<?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>CAYMAN ISLANDS</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>Hawksford Governance Services Cayman Ltd</street1>
                <street2>Ste A 4th Fl, Century Yard, Cricket Sqr</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>Hawksford Governance Services Cayman Ltd</street1>
                <street2>Ste A 4th Fl, Century Yard, Cricket Sqr</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>0000935836-25-000200</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>
            <recipient>
                <recipientName>Crewe Capital</recipientName>
                <recipientCRDNumber>000152527</recipientCRDNumber>
                <associatedBDName>None</associatedBDName>
                <associatedBDCRDNumber>None</associatedBDCRDNumber>
                <recipientAddress>
                    <street1>650 S.  Main Street, Suite 777</street1>
                    <city>Salt Lake City</city>
                    <stateOrCountry>UT</stateOrCountry>
                    <stateOrCountryDescription>UTAH</stateOrCountryDescription>
                    <zipCode>84101</zipCode>
                </recipientAddress>
                <statesOfSolicitationList>
                    <value>All States</value>
                </statesOfSolicitationList>
                <foreignSolicitation>false</foreignSolicitation>
            </recipient>
            <recipient>
                <recipientName>Capital Connect, LLC</recipientName>
                <recipientCRDNumber>000329399</recipientCRDNumber>
                <associatedBDName>None</associatedBDName>
                <associatedBDCRDNumber>None</associatedBDCRDNumber>
                <recipientAddress>
                    <street1>191 Silver Moss Drive</street1>
                    <city>Vero Beach</city>
                    <stateOrCountry>FL</stateOrCountry>
                    <stateOrCountryDescription>FLORIDA</stateOrCountryDescription>
                    <zipCode>32963</zipCode>
                </recipientAddress>
                <statesOfSolicitationList>
                    <state>AZ</state>
                    <description>ARIZONA</description>
                    <state>CA</state>
                    <description>CALIFORNIA</description>
                    <state>CO</state>
                    <description>COLORADO</description>
                    <state>CT</state>
                    <description>CONNECTICUT</description>
                    <state>DE</state>
                    <description>DELAWARE</description>
                    <state>DC</state>
                    <description>DISTRICT OF COLUMBIA</description>
                    <state>FL</state>
                    <description>FLORIDA</description>
                    <state>GA</state>
                    <description>GEORGIA</description>
                    <state>IN</state>
                    <description>INDIANA</description>
                    <state>IA</state>
                    <description>IOWA</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>NV</state>
                    <description>NEVADA</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>OK</state>
                    <description>OKLAHOMA</description>
                    <state>OR</state>
                    <description>OREGON</description>
                    <state>PA</state>
                    <description>PENNSYLVANIA</description>
                    <state>SC</state>
                    <description>SOUTH CAROLINA</description>
                    <state>TN</state>
                    <description>TENNESSEE</description>
                    <state>TX</state>
                    <description>TEXAS</description>
                    <state>UT</state>
                    <description>UTAH</description>
                    <state>VA</state>
                    <description>VIRGINIA</description>
                    <state>WA</state>
                    <description>WASHINGTON</description>
                    <state>WI</state>
                    <description>WISCONSIN</description>
                    <state>WY</state>
                    <description>WYOMING</description>
                </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 the entities listed in Item 12.</clarificationOfResponse>
        </salesCommissionsFindersFees>
        <useOfProceeds>
            <grossProceedsUsed>
                <dollarAmount>4000</dollarAmount>
                <isEstimate>true</isEstimate>
            </grossProceedsUsed>
            <clarificationOfResponse>The issuer pays fees of approximately $4,000.00 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>2026-02-23</signatureDate>
            </signature>
        </signatureBlock>
    </offeringData>
</edgarSubmission>
