Magical Girl ER: All Endings and Achievements

Magical Girl ER has 11 endings and eight extra achievements, and most of them hinge on a handful of choices: who you let in, who you treat or lose, and what you do with four unusual visitors. This page gives the requirement for every ending, shows how the MIRAGE transfer request splits the results, and explains each of the other achievements.

The short version: stay at 100 reputation and treat everyone for the clean ending, reload your bedtime save whenever the visitor you need does not show up, and watch the four odd NPCs, because they lead into five of the other endings.

This guide spoils story events and ending names, so skip it if you want to find them yourself.

All 11 endings at a glance

Ending	Name	What it needs
END 01	Magical Girl ER	Keep 100 reputation, treat and discharge everyone
END 02	Lingering Regret	MIRAGE route with the man returning, at 100 reputation
END 03	Promotion Celebration	Finish Day 8 with reduced reputation
END 04	This Is MIRAGE	MIRAGE route with the man never returning
END 05	Just as You Are	Follow the hooded figure's instructions from Day 2
END 06	Mom…	Admit the Day 5 visitor shown as ???
END 07	So They Claim	The energy drink route
END 08	Incompetent Doctor	Patient deaths drive reputation to 0
END 09	What Are You Doing?	Refused admissions drive reputation to 0
END 10	You Traitor	Only state-affiliated girls die
END 11	Two as One	Sakura and Cherry together, Cherry dies first

How visits, injuries and deaths work

The magical girl who visits your hospital is picked at random when the day starts. If you need a particular one and she does not turn up, reload the save you made before going to bed the night before and the game rolls a new visitor. Every "I need this specific girl" problem below is solved this way, so it is the first tool to reach for.

If you misdiagnose a patient or skip the diagnosis, the game runs a survival check based on her mortality rate. Pass and she lives, fail and she dies. The next day's news tells you which.

Outcome	When it happens	What the next day's news says	Reputation
Injury	Wrong or skipped diagnosis, and she passes the survival check	Her condition got worse and she needs another examination	No loss
Death	Wrong or skipped diagnosis, and she fails the check	She lost her life while hospitalized	Drops, by an amount that depends on how popular that magical girl is
Re-examination	A correct diagnosis, followed by a new condition as she recovers	Further examination is required	No loss

The four special NPCs

Four visitors give hints toward particular routes. The sections for the endings and achievements named below carry the details.

NPC	Leads to
Hooded figure	END 05
NPC who offers an energy drink	END 07 and the Serial Killer achievement
Man who asks to transfer patients to MIRAGE	END 02 and END 04
Visitor shown as ???, on Day 5	END 06 and the Actually, Never Mind. achievement

END 01: Magical Girl ER

END 01, Magical Girl ER, is the clean ending. Keep your reputation at 100, treat and discharge every magical girl, and finish Day 8. A death costs reputation, so a misdiagnosis that kills is the main thing to avoid. If you also avoid every injury, the I'll Save Them All achievement comes with it.

END 02: Lingering Regret

END 02, Lingering Regret, needs 100 reputation and the MIRAGE route where the transfer man comes back. Accept his Day 4 request, let him return at least once, and finish Day 8. Whether you accept or refuse his later requests makes no difference. The full split is in the transfer table below.

END 03: Promotion Celebration

END 03, Promotion Celebration, is what you get for finishing Day 8 with reduced reputation. It also appears if you accepted the transfer, the man returned, and your reputation was under 100.

END 04: This Is MIRAGE

END 04, This Is MIRAGE, comes from accepting the transfer request on Day 4 and finishing Day 8 without the man returning. Reputation does not appear to affect it, which is why the table below lists END 04 in both reputation columns. To keep him away, treat every patient correctly on Day 5 so nobody is still in the hospital when Day 6 begins, then check the Day 6 news to confirm they were discharged.

END 05: Just as You Are

END 05, Just as You Are, follows the instructions of the hooded figure, who first appears on Day 2. Do these in order, starting with an injury:

1. Misdiagnose a magical girl so that she is injured, but make sure she does not die.
2. After the hooded figure returns, do not examine arms.
3. On Day 8, accept his call.

After you have heard the hooded figure's first explanation, any injury shows a blinking eye animation at the start of the following day. That cue only applies from that point on.

END 06: Mom…

END 06, Mom…, needs you to let the visitor shown as ??? on Day 5 into the hospital and have a casual conversation with them on Day 8. This visitor is easier to run into while you are working on END 05. Evicting them the same day earns an achievement instead, covered further down.

END 07: So They Claim

END 07, So They Claim, is the energy drink ending. An NPC hands you an energy drink on Day 5, and you drink it. At the start of Day 8 the game offers the drink again, and you pick the option on the right to drink it. Then you must also carry out one additional examination before the day ends. If you refuse the drink, or skip that examination, you land on END 01 or END 03 instead, depending on your reputation. Reputation plays no part in END 07 itself.

END 08: Incompetent Doctor

END 08, Incompetent Doctor, is reached by letting hospitalized patients die until your reputation hits 0. The cost of each death is in the injury and death table above.

END 09: What Are You Doing?

END 09, What Are You Doing?, is the other way to reach 0 reputation: refuse to admit magical girls until it runs out. This route is about refusals, not deaths.

END 10: You Traitor

END 10, You Traitor: in a single playthrough, the only deaths allowed are state-affiliated magical girls: Calm, Gnome and Cherry. Everyone else must live and Day 8 must be finished. One death out of the three is enough. Several deaths cost a lot of reputation and can send you to a different ending. If the girl you need does not visit, use the reload trick.

END 11: Two as One

END 11, Two as One: Sakura visits on Day 1, so reload your Day 1 bedtime save until Cherry arrives on Day 2, which puts both of them in the hospital together. Then make sure Cherry dies before Sakura.

MIRAGE transfers: which ending you get

The transfer man appears on Days 4, 6 and 8. Your answer to the first request, whether he returns, and your reputation decide the outcome. If you meet the conditions of another special ending, that ending takes priority.

First transfer request	Man returns	At 100 reputation	At 1 to 99 reputation
Refuse	Not relevant	END 01	END 03
Accept	No	END 04	END 04
Accept	At least once	END 02	END 03

If he does not appear on Day 6, he will not come on Day 8 either.

Other achievements

Eight achievements sit outside the endings. The table gives the gist, and each one has its own section below.

Achievement	In short
I'll Save Them All	A clean END 01 with no injuries
Forever Grateful	Treat every magical girl at least once
You Monster!	Refuse the four one-star girls
You Call Yourself a Doctor?!	Misdiagnose three patients at once
Actually, Never Mind.	Admit the Day 5 ??? visitor, then evict it
Eleven Endings	Unlock all 11 endings
Serial Killer	The Day 8 hallucination route
Tell Me Your Story	See every daily conversation

I'll Save Them All

For the I'll Save Them All achievement, reach the clean ending with no treatment mistakes. Every magical girl must visit in that same run and none may be injured, so expect to lean on the reload trick from the top of the page.

Forever Grateful

Forever Grateful asks you to treat every magical girl successfully at least once, meaning cured and discharged. Use the reload trick for any who have not visited yet.

You Monster!

You Monster! is for refusing admission to each of the four one-star magical girls (Blood, Nail, Bomb and Delta) at least once. Use the reload trick if one of them is missing.

You Call Yourself a Doctor?!

To earn You Call Yourself a Doctor?! have three patients in the hospital at once, misdiagnose all three, and move on to the next day.

Actually, Never Mind.

Actually, Never Mind. is unlocked by admitting the mysterious humanoid shown as ??? and kicking it out the same day. It is the visitor from END 06, and the quick eviction is what separates the two.

Eleven Endings

Unlock every one of the 11 endings in the table at the top for the Eleven Endings achievement.

Serial Killer

Serial Killer uses the same Day 5 energy drink as END 07. Drinking it is what causes the hallucination on Day 8, where all text reads ???. With three magical girls hospitalized, prescribe psychiatric medication to all three. The medication names read ??? as well, so pick the option that corresponds to that medication.

Tell Me Your Story

Tell Me Your Story needs every daily conversation of every magical girl. Her first conversation is always a greeting, and after that she has different talk when healthy and when injured.

To find what you missed, open Main Menu, then Gallery. The Gallery screen has an END tab and a CHARACTER tab, and the CHARACTER tab is the one you want, as marked in the first screenshot.

Open a character there and step through her dialogue entries one at a time, as on the character page in the second screenshot. A character whose list skips entries as you browse may still have conversations you have not seen. For her, save before sleeping on Day 1 and reload until she is the Day 2 visitor, then work on her missing lines. The exact number of conversations and what triggers each one are unconfirmed, so treat this as a rough method.