e23239 Background: Genetic testing for BRCA 1/2 in breast cancer patients have important implications on systemic therapy options, particularly for qualification of PARP inhibitor therapy. NCCN guidelines currently recommend genetic testing for all patients with metastatic or recurrent breast cancer, triple negative breast cancer, as well as high-risk HER2-negative breast cancer. Despite these recommendations, germline genetic testing in these populations remain suboptimal in part due to limited access to genetic counselors. Introducing pathways to identify patients who qualify for genetic testing through nurse navigator screening and increasing provider ordered testing can help bridge the gap to expedite genetic testing. Methods: A retrospective review of metastatic breast cancer patients who were seen at MD Anderson Cancer Center (MDA) between 01/01/2021 and 12/31/2021 was performed to determine a baseline rate at which this population met with genetic counselors. A new protocol was established to aid nurse navigators in identifying patients establishing care at MDA who qualify for testing and guide providers on ordering genetic testing at initial appointment. Nurse navigators and providers underwent a formal training session on protocol with guidelines on patient qualification. Additionally, a best practice advisory (BPA) was implemented into the electronic medical record to alert providers to patients who should be tested. Results: At baseline, 29.6% of patients with metastatic breast cancer had met with genetic counselors at our institution in 2021. Based on this finding, the provider initiated genetic testing process was implemented, where providers order genetic testing at the initial appointment. Initial uptake of this process was low with less than 10 tests ordered in the first three months of intervention. Therefore, a nurse navigator pathway was implemented as well as a BPA within our electronic medical records to alert providers on patients who qualify for testing. This BPA flags patients with stage IV breast cancer that have not seen genetic counselors at our institution and guides providers to either order genetic testing, place a referral for genetic counseling, or dismiss the BPA due to specified reasons. Conclusions: It is imperative that patients with metastatic breast cancer have access to genetic testing at diagnosis to determine optimal therapy. With the expansion of genetic testing recommendations, moving toward a provider driven testing model may expedite and increase access to genetic testing. By implementing additional screening through our nurse navigators and BPA advisories, we hope to increase provider driven testing at our institution. Additionally, we aim to expand these interventions to other subgroups of breast cancer who would qualify for adjuvant PARP therapy in the next phase of intervention.