Hospital air conditioning is always considered as high sensitive issue while planning with other services. Recently completed healthcare project by Cool Earth Team is a multi-specialty hospital located in Tirupati, Amraja Hospitals, where two aspects were very important. One is the high end HVAC system required for healthcare and second is the height restriction in between false ceiling and slab to run all services. Another challenge came while crossing the ducts and pipes within the beams. Care has been taken to provide all modern facilities available in this type of hospitals where construction area is nearly 6,000 square feet.