediately upon submission. If you receive a pass result, you can expect to receive an email from MROCC in approximately 5 days with instructions for accessing your official verification and ordering a professionally-printed certificate. If you do not receive a passing result, you can expect to receive an email within 24 hours that includes a link to the examination retest form.

MRO TEAM MEMBER RETEST POLICY

While we hope that everyone who takes the examination will pass it; we know realistically that there are many factors which can interfere with performance. In recognition of these possible complicating factors, the MROCC Board has adopted a policy on retests. If you submit your examination and do not receive a passing result, you may pay an additional $50 for a retest opportunity. Prior to retaking the examination, review of materials and resources from the MRO Team Member/Assistant training course, as well as the MRO Team Member Competencies, and the federal regulations within 49 CFR Part 40 is recommended.To register for a retest, go to http://mrocc.org/retest_form_mrotm.pdf

THE ONLINE EXAM

If you are taking the examination online, a quick review of the screenshots below may help to navigate the examination a little more easily. Click on an image below to enlarge it.

STARTING THE EXAM (click image to enlarge)...

AGREEMENT OF INTEGRITY (click image to enlarge)...

EXAM INSTRUCTIONS (click image to enlarge)...

Sample Examination Question (click image to enlarge)...

WHAT TO EXPECT

Once you have registered/paid for the examination, you can expect the following:

• An immediate email receipt for your credit card payment.
• Once MROCC has processed your registration, a confirmation email will be sent within 48 hours that includes instructions and logon information for your examination.
• Upon submission of your online examination, results are available immediately.
• If the examination was not passed, a link for a retest order form will be included in your result notification email.
• After your passing result is processed, you can expect an email within 5 days with instructions on accessing your official verification and ordering a certificate.

Begin the Exam Registration

To begin the registration process, please select from the choices below.