<?xml version="1.0"?>
<edgarSubmission>

    <schemaVersion>X0708</schemaVersion>

    <submissionType>D/A</submissionType>

    <testOrLive>LIVE</testOrLive>

    <primaryIssuer>
        <cik>0001372021</cik>
        <entityName>PALO ALTO HEALTHCARE OFFSHORE LTD</entityName>
        <issuerAddress>
            <street1>C/O WALKERS CORPORATE LIMITED</street1>
            <street2>190 ELGIN AVENUE</street2>
            <city>GEORGE TOWN, GRAND CAYMAN</city>
            <stateOrCountry>E9</stateOrCountry>
            <stateOrCountryDescription>CAYMAN ISLANDS</stateOrCountryDescription>
            <zipCode>KY1 - 9008</zipCode>
        </issuerAddress>
        <issuerPhoneNumber>650-325-0772</issuerPhoneNumber>
        <jurisdictionOfInc>CALIFORNIA</jurisdictionOfInc>
        <issuerPreviousNameList>
            <value>None</value>
        </issuerPreviousNameList>
        <edgarPreviousNameList>
            <value>None</value>
        </edgarPreviousNameList>
        <entityType>Other</entityType>
        <entityTypeOtherDesc>Cayman Islands Exempted Company</entityTypeOtherDesc>
        <yearOfInc>
            <overFiveYears>true</overFiveYears>
        </yearOfInc>
    </primaryIssuer>

    <relatedPersonsList>
        <relatedPersonInfo>
            <relatedPersonName>
                <firstName>Cary</firstName>
                <lastName>Marr</lastName>
            </relatedPersonName>
            <relatedPersonAddress>
                <street1>c/o Paradigm Governance Partners Limited</street1>
                <street2>1 Capital Place, 3rd Fl, 136 Shedden Rd</street2>
                <city>Grand Cayman</city>
                <stateOrCountry>E9</stateOrCountry>
                <stateOrCountryDescription>CAYMAN ISLANDS</stateOrCountryDescription>
                <zipCode>KY1-9006</zipCode>
            </relatedPersonAddress>
            <relatedPersonRelationshipList>
                <relationship>Director</relationship>
            </relatedPersonRelationshipList>
        </relatedPersonInfo>
        <relatedPersonInfo>
            <relatedPersonName>
                <firstName>Jonathan</firstName>
                <lastName>Roney</lastName>
            </relatedPersonName>
            <relatedPersonAddress>
                <street1>c/o Paradigm Governance Partners Limited</street1>
                <street2>1 Capital Place, 3rd Fl, 136 Shedden Rd</street2>
                <city>Grand Cayman</city>
                <stateOrCountry>E9</stateOrCountry>
                <stateOrCountryDescription>CAYMAN ISLANDS</stateOrCountryDescription>
                <zipCode>KY1-9006</zipCode>
            </relatedPersonAddress>
            <relatedPersonRelationshipList>
                <relationship>Director</relationship>
            </relatedPersonRelationshipList>
        </relatedPersonInfo>
    </relatedPersonsList>

    <offeringData>
        <industryGroup>
            <industryGroupType>Pooled Investment Fund</industryGroupType>
            <investmentFundInfo>
                <investmentFundType>Hedge Fund</investmentFundType>
                <is40Act>false</is40Act>
            </investmentFundInfo>
        </industryGroup>
        <issuerSize>
            <aggregateNetAssetValueRange>Decline to Disclose</aggregateNetAssetValueRange>
        </issuerSize>
        <federalExemptionsExclusions>
            <item>06b</item>
            <item>3C</item>
            <item>3C.1</item>
        </federalExemptionsExclusions>
        <typeOfFiling>
            <newOrAmendment>
                <isAmendment>true</isAmendment>
                <previousAccessionNumber>0000935836-24-000269</previousAccessionNumber>
            </newOrAmendment>
            <dateOfFirstSale>
                <value>2006-07-01</value>
            </dateOfFirstSale>
        </typeOfFiling>
        <durationOfOffering>
            <moreThanOneYear>true</moreThanOneYear>
        </durationOfOffering>
        <typesOfSecuritiesOffered>
            <isEquityType>true</isEquityType>
            <isPooledInvestmentFundType>true</isPooledInvestmentFundType>
            <isOtherType>true</isOtherType>
            <descriptionOfOtherType>Redeemable Shares</descriptionOfOtherType>
        </typesOfSecuritiesOffered>
        <businessCombinationTransaction>
            <isBusinessCombinationTransaction>false</isBusinessCombinationTransaction>
        </businessCombinationTransaction>
        <minimumInvestmentAccepted>1000000</minimumInvestmentAccepted>
        <salesCompensationList>
            <recipient>
                <recipientName>MMX Global Partners, LLC</recipientName>
                <recipientCRDNumber>000286531</recipientCRDNumber>
                <associatedBDName>None</associatedBDName>
                <associatedBDCRDNumber>None</associatedBDCRDNumber>
                <recipientAddress>
                    <street1>1515 NORTH FEDERAL HIGHWAY, SUITE 306</street1>
                    <city>BOCA RATON</city>
                    <stateOrCountry>FL</stateOrCountry>
                    <stateOrCountryDescription>FLORIDA</stateOrCountryDescription>
                    <zipCode>33432</zipCode>
                </recipientAddress>
                <statesOfSolicitationList>
                    <state>CA</state>
                    <description>CALIFORNIA</description>
                    <state>CO</state>
                    <description>COLORADO</description>
                    <state>CT</state>
                    <description>CONNECTICUT</description>
                    <state>DC</state>
                    <description>DISTRICT OF COLUMBIA</description>
                    <state>FL</state>
                    <description>FLORIDA</description>
                    <state>GA</state>
                    <description>GEORGIA</description>
                    <state>IL</state>
                    <description>ILLINOIS</description>
                    <state>KS</state>
                    <description>KANSAS</description>
                    <state>MD</state>
                    <description>MARYLAND</description>
                    <state>MA</state>
                    <description>MASSACHUSETTS</description>
                    <state>MI</state>
                    <description>MICHIGAN</description>
                    <state>MN</state>
                    <description>MINNESOTA</description>
                    <state>MO</state>
                    <description>MISSOURI</description>
                    <state>NE</state>
                    <description>NEBRASKA</description>
                    <state>NJ</state>
                    <description>NEW JERSEY</description>
                    <state>NY</state>
                    <description>NEW YORK</description>
                    <state>NC</state>
                    <description>NORTH CAROLINA</description>
                    <state>OH</state>
                    <description>OHIO</description>
                    <state>OR</state>
                    <description>OREGON</description>
                    <state>PA</state>
                    <description>PENNSYLVANIA</description>
                    <state>TN</state>
                    <description>TENNESSEE</description>
                    <state>TX</state>
                    <description>TEXAS</description>
                    <state>VA</state>
                    <description>VIRGINIA</description>
                    <state>WA</state>
                    <description>WASHINGTON</description>
                </statesOfSolicitationList>
                <foreignSolicitation>false</foreignSolicitation>
            </recipient>
            <recipient>
                <recipientName>Morgan Stanley Smith Barney LLC</recipientName>
                <recipientCRDNumber>000149777</recipientCRDNumber>
                <associatedBDName>None</associatedBDName>
                <associatedBDCRDNumber>None</associatedBDCRDNumber>
                <recipientAddress>
                    <street1>200 WESTCHESTER AVE</street1>
                    <city>PURCHASE</city>
                    <stateOrCountry>NY</stateOrCountry>
                    <stateOrCountryDescription>NEW YORK</stateOrCountryDescription>
                    <zipCode>10577-2530</zipCode>
                </recipientAddress>
                <statesOfSolicitationList>
                    <value>All States</value>
                </statesOfSolicitationList>
                <foreignSolicitation>false</foreignSolicitation>
            </recipient>
        </salesCompensationList>
        <offeringSalesAmounts>
            <totalOfferingAmount>Indefinite</totalOfferingAmount>
            <totalAmountSold>45850000</totalAmountSold>
            <totalRemaining>Indefinite</totalRemaining>
            <clarificationOfResponse>This is a continuous offering. The amount disclosed is the gross amount of interest sold by the Issuer and does not include redemptions by investors. The number of investors disclosed in Item 14 below is an estimate and does not include redemptions.</clarificationOfResponse>
        </offeringSalesAmounts>
        <investors>
            <hasNonAccreditedInvestors>false</hasNonAccreditedInvestors>
            <totalNumberAlreadyInvested>17</totalNumberAlreadyInvested>
        </investors>
        <salesCommissionsFindersFees>
            <salesCommissions>
                <dollarAmount>0</dollarAmount>
                <isEstimate>true</isEstimate>
            </salesCommissions>
            <findersFees>
                <dollarAmount>0</dollarAmount>
                <isEstimate>true</isEstimate>
            </findersFees>
            <clarificationOfResponse>The issuer does not pay any sales commissions or finders' fees expenses. The Investment Manager of the Issuer pays a portion of the management fees it receives from the issuer to MMX Global Partners, LLC and Morgan Stanley Smith Barney LLC.</clarificationOfResponse>
        </salesCommissionsFindersFees>
        <useOfProceeds>
            <grossProceedsUsed>
                <dollarAmount>12000</dollarAmount>
                <isEstimate>true</isEstimate>
            </grossProceedsUsed>
            <clarificationOfResponse>The issuer pays fees of approximately $12,000.00 per annum to its directors. Customary advisory fees are paid by the Issuer to the General Partner and Investment Manager (as applicable) as provided for in the Issuer's offering materials.</clarificationOfResponse>
        </useOfProceeds>
        <signatureBlock>
            <authorizedRepresentative>false</authorizedRepresentative>
            <signature>
                <issuerName>PALO ALTO HEALTHCARE OFFSHORE LTD</issuerName>
                <signatureName>Jonathan Roney</signatureName>
                <nameOfSigner>Jonathan Roney</nameOfSigner>
                <signatureTitle>Director</signatureTitle>
                <signatureDate>2025-02-26</signatureDate>
            </signature>
        </signatureBlock>
    </offeringData>
</edgarSubmission>
