Try this:
set var “10930,1234567890,123456,PATIENT,FNAME,1011945,TST1,Result 1,TST2,Result 2”
set res “10930,1234567890,123456,PATIENT,FNAME,1011945~TST1,Result 1,TST2,Result 2”
regsub — {(.*?,.*?,.*?,.*?,.*?,.*?),(.*?,.*?,.*?,.*?)} $var {1-2} newVar
puts $newVar
#returns: 10930,1234567890,123456,PATIENT,FNAME,1011945-TST1,Result 1,TST2,Result 2