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Proc-Type: 2001,MIC-CLEAR
Originator-Name: webmaster@www.sec.gov
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<SEC-DOCUMENT>0000935836-09-000493.txt : 20090306
<SEC-HEADER>0000935836-09-000493.hdr.sgml : 20090306
<ACCEPTANCE-DATETIME>20090306105538
ACCESSION NUMBER:		0000935836-09-000493
CONFORMED SUBMISSION TYPE:	D/A
PUBLIC DOCUMENT COUNT:		1
ITEM INFORMATION:		Rule 506
ITEM INFORMATION:		Investment Company Act Section 3(c)
ITEM INFORMATION:		Section 3(c)(7)
FILED AS OF DATE:		20090306
DATE AS OF CHANGE:		20090306
EFFECTIVENESS DATE:		20090306

FILER:

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			PALO ALTO HEALTHCARE OFFSHORE II LTD
		CENTRAL INDEX KEY:			0001430918
		IRS NUMBER:				000000000
		STATE OF INCORPORATION:			XX

	FILING VALUES:
		FORM TYPE:		D/A
		SEC ACT:		1933 Act
		SEC FILE NUMBER:	021-116452
		FILM NUMBER:		09661055

	BUSINESS ADDRESS:	
		STREET 1:		C/O CITCO FUND SERVICES (BERMUDA) LTD
		STREET 2:		WASH. MALL WEST, 2ND FLOOR, 7 REID ST
		CITY:			HAMILTON
		STATE:			XX
		ZIP:			HM 11
		BUSINESS PHONE:		441 295-7149

	MAIL ADDRESS:	
		STREET 1:		C/O CITCO FUND SERVICES (BERMUDA) LTD
		STREET 2:		WASH. MALL WEST, 2ND FLOOR, 7 REID ST
		CITY:			HAMILTON
		STATE:			XX
		ZIP:			HM 11
</SEC-HEADER>
<DOCUMENT>
<TYPE>D/A
<SEQUENCE>1
<FILENAME>primary_doc.xml
<TEXT>
<XML>
<?xml version="1.0"?>
<edgarSubmission>

    <schemaVersion>X0201</schemaVersion>

    <submissionType>D/A</submissionType>

    <testOrLive>LIVE</testOrLive>

    <primaryIssuer>
        <cik>0001430918</cik>
        <entityName>PALO ALTO HEALTHCARE OFFSHORE II LTD</entityName>
        <issuerAddress>
            <street1>c/o Citco Fund Services (Bermuda) Ltd.</street1>
            <street2>2nd Floor, 7 Reid Street</street2>
            <city>Hamilton</city>
            <stateOrCountry>D0</stateOrCountry>
            <zipCode>HM 11</zipCode>
        </issuerAddress>
        <issuerPhoneNumber>(441) 295-7149</issuerPhoneNumber>
        <issuerPreviousNameList>
            <value>None</value>
        </issuerPreviousNameList>
        <jurisdictionOfInc>XX</jurisdictionOfInc>
        <entityType>Other</entityType>
        <yearOfInc>
            <withinFiveYears>true</withinFiveYears>
            <value>2007</value>
        </yearOfInc>
    </primaryIssuer>

    <relatedPersonsList>
        <relatedPersonInfo>
            <relatedPersonName>
                <firstName>Ronan</firstName>
                <middleName></middleName>
                <lastName>Guilfoyle</lastName>
            </relatedPersonName>
            <relatedPersonAddress>
                <street1>c/o dms Management Ltd., POBox 31910 SMB</street1>
                <street2>2nd Fl,  Ansbacher Hse, 20 Genesis Close</street2>
                <city>George Town, Grand Cayman</city>
                <stateOrCountry>E9</stateOrCountry>
            </relatedPersonAddress>
            <relatedPersonRelationshipList>
                <relationship>Director</relationship>
            </relatedPersonRelationshipList>
        </relatedPersonInfo>
        <relatedPersonInfo>
            <relatedPersonName>
                <firstName>Roger</firstName>
                <middleName>H.</middleName>
                <lastName>Hanson</lastName>
            </relatedPersonName>
            <relatedPersonAddress>
                <street1>c/o dms Management Ltd., POBox 31910 SMB</street1>
                <street2>2nd Fl,  Ansbacher Hse, 20 Genesis Close</street2>
                <city>George Town, Grand Cayman</city>
                <stateOrCountry>E9</stateOrCountry>
            </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>06</item>
            <item>3C</item>
            <item>3C.7</item>
        </federalExemptionsExclusions>
        <typeOfFiling>
            <newOrAmendment>
                <isAmendment>true</isAmendment>
                <previousAccessionNumber>9999999997-08-016329</previousAccessionNumber>
            </newOrAmendment>
            <dateOfFirstSale>
                <value>2008-01-01</value>
            </dateOfFirstSale>
        </typeOfFiling>
        <durationOfOffering>
            <moreThanOneYear>true</moreThanOneYear>
        </durationOfOffering>
        <typesOfSecuritiesOffered>
            <isPooledInvestmentFundType>true</isPooledInvestmentFundType>
            <isOtherType>true</isOtherType>
            <descriptionOfOtherType>Redeemable shares</descriptionOfOtherType>
        </typesOfSecuritiesOffered>
        <businessCombinationTransaction>
            <isBusinessCombinationTransaction>false</isBusinessCombinationTransaction>
        </businessCombinationTransaction>
        <minimumInvestmentAccepted>1000000</minimumInvestmentAccepted>
        <salesCompensationList>
            <recipient>
                <recipientName>Citigroup Global Markets Inc.</recipientName>
                <recipientCRDNumber>7059</recipientCRDNumber>
                <associatedBDName>None</associatedBDName>
                <associatedBDCRDNumber>None</associatedBDCRDNumber>
                <recipientAddress>
                    <street1>390 - 388 Greenwich Street</street1>
                    <city>New York</city>
                    <stateOrCountry>NY</stateOrCountry>
                    <zipCode>10013</zipCode>
                </recipientAddress>
                <statesOfSolicitationList>
                    <value>All States</value>
                </statesOfSolicitationList>
            </recipient>
        </salesCompensationList>
        <offeringSalesAmounts>
            <totalOfferingAmount>500000000</totalOfferingAmount>
            <totalAmountSold>21838303</totalAmountSold>
            <totalRemaining>478161697</totalRemaining>
        </offeringSalesAmounts>
        <investors>
            <hasNonAccreditedInvestors>false</hasNonAccreditedInvestors>
            <totalNumberAlreadyInvested>10</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 adviser of the issuer pays a portion of the management fees it receives from the issuer to Citigroup World Markets Inc.</clarificationOfResponse>
        </salesCommissionsFindersFees>
        <useOfProceeds>
            <grossProceedsUsed>
                <dollarAmount>0</dollarAmount>
                <isEstimate>true</isEstimate>
            </grossProceedsUsed>
            <clarificationOfResponse>None, although the investment adviser of the issuer receives investment management fees and performance fees.</clarificationOfResponse>
        </useOfProceeds>
        <signatureBlock>
            <authorizedRepresentative>false</authorizedRepresentative>
            <signature>
                <issuerName>Palo Alto Healthcare Offshore II Ltd.</issuerName>
                <signatureName>Ronan Guilfoyle</signatureName>
                <nameOfSigner>Ronan Guilfoyle</nameOfSigner>
                <signatureTitle>Director</signatureTitle>
                <signatureDate>2009-03-05</signatureDate>
            </signature>
        </signatureBlock>
    </offeringData>
</edgarSubmission>
</XML>
</TEXT>
</DOCUMENT>
</SEC-DOCUMENT>
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