e18653 Background: An estimated 65 million people or approximately 20% of the United State residents live in rural areas based on the Census Bureau designation. As of December 31, 2021, 61.5% of the health professional shortage areas were designated in rural primary medicine. The Northern Arizona Healthcare (NAH) system is based in a rural area and experiencing shortages in both primary care and subspecialty physicians. This is making accurate and timely diagnostic studies key to facilitating early treatment. The objective of this study is to review whether complete diagnostic work up was performed for patients with suspected multiple myeloma (MM) or monoclonal gammopathy (MG) disorders prior to the oncology referral. The future goal of this study is to prompt further reviews and creations of order modules to help optimize healthcare for individuals in rural areas. Methods: This retrospective study included patients with the diagnosis of multiple myeloma or monoclonal gammopathy in the NAH system from 2015 to 2020. Data was reviewed to determine if serum protein electrophoresis (SPEP) with immunofixation was requested prior to oncology referral or at first oncology visit. Additionally, we evaluated if the urine protein electrophoresis (UPEP) order was requested on these visits as well. Results: The data consisted of 74 patients. On review, prior to oncology referral or at first oncology visit, only 18 patients (24%) had SPEP with immunofixation and UPEP ordered. 23 patients (31%) had SPEP orders only requesting additional immunofixation for further interpretation of data on future visits, and 47 patients (63%) were missing concurrent UPEP and SPEP orders. Conclusions: This retrospective study demonstrated that for patients with a confirmed final diagnosis of either MM or MG, 31% and 63% of patients had missing immunofixation and concurrent UPEP plus SPEP results respectively. The outpatient cerner system orders were adjusted to remove SPEP and UPEP only orders in the LabCorp and Senora Quest options. These were replaced with SPEP and UPEP with reflux to immunofixation orders. The goal of this adjustment is to prevent re-ordering of labs at initial oncology visit limiting cost burden and delay of diagnosis. In the future, patient care will be further optimized at NAH with the creation of an order set module. This module will include the complete lab workup required for multiple myeloma or monoclonal gammopathy with hematology/oncology referral and allow for further integration of non-oncology clinicians into care delivery.