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hello thank you for coming to listen to me Im Estella Wetzel Im frontier graduate in class 78 and a Duke Johnson Johnson nurse leadership fellow for 2019 to 2020 I have had some experience working with the rural populations through Ohio a few of the counties Ive been in a Clark Champaign Ross safed Butler Ashland and Greene counties Im currently practicing in Beaver Creek I have no disclosures but this does not mean Im boring some of my clinical experience was starting a primary care within a mental health center in Ross County I learned a lot from that population and a lot from the culture of the area the objectives of this presentation are to know how misinterpreted drug test results affect patients understand the differences between screening and confirmation testing identify potential drug cross reactivity recognized some ways urine tampering occurs distinguish expected from unexpected drug test results and discern plausible reasons for unexpected drug test results to consid