Magical Girl ER Endings & Achievements Guide (All 11

Finding every single outcome in this hospital management visual novel can be surprisingly tricky without a solid save plan. This walkthrough covers all 11 endings, tricky achievement requirements, and ways to track down missing daily conversations.

Patient visits are randomized at the start of each day, so you will want to rely heavily on reloading saves before going to sleep. Keep a clean set of backup saves early on so you do not have to replay entire runs just to catch a missed interaction.

Before diving into the list, make sure you understand how the hospital reputation and patient survival mechanics operate. Getting this right saves hours of backtracking and prevents accidental low-reputation endings.

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.

Progression Strategies

Managing your save files effectively is the single most important habit for seeing everything the game offers. Whenever a specific patient refuses to show up, a quick reload before bedtime lets you reroll the visitor pool.

Magical Girl Visits and Save Management

The visitor queue resets every single morning based on RNG rolls. Dropping an evening save right before turning in for the night is your best tool for target-farming specific characters.

Injury and Death Outcomes

Skipping a diagnosis or guessing incorrectly triggers a hidden survival check dictated by the patient mortality rate. Surviving the check results in an injury, while failing it leads straight to a fatality.

• Injury: The patient survives, triggering a news article next morning about worsening conditions that require re-examination without harming your reputation.
• Death: The patient passes away, generating a hostile news report and dropping your standing depending on their personal popularity.
• Re-examination: Healthy patients can occasionally develop secondary complications during recovery, prompting follow-up care checks without penalties.

Keep an eye out for a blinking-eye animation at the start of the day after your initial chat with the hooded figure. This visual cue confirms an active injury outcome is pending.

Special NPC Encounters

Four unique visitors wander into your facility across the playthrough to drop subtle hints for secret objectives. Pay close attention to what they say before making major choices.

• Hooded Figure: Drops crucial hints toward unlocking END 05.
• NPC Offering an Energy Drink: Seeds clues required for END 07 and the Serial Killer achievement.
• Man Requesting Transfers to MIRAGE: Sets up the narrative trail for END 02 and END 04.
• ???: Appears during specific hooded figure routes to hint at END 06 and the Actually, Never Mind achievement.

Complete Ending Walkthrough

Detail	Info
END 01 – Magical Girl ER	Maintain 100 reputation, treat and discharge every magical girl, and complete Day 8.
END 02 – Lingering Regret	Maintain 100 reputation and transfer one magical girl to MIRAGE on Day 4. Refuse all subsequent transfer requests when the NPC returns, then finish Day 8.
END 03 – Promotion Celebration	Complete Day 8 with a diminished reputation score.
END 04 – This Is MIRAGE	Complete Day 8 after sending at least one magical girl to MIRAGE, or if the transfer recruiter never returns.
END 05 – Just as You Are	On Day 2, accept the religious invitation. Misdiagnose a patient to injure them without killing, then follow the instruction to avoid examining arms from then on.
END 06 – Mom…	Admit the mysterious visitor on Day 5 and have a casual chat with them on Day 8.
END 07 – So They Claim	Accept the energy drink from the Day 5 visitor, then drink it when they call on Day 8.
END 08 – Incompetent Doctor	Let hospitalized patients perish until your reputation hits absolute zero.
END 09 – What Are You Doing?	Refuse incoming admissions repeatedly until your reputation tanks to zero.
END 10 – You Traitor	Engineer situations where only the three state-affiliated characters—Magical Calm, Magical Gnome, and Magical Cherry—die.
END 11 – Two as One	Hospitalize Sakura and Cherry at the same time, then let Cherry succumb first.

Other Achievements

Detail	Info
I’ll Save Them All	Reach END 01 cleanly without a single treatment error across the entire run.
Forever Grateful	Successfully treat every single magical girl at least one time.
You Monster!	Refuse admission to the four one-star characters—Blood, Nail, Bomb, and Delta—at least once.
You Call Yourself a Doctor?!	Have three patients hospitalized simultaneously, misdiagnose all of them, and advance the day.
Actually, Never Mind.	Admit the mysterious humanoid creature (???) and throw it out on the exact same day.
Eleven Endings	Unlock all 11 distinct narrative endings.
Serial Killer	Drink the Day 5 energy drink, hospitalize three patients on Day 8, and prescribe psychotropic meds showing as ???.
Tell Me Your Story	Unlock and view every single daily character conversation.

Achievement Strategy Tips

Tackling the tougher achievement unlocks requires methodical patience and proper save utilization. Use the breakdown below to knock out the most frustrating badges without guesswork.

Always cross-reference your current progress with the achievement table to ensure you are on the right route before committing hours to a specific run.

You Monster!

You must turn away all four one-star magical girls: Blood, Nail, Bomb, and Delta.

RNG can make finding these specific characters annoying, so abuse your evening save files. Reloading before sleep lets you cycle through fresh batches of incoming patients until the right one appears.

This same save-scumming trick works wonders for knocking out END 10 and END 11 since both demand specific patient spawns.

Serial Killer

Consuming the energy drink handed over on Day 5 triggers intense hallucinations when Day 8 rolls around, masking all text as question marks.

Admit three patients while under the influence and prescribe psychotropic drugs to all three while the UI is scrambled.

Since the medication names will also display as question marks, simply pick the corresponding slot to trigger the unlock.

Tell Me Your Story

This badge requires experiencing every single piece of dialogue each character has to offer, which demands careful tracking.

Initial chats are always simple greetings, but subsequent lines alter depending on whether the girl is healthy or currently injured.

Checking Missing Conversations

Navigate to Main Menu -> Extras -> Character Dialogue List to audit your unlocked conversations entry by entry.

Gaps in the ledger indicate missed interactions with specific characters that you need to target on subsequent runs.

Drop a save before sleeping on Day 1, then reload until your target character visits on Day 2 to knock out their missing lines efficiently.

Keep in mind that exact conversation triggers can occasionally behave unpredictably, so treat these checks as a general guideline.

Pro tip: Always keep a separate save file right before Day 4 so you can easily branch into the MIRAGE endings without replaying the first half of the game.