Why does there need to be PII on samples going to Texas anyway? Have Seattle take the lab samples and do any medical billing, generate a unique id to go on that set of lab samples, keep the link between the patient and ID tied to the record back in Seattle, and then send the samples to Texas.

Texas tests samples and returns results for Patient 3418-6834-0556 when Seattle knows that actually means they're for Bob Smith taken on September 18, 2026.