This guide covers all 11 endings and achievements in Magical Girl ER, including some of the things that are easy to miss during a playthrough. I explain the requirements for each ending, tips for unlocking difficult achievements, and ways to find missing daily conversations.
My Tips for Progression
Here are a few things I keep in mind while playing Magical Girl ER. For the requirements of each ending, I refer to the “Ending List” section.
Magical Girl Visits and Save Management
The magical girls who visit the hospital are selected randomly at the beginning of each day. If the magical girl I’m looking for doesn’t appear, I reload a save from before going to bed the previous night and try again.
Injury and Death Outcomes
If I make an incorrect diagnosis or skip the diagnosis, a survival check is performed 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 following day saying that their condition has worsened and further medical examination is required. My reputation does not decrease.
- Death: If the patient dies, a news article appears the following day reporting that they lost their life while hospitalized. My reputation decreases depending on the magical girl’s popularity.
- Re-examination: Even after making the correct diagnosis, the patient may develop another medical condition while recovering. In this case, a news article appears the following day saying that further medical examination is required. My reputation does not decrease.
After I hear the hooded figure’s initial explanation, an injury outcome causes a blinking-eye animation to appear at the beginning of the following day.
Special NPC Encounters
There are four special NPCs in the game. Each one provides hints related to specific endings or achievements.
- Hooded Figure: Provides hints on how to unlock END 05.
- NPC Offering an Energy Drink: Provides hints related to END 07 and the Serial Killer achievement.
- Man Requesting Transfers to MIRAGE: Provides hints on how to unlock END 02 and END 04.
- ???: Provides hints related to END 06 and the Actually, Never Mind. achievement. I can encounter this NPC while following the conditions hinted at by the hooded figure. It hasn’t been confirmed whether there are other ways to encounter this NPC.
Ending Walkthrough
| Ending | Walkthrough |
|---|---|
| END 01 – Magical Girl ER | I maintain 100 reputation, treat and discharge every magical girl, and complete Day 8. |
| END 02 –Lingering Regret | I maintain 100 reputation and transfer one magical girl to MIRAGE on Day 4. Whenever the NPC returns, I refuse all subsequent transfer requests. I then complete Day 8. |
| END 03 –Promotion Celebration | I complete Day 8 with reduced reputation. |
| END 04 –This Is MIRAGE | I complete Day 8 after transferring at least one magical girl to MIRAGE. This ending can also occur if the NPC never returns to request another transfer. |
| END 05 –Just as You Are | On Day 2, I accept the NPC’s invitation to join the religion and complete both tasks in order. First, I misdiagnose a magical girl and injure her without killing her. When the NPC returns, I follow their instruction not to examine arms from the next diagnosis onward. If I fail the first task, the NPC will not return. |
| END 06 – Mom… | I let 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 | I receive the energy drink from the NPC who appears on Day 5. At the beginning of Day 8, the NPC calls me, and I choose the option to drink it. |
| END 08 – Incompetent Doctor | I let hospitalized patients die until my reputation drops to 0. |
| END 09 – What Are You Doing? | I refuse to admit magical girls until my reputation drops to 0. |
| END 10 – You Traitor | I make sure that only the three state-affiliated magical girls—Magical Calm, Magical Gnome, and Magical Cherry—die. |
| END 11 – Two as One | I make sure Sakura and Cherry are hospitalized at the same time, then let Cherry die first. |
Other Achievements
| Achievement | How to Unlock |
|---|---|
| I’ll Save Them All | I 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 | I successfully treat every magical girl at least once. |
| You Monster! | I refuse admission to each of the four one-star magical girls—Blood, Nail, Bomb, and Delta—at least once. |
| You Call Yourself a Doctor?! | I have three magical girls hospitalized at the same time, misdiagnose all three, and advance to the next day. |
| Actually, Never Mind. | I let the mysterious humanoid creature (???) into the hospital, then kick it out on the same day. |
| Eleven Endings | I unlock all 11 endings. |
| Serial Killer | I drink the energy drink given by the NPC on Day 5. On Day 8, I have three magical girls hospitalized and prescribe psychotropic medication to all three. Due to hallucinations, the medication will appear as ???. |
| Tell Me Your Story | I view every daily conversation. |
Achievement Tips
Here are a few additional tips for unlocking some of the more difficult achievements.
For the basic requirements, I refer to the achievement table above.
You Monster!
I need to refuse admission to all four one-star magical girls: Blood, Nail, Bomb, and Delta.
If the magical girl I’m looking for doesn’t appear, I reload a save from before going to sleep the previous night. This lets me try again with a different selection of patients visiting the hospital.
I can also use this method to unlock END 10 and END 11, since both endings require specific magical girls to appear.
Serial Killer
After I drink the energy drink given by the NPC on Day 5, I automatically experience hallucinations on Day 8. This causes all text to appear as “???”.
While the hallucinations are active, I hospitalize three magical girls and prescribe psychotropic medication to all three to unlock the achievement.
The medication names also appear as “???”, so I select the corresponding option.
Tell Me Your Story
For this achievement, I need to view every magical girl’s daily conversations. Finding the conversations I’ve missed can take some time.
The first conversation with each magical girl is always a greeting. After that, the conversations change depending on whether the magical girl is in her normal or injured state.
How to Check for Missing Conversations
I go to Main Menu -> Extras -> Character Dialogue List and check each character’s dialogue entries one by one.
If I notice that the list skips certain entries while browsing, that character may still have conversations I haven’t seen.
In that case, I save before going to sleep on Day 1, then reload until the magical girl I’m looking for visits on Day 2. This lets me focus on unlocking her remaining conversations.
However, the exact number of conversations and their trigger conditions haven’t been fully confirmed, so I treat this information as a general reference.