Learn 18 documented patient warning signs, then separate admission anomalies from enemies, emergencies, and Journal encounters.
Slimebert appears during a Slime Shift and is tracked by the Journal, but he is not handled like a patient at the admission window. Keep your distance, use the Fire Extinguisher only for a temporary stun, and follow the full Slimebert survival guide.
Use the interactive Visual, Photo, CCTV, and Document or Scanner checklist.
Find roaming and environmental enemies that are not solved by admission rejection.
Respond to fires, rituals, critical patients, ambulance surges, and monster events.
Track the named Anomaly entries recorded by the lobby Journal.
Review the relevant checks before treatment. An anomaly can fail any single check — you only need one clear red flag to reject.
Flickering lights are also an anomaly signal. Treat them as a reason to slow down and complete the full check order.
Spotted through the window with your own eyes.
8 anomalies
Detected by comparing the clipboard photo to the patient.
2 anomalies
Only visible on the security camera feed.
7 anomalies
Special high-risk threats that can pass ordinary checks.
1 anomaly
Appearance: The patient's face has a crooked, distorted smile with sharp teeth and large mismatched eyes with oversized pupils positioned high on the face.
Tell signs: Crooked smile, sharp teeth, large mismatched eyes, or eyes positioned unusually high on the face.
How to handle: Reject before treatment. If the smile changes, the mismatched eyes still confirm the anomaly.
Appearance: Three slightly off-center glowing red eyes replace the patient's normal eyes; the original eyes may still be visible underneath.
Tell signs: Three glowing red eyes, extra eye placement, or an eye count that does not match the patient's normal model.
How to handle: Reject before treatment. Confirm the eye count at the window and do not rely on the photo alone.
Appearance: The patient has dark hollow eyes and a sunken face, and usually also twitches with a hunched posture.
Tell signs: Dark hollow eyes, sunken facial features, twitching, and a hunched posture.
How to handle: Reject unless you intentionally handle the event route. If a Hollow Face begins a Death Ritual, stay in the room and use IV Drops, Eye Drops, or coffee to put out candles without losing sanity.
Appearance: The patient has large eyes with black pupils and prominent under-eye bags, paired with a large drawn-on smile.
Tell signs: Large black-pupil eyes, heavy under-eye bags, and a fixed oversized smile that does not match the normal patient.
How to handle: Reject before treatment. Tasing the patient can make the anomalous smile disappear, so do not use that as proof that the patient is normal.
Appearance: Patient twitches or jerks erratically with unnatural, mechanical-looking movements.
Tell signs: Erratic jerking movements, unnatural head/limb twitches, movement pattern different from all normal patients.
How to handle: Observe at the window for a few seconds — if twitching persists, reject.
Appearance: The patient stares directly at the player and rotates its head up to 60 degrees on either side at the check-in window.
Tell signs: Sustained direct eye contact, head rotation that follows the player, and a gaze that does not break normally.
How to handle: Move around the window and compare the patient's head movement. Reject if the stare follows you; do not reject Ratthew for this behavior alone.
Appearance: The patient appears extremely small and has a very high-pitched voice. A pink bunny with a short tail and three glowing red eyes is the known example.
Tell signs: Unusually tiny body size, high-pitched voice, short-tailed pink bunny model, or multiple glowing red eyes.
How to handle: Reject before checking in. Do not let the unusual size or voice distract you from the standard photo and CCTV checks.
Appearance: The patient's face has small wide circular eyes with black pupils and realistic teeth, creating an X-rayed appearance.
Tell signs: Small wide circular eyes, black pupils, realistic teeth, or an X-rayed-looking face that appears only in one expression.
How to handle: Observe the patient's face and reject if the X-rayed features appear. Do not clear the patient only because the face briefly looks normal after an expression change.
Appearance: Something in the patient's photo differs from the real patient, such as the face, ears, ear color, or other model details.
Tell signs: Different face, eye or mouth shape, ear shape, ear color, or another visible difference between the photo and the patient.
How to handle: Compare the clipboard photo to the patient at the window. Reject when any confirmed model detail does not match.
Appearance: The clipboard photo shows only static/TV snow or a completely blank image.
Tell signs: Photo replaced entirely by static/TV snow, blank or black photo frame, no identifiable patient image.
How to handle: After Shift 10, close the shutters instead of tasing or shooting a patient based only on a static photo. Use the other checks before treatment.
Appearance: The patient has a different face on the security camera than at the check-in window.
Tell signs: Face shape, eyes, mouth, or other facial details change between the window and the CCTV feed.
How to handle: Use a clear camera angle, preferably a Deployable Camera near the office, then reject when the CCTV face does not match.
Appearance: The patient's head is obstructed by a black bar and realistic black eyes stare from the CCTV feed.
Tell signs: Black bar across the head, realistic black eyes, or direct staring from the patient on the CCTV feed.
How to handle: Check the security cameras before treatment and reject when the Black Eyes form appears.
Appearance: On CCTV, the patient's body is distorted — elongated limbs, extra appendages, or wrong proportions.
Tell signs: Elongated limbs on CCTV, extra appendages visible, body proportions don't match any normal patient.
How to handle: Check CCTV before admitting. Unnatural body on camera = reject.
Appearance: The patient looks directly into the CCTV camera at all times, even while walking through the hospital.
Tell signs: Unbroken eye contact with the camera, direct gaze while walking, or head movement that keeps the camera in view.
How to handle: Monitor the camera feed for several seconds and reject if the patient continues staring directly at the camera.
Appearance: The patient appears as a solid black silhouette or void on the CCTV feed, even though it looks normal at the window.
Tell signs: Solid black silhouette on CCTV, no features visible on camera despite being visible at window, void-like shape on feed.
How to handle: Trust the CCTV. If the feed shows a void/black figure, reject regardless of other layers.
Appearance: The patient twitches only on the CCTV feed; the movement may look jerky or the video may flicker around the patient.
Tell signs: Jerky CCTV movement, flickering around the patient, or motion artifacts that are absent at the window.
How to handle: Compare the feed with the window view and reject when the CCTV-only twitching persists.
Appearance: The patient's ears or horns look different on the security camera than they do at the check-in window.
Tell signs: Different ear or horn shape, length, color, or count when comparing the window with the camera feed.
How to handle: Compare the CCTV view with the patient's visible model and reject when the ears or horns do not match.
Appearance: The patient appears as a Mimic only on security cameras, while the window and photo may look normal.
Tell signs: Mimic form visible on CCTV, camera-only twitching, or a monstrous form that is absent at the window and in the photo.
How to handle: Use the lobby camera or a Deployable Camera to confirm the Mimic form, then reject before treatment. Follow the separate Skinwalker enemy guide when the game identifies the threat as a Skinwalker.
| Detection lane | What exposes it | Most common misread | Read next |
|---|---|---|---|
| Visual | Window appearance and body shape | Overconfidence after one glance | Patient Roster |
| Photo | Clipboard image mismatch | Treating after a clean room view only | Beginner Guide |
| CCTV | Camera-only distortion or hidden form | Ignoring deeper checks once the queue is busy | How to Identify Anomalies |
| Skinwalker | Special high-risk hidden threat | Using normal anomaly logic on a special threat | Enemies, Shifts |
Use this page as a verified reference, then narrow your practice to the check that is currently costing you runs. If visual tells are already easy, move deeper into photo and CCTV work. If special threats keep slipping through, stop relying on first impressions and treat the listed deeper checks as mandatory.
No. Slimebert is a special enemy and Journal anomaly entry that roams the hospital during a Slime Shift. Do not use the normal check-in rejection flow; avoid him and complete the shift.
This page tracks 18 patient warning signs across Visual, Photo, CCTV, and Skinwalker detection. The wider game also uses named Journal anomalies, enemies, and emergency events, so the patient-sign count is not a total for every dangerous encounter.
Treating an anomaly instead of rejecting it is the core mistake the game punishes. It drains your sanity and can cause the anomaly to escalate into a Skinwalker — one of the deadliest threats. Review the relevant Visual, Photo, CCTV, and special-threat guidance before treating any patient.
Regular anomalies can be rejected through the standard anomaly-handling action once you spot their tell signs. A Skinwalker can pass ordinary visual and photo checks, so use the listed deeper check before choosing how to handle it. Follow each entry's handling note rather than treating every special threat the same way.
No single check catches everything. Visual catches obvious signs (extra eyes, sharp teeth, black bodies). Photo catches mismatches between the patient and their clipboard image. CCTV reveals hidden distortions (void bodies, unnatural movements). Flickering lights can also signal an anomaly even when a patient card looks normal. Special-threat entries require the deeper check described on their cards.
Yes. Some anomalies fail multiple checks simultaneously — for example, an all-black body anomaly may also show as void/black on CCTV. Cross-referencing the relevant checks gives you higher confidence in your identification. Treat a patient only after the listed warning signs are clear.
Yes. The developer Animal Anomaly adds new anomaly forms and detection clues through major updates. We track each new appearance, photo, CCTV, and special-threat entry as it is confirmed. Check back after major updates for new entries.
The Skinwalker Detection category contains 1 documented entry: Mimic. The remaining camera-only forms, including Mismatching Ears and Mismatching Face, are listed in the CCTV section and still require deeper inspection.
Rankings by danger level — know which anomalies to learn first.
Learn the four-part detection method step by step.
Roaming threats — some start as anomalies and escalate.
Know the normal patients so corrupted versions stand out.
Step-by-step checks for spotting a fake patient.
