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The best description of the review process for a positive drug screen is that the Medical Review Officer (MRO) performs the review. The MRO plays a critical role in the confirmation and interpretation of drug test results. They are a licensed physician with knowledge of drug abuse disorders and controlled substances, responsible for reviewing laboratory results and ensuring that legitimate medical explanations are considered.

When a drug test yields a positive result, the MRO contacts the individual to discuss the result, provide an opportunity for the individual to explain any possible legitimate medical reasons for the result, and to confirm whether the test should indeed be reported as positive. This process ensures fairness and accuracy in assessing drug test results, providing a safeguard against wrongful reporting.

In contrast, immediate decisions by a medical examiner, reviews by a board, or automatic reporting to the Federal Motor Carrier Safety Administration (FMCSA) do not accurately reflect the structured and thorough procedure mandated for evaluating positive drug screens. The involvement of an MRO is essential for compliance with regulations and accuracy in reporting, underscoring why this is the correct choice.