Occasionally, I’ve heard it said that some players build their clinic nearly the same way every time, and that the construction part of the game lacks variety. So, in The Extension, I added Urban Design 1.0 to require different floor plans, and Underground Utility Work to reduce the available space and to resize and reconfigure your player boards however you want. Then, in the 3rd Extension, I added Urban Design 2.0. But still… you have all become veterans of all of these obstacles, and now you need more! So, I offer you new layouts for the ground floor, and a new series of double tiles, which should not only accelerate development of your clinic, but also allow you to play on these more difficult floors — plenty to get you out of your rut! —From the introduction of the rulebook