In this guide, I cover all the endings, achievement requirements, and some useful tips for the parts that can be easy to miss. If you’re having trouble reaching a particular ending or unlocking an achievement, this guide should help you figure out what to do.
Tips for Progression
I’ve put together a few tips that can help while playing Magical Girl ER. For the requirements of each ending, check the Ending Walkthrough section below.
Magical Girl Visits and Save Management
The magical girls who visit the hospital are selected randomly at the start of each day. If the magical girl you need doesn’t appear, load your save from before going to bed the previous night and try again.
Injury and Death Outcomes
If you make an incorrect diagnosis or skip the diagnosis, the game performs a survival check based on the patient’s mortality rate. If the check succeeds, the patient survives. If it fails, the patient dies.
- Injury: If the patient survives, a news article appears the next day saying their condition has worsened and further examination is required. Your reputation doesn’t decrease.
- Death: If the patient dies, a news article appears the next day reporting that they died while hospitalized. Your reputation decreases depending on the magical girl’s popularity.
- Re-examination: Even after a correct diagnosis, another medical condition can develop while the patient is recovering. A news article appears the next day saying further examination is required, but your reputation doesn’t decrease.
After hearing the hooded figure’s initial explanation, an injury outcome will trigger a blinking-eye animation at the start of the following day.
Special NPC Encounters
There are four special NPCs in the game, and each one provides hints related to specific endings or achievements.
- Hooded Figure: Provides hints for END 05.
- NPC Offering an Energy Drink: Provides hints for END 07 and the Serial Killer achievement.
- Man Requesting Transfers to MIRAGE: Provides hints for END 02 and END 04.
- ???: Provides hints for END 06 and the Actually, Never Mind. achievement.
Ending Walkthrough
END 01 — Magical Girl ER
Maintain 100 reputation, treat and discharge all magical girls, and complete Day 8.
END 02 — Lingering Regret
Maintain 100 reputation and accept the NPC’s MIRAGE transfer request on Day 4. The NPC must return at least once. You can accept or refuse any further transfer requests. Complete Day 8.
END 03 — Promotion Celebration
Complete Day 8 with reduced reputation. This ending can also occur if you accept the MIRAGE transfer request, the NPC returns, and your reputation is below 100.
END 04 — This Is MIRAGE
Accept the NPC’s MIRAGE transfer request on Day 4, then complete Day 8 without the NPC returning. Reputation doesn’t appear to matter.
END 05 — Just as You Are
Follow the mysterious man’s instructions from Day 2. Misdiagnose a magical girl without killing her, then avoid examining arms after he returns. Accept his call on Day 8.
END 06 — Mom…
Allow the mysterious visitor (???) who appears on Day 5 into the hospital, then have a casual conversation with them on Day 8.
END 07 — So They Claim
Drink the energy drink given to you by the NPC on Day 5. At the beginning of Day 8, choose the option to drink it again (the right option), then complete Day 8.
END 08 — Incompetent Doctor
Let hospitalized patients die until your reputation drops to 0.
END 09 — What Are You Doing?
Refuse to admit magical girls until your reputation drops to 0.
END 10 — You Traitor
In one playthrough, let only state-affiliated magical girls (Calm, Gnome, and Cherry) die while keeping all other magical girls alive. Complete Day 8.
END 11 — Two as One
Have Sakura and Cherry hospitalized at the same time, then make sure Cherry dies first.
Ending Tips
END 01 — Maintaining Reputation
Maintain 100 reputation, treat and discharge every magical girl, and complete Day 8.
If you complete the game without injuring a single magical girl, you can also unlock the I’ll Save Them All achievement.
END 02 · END 03 · END 04 — MIRAGE Transfers and Ending Routes
The ending depends on whether you accept the initial transfer request on Day 4, whether the NPC returns, and your reputation. If you meet the requirements for another special ending, that ending takes priority.
| Initial Transfer Request | NPC Return Visit | 100 Reputation | 1–99 Reputation |
|---|---|---|---|
| Refuse | N/A | END 01 | END 03 |
| Accept | None | END 04 | END 04 |
| Accept | At least once | END 02 | END 03 |
Important: Make sure no magical girls are hospitalized on Day 6, when the NPC makes their second visit. Discharge all hospitalized patients by the end of Day 5 to meet this condition.
END 06 — Mom…
You’re likely to encounter the mysterious visitor (???) from Day 5 while working toward END 05. It’s not confirmed whether this NPC can appear through other methods.
END 10 — You Traitor
In one playthrough, let only state-affiliated magical girls (Calm, Gnome, and Cherry) die while keeping everyone else alive. You only need one of them to die, not all three. However, multiple deaths can lower your reputation enough to trigger a different ending.
END 11 — Two as One
Sakura visits on Day 1, so I recommend using save-and-reload to make Cherry appear on Day 2. This makes it easier to have both hospitalized at the same time.
Load your save from before going to bed on Day 1 until Cherry appears. Then make sure Cherry dies before Sakura.
Other Achievements
I’ll Save Them All
Reach END 01 without making a single treatment mistake. All magical girls must visit the hospital and be discharged without being injured during the same playthrough.
Forever Grateful
Successfully treat every magical girl at least once.
You Monster!
Refuse admission to each of the four one-star magical girls—Blood, Nail, Bomb, and Delta—at least once.
You Call Yourself a Doctor?!
Have three magical girls hospitalized at the same time, misdiagnose all three, and then advance to the next day.
Actually, Never Mind.
Let the mysterious humanoid creature (???) into the hospital, then kick it out on the same day.
Eleven Endings
Unlock all 11 endings.
Serial Killer
Drink the energy drink given to you by the NPC on Day 5. On Day 8, have three magical girls hospitalized and prescribe psychotropic medication to all three. Due to hallucinations, the medication will appear as ???.
Tell Me Your Story
View every daily conversation.
Achievement Tips
I’ve added some extra tips below for the achievements that can take more time to unlock. For the basic requirements, check the achievement list above.
You Monster!
You need to refuse admission to all four one-star magical girls: Blood, Nail, Bomb, and Delta.
If the magical girl you’re looking for doesn’t appear, load your save from before going to bed the previous night and try again. This changes which patients visit your hospital.
You can also use this method for END 10 and END 11, since both endings require specific magical girls to appear.
Serial Killer
Drink the energy drink given to you by the NPC on Day 5. On Day 8, you’ll automatically experience hallucinations, causing all text to appear as ‘???’.
While in this state, have three magical girls hospitalized and prescribe psychiatric medication to all three. The medication names will also appear as ‘???’, so select the corresponding option to unlock the achievement.
Tell Me Your Story
For this achievement, you need to view every magical girl’s daily conversations. Finding the conversations you’ve missed can take some time.
Your first conversation with each magical girl will always be a greeting. After that, you can see different conversations depending on whether they’re in their normal or injured state.
How to Check for Missing Conversations
Go to Main Menu → Extras → Character Dialogue List and check each character’s dialogue entries one by one.
If the list skips certain entries while you’re browsing, that character may still have conversations you haven’t seen.
I recommend saving before going to bed on Day 1, then reloading until the magical girl you’re looking for visits on Day 2. This lets you focus on unlocking her remaining conversations.
The exact number of conversations and their trigger conditions haven’t been fully confirmed, so use this information as a general reference.