A positive drug test result means a specimen has tested positive on both the initial immunoassay screen and the confirmation test (GC-MS or LC-MS/MS) at or above SAMHSA-established cutoff concentrations. Before reporting a positive to the employer, the Medical Review Officer (MRO) must attempt to contact the donor for a verification interview to determine if there is a legitimate medical explanation (such as a valid prescription). If no legitimate explanation exists, the MRO reports the result as positive to the employer. Under DOT regulations, a confirmed positive requires immediate removal from safety-sensitive functions and referral to a Substance Abuse Professional (SAP).