Background: Efforts are occurring across the United States to improve the rates of identification and standard of care genetic counseling (GC) and genetic testing (GT) of pts with breast and ovarian cancer. Following a successful quality improvement (QI) initiative to increase referrals and utilization of GC/GT among pts with breast and ovarian cancer to >80% at our host site (HS), we sought to disseminate the QI project to three unique oncology care settings (OCS). Methods: The OCS described in the Table are certified members of the HS network, were strategically identified, and agreed to participate in the QI project. Genetic counselors at the HS and OCS built teams to plan and initiate the project. A 130-item environmental scan was created by the HS team to assess OCS structure, resources, and GC/GT processes. OCS teams completed the environmental scan and a semi-structured interview with the HS; and from this, barriers to GC/GT were identified, then categorized using Ishikawa diagrams. Clinical interventions were designed to address these barriers. Resulting QI protocols follow the PDSA-cycle QI model. A database was built for retrospective and prospective data collection of eligible pts and rates of GC/GT referral and completion from 2015-2018. Results: Although unique barriers were identified at each OCS, all identified: pt referral/scheduling issues, technology and electronic medical record system inefficiencies, and inconsistent physician referral/GT practices. OCS interventions include: implementation of physician-coordinated GT, GC within chemo infusion suites, physician education sessions, GC scheduling improvements, creation of pt education documents, and development of referral tracking processes. Conclusions: Genetic counselors collaborated, planned, and initiated dissemination of a QI project to improve GC/GT utilization at three unique OCS. QI interventions were developed to address the unique environment and barriers at each OCS.