You may occasionally collect a specimen using direct observation. When an order for specimen collection mandates direct observation, the observer must be the same sex as the person producing the specimen.²¹ Common reasons for mandating direct observation include the following:

• The laboratory reports that a previously collected specimen produced invalid test results for which the medical review officer had no medical explanation.
• The laboratory reports that the technician couldn’t perform a split specimen test on a previously collected specimen.
• The medical review officer reports a diluted test result from a previously collected specimen and the creatinine concentration of the specimen is greater than or equal to 2 mg/dL but less than or equal to 5 mg/dL.
• Follow-up testing is required.
• The collector observed patient conduct that indicated that the patient tampered with the previously collected specimen.
• The temperature of a previously collected specimen was outside of the normal temperature range.