The project consists of a clinic expansion on the 6th floor of the Medical Office Building at Texas Children's Hospital The Woodlands to serve the Neurology Outpatient Clinic. The scope includes partial demolition of shell space and construction of the new build-out space. The clinic expansion is 6,300 square feet and consists of 12 exam rooms, 1 procedure room and support spaces. The reception 'clubhouse' consists of design components matching the existing clubhouses, a fun and inviting feature/design element for children. The project offered several challenges. First, the 6th floor included an existing clinic which was operational during construction. We were challenged with keeping the patients and staff safe as well as not disrupting daily activities. Temporary barriers, containment and directional signage were installed to isolate construction from clinic activities. Additionally, constant communication with the office manager was required to ensure major noise generating activities were avoided when testing, which required silence, was being performed. Second, plenum space above ceiling was limited. The roof concrete structure was sloped and therefore reduced the space for equipment, ductwork and piping above ceiling. Subcontractors surveyed the existing construction, included this information with their new work, coordinated the new work via BIM (Building Information Modeling) and were diligent and accurate in the field implementation of their coordinated efforts. Finally, the schedule duration required quick procurement of materials and had to be done in consideration of the holiday season (Thanksgiving, Christmas and New Year). The team understood this constraint and worked diligently to ensure timely delivery. The construction team submitted for approval all required items quickly and in many cases, prior to the NTP being given. The design team expedited their review and Owner made timely decisions which resulted in all materials arriving on time.