Dice Hospital: Community Care

Dice Hospital: Community Care Rulebook

Table of Contents

Components
The City Expansion
The Investments Expansion
The Maternity Expansion
Combinations
Solo Automa

Components

1 Intake Tracker board
20 City tiles
4 Paramedic meeples
4 Intake Tracker markers
4 numbered Player Order tokens
1 Helicopter token
30 City Bonus tokens

Deluxe Edition components: 1 Paramedic meeple, 1 Intake Tracker marker, 1 Player Order token, 1 Helicopter mini (replaces the Helicopter token), 5 Intake Tracker tokens.

Investments Expansion components: 1 Supplemental Intake board, 8 Department tiles, 1 Investment Action board, 8 Specialist cards, 1 Administrator card, 42 Investment tokens in 3 colours.

Maternity Expansion components: 16 Mother six-sided dice, 24 Small Infant six-sided dice, 2 Administrator cards, 18 Maternity Specialist cards (printed as "Specilist"), 16 Maternity Department tiles, 16 Paediatric Ward Chevron tiles, 8 Nurse meeples (pink), 1 Midwife die.

Maternity Deluxe Edition components: 4 Mother six-sided dice, 6 Small Infant six-sided dice, 4 Paediatric Ward Chevron tiles.

Combinations and Automa components: 1 Maternity Investment Action board, 14 Maternity Investment tokens; 12 Automa Decision cards, 12 Automa Hospital cards, 8 Automa First Player tiles.

5th player base game components (Deluxe Edition): 1 Parking Garage, 9 dice, 1 Player board, 1 Round Tracker overlay, 5 Score Tracker tokens, 4 Nurse tokens, 4 Nurse meeples.

The City Expansion

City Game Setup

Set up the game as normal except for the following changes.

Instead of Step 2: Give an ambulance to each player. Return any unused ambulances to the box. Place the helicopter to one side for now. Give each player a Paramedic meeple in their colour.

After Step 3: Place the Intake Tracker board and the Player Order tokens next to the score/round board. Place an Intake Tracker marker in each player's colour next to the Intake Tracker board.

Create the City grid, based on the number of players, as follows. Select the City tiles at random and return any unused tiles to the box. Should any of the selected tiles show a pink die placement spot, place these tiles with this spot face down. These sides of the tiles are only used when used in combination with the Maternity expansion.

Players	Size of City
2	3 x 4 (12 tiles)
3	4 x 4 (16 tiles)
4-5	5 x 4 (20 tiles)

Create the grid one row at a time, from top to bottom. Create each row from left to right. The first (top-left) tile should be rotated clockwise until both the right and the bottom of the tile show a road.

When placing a subsequent tile in the first row, it should be rotated clockwise (if necessary) so that its left side matches the right side of the previous tile if possible. Tile sides match according to the presence or absence of a road.

When placing a tile in each subsequent row, it should be rotated clockwise (if necessary) to maximise the number of matching sides with existing tiles.

Any City tile that is placed in a way that positions a road on the outside edge of the City becomes a City Entrance where players may start each round.

After Step 7: Shuffle the City Bonus tokens and place them face down in a pile in a general supply close to the City grid, leaving space for a discard pile next to them.

After Step 9: The First Player should draw, roll, and place a new die on each City tile in turn, starting in the top left-hand corner. Re-roll 1s and 6s as normal, so there are no patients of these values in the City. Each tile should begin with one patient die placed on it.

For each patient die of value 2 on the City grid, draw a City Bonus token from the top of the pile and place it face up on the same City tile as that die.

City Bonus tokens: One of these tokens is placed whenever a patient die of value 2 is added to the City, either when refilling a row or column, or when a patient die in the City suffers neglect and drops from value 3 to 2. Place the City Bonus token on the same City tile as the patient die of value 2. If you collect a patient die in the same space as a City Bonus token, you also collect that token.

City Game Sequence

The City Expansion plays over the same phases as the base game, with some notable changes. These rules concentrate on what is different from the base game. Where these rules contradict the rules of the base game, follow these rules.

City Phase 1 - Patient Intake

This phase is completely replaced by this expansion. Use the rules below instead of the base game rules for this phase.

In player order, each player should take a turn to collect three dice from the grid of City tiles.

City Entrances: Any City tile with a road positioned on the outside edge of the City grid is a City Entrance. This is where players' ambulances will be placed. Players may not share the same City Entrance tile.

Ambulance Placement (first round of the game only): Starting with the First Player, and continuing clockwise, each player chooses a different City Entrance, and places their ambulance with their Paramedic meeple next to it.

Ambulance Movement (skip this in the first round of the game): From the second round of the game onwards, player order will be based on the Player Order tokens held by each player. The player with Player Order token 1 will play first, with play then continuing in ascending order of Player Order token.

In player order, you may choose to move your ambulance 0, 1, or 2 City Entrance tiles clockwise or anti-clockwise around the edge of the City to an unclaimed City Entrance. Treat each corner tile with 1 or 2 City Entrances as a single space for movement purposes. In your movement, skip over and do not count spaces already occupied by other players' ambulances and City tiles that are not entrances, i.e. those without an exterior road.

The First Player (who will have claimed the Helicopter during the previous round) may use the Helicopter instead of their ambulance, placing it on any City tile not claimed by another player, including those without City Entrances and those in the centre of the grid.

Example (diagram): the blue player's ambulance can move up to 2 unoccupied City Entrance tiles in either direction. Moving clockwise, the corner tile is counted first. The player skips over the red ambulance to count the next unoccupied City Entrance tile as their second point of movement. Moving anti-clockwise, the blue player simply counts 1 or 2 tiles with City Entrances in that direction, as there are no other players in the way.

Dice Collection: In player order, each player will collect 3 dice from the City as follows.

Place your Paramedic on the tile next to your ambulance. If there is a patient on that tile you must take that patient. If the tile you collected the patient from also has a City Bonus token, put that token next to your ambulance.
Move your Paramedic onto any adjacent tile that is connected by a road. You may move onto empty tiles, including City tiles that you have already moved onto this round.
If there is a patient on that tile you must move that patient to your ambulance. If the tile you collected the patient from also has a City Bonus token, put that token next to your ambulance.
Repeat steps 2 and 3 until you have collected 3 patients and any corresponding City Bonus tokens.

Example (diagram): Mike is the first player, and must take the patient on the tile where his Paramedic is, and place it in his ambulance. After collecting this patient Mike has two choices for his second patient; either the yellow 2 or green 2.

Note: Even if a tile is adjacent and within range of your Paramedic, if the roads do not connect the two tiles directly then you may not move directly to that tile. So Mike cannot collect the yellow patient in the top left corner.

Example (diagram): Mike collects the yellow patient from the middle row and the City Bonus token. This leaves three further choices for his third patient; either the red 5, red 4, or green 2.

Once you have collected 3 patient dice, return your Paramedic to your ambulance. You must now keep only one of the City Bonus tokens you have next to your ambulance; choose which one to keep and place it with any others you may have next to your hospital, placing the remainder in the discard pile.

If a row or column of City tiles is empty of patients, draw, roll, and place a new patient on each tile in that row or column before the next player's turn. Should an intersecting row and column both become empty at the same time, refill both.

Total the value of the dice in your ambulance.

If you have any -2 bonus token(s) that you picked up in this round or a previous round you may use them to adjust your total dice value for the purposes of determining turn order.

In player order, place your marker on the space of the Intake Tracker board that matches your total. If another player already has a marker there, place yours on top of it. Players' positions on this board will determine player order for the remainder of the round.

Determining Player Order: Once all players have collected their 3 patients and marked their total die value on the Intake Tracker board, determine the player order for the rest of the round as follows. This player order replaces the ambulance numbers used in the base game.

The player with the lowest total should take Player Order token '1'. The player with the next lowest total should take Player Order token '2', and so on from the lowest total to highest. The player with the lowest total also takes the First Player marker, the Helicopter, and a Blood Bag from the supply.

If two or more players are tied for dice total, and therefore have Intake Tracker markers on the same space, they should collect Player Order tokens starting with the player whose marker is on top, then continuing from top to bottom.

Once each player has their new Player Order token, all patients should be moved from the ambulances to the hospitals in the normal fashion, and play should proceed to Phase 2 - Hospital Improvement.

City Phase 2 - Hospital Improvement

This phase happens as described in the base game rulebook.

City Phase 3 - Hospital Activation

Players may use any City Bonus tokens they have gained over the course of the game. There is no limit to the number of City Bonus tokens you may use in the same round, and you may keep as many as you wish between rounds.

Once used, a City Bonus token should be placed face up in the discard pile.

See Glossary: City Bonus Tokens below for a full list of available tokens and their effects.

City Phase 4 - Neglected Patients

During this Phase, in addition to untreated patients in your hospital, every patient die left in the City also suffers neglect and drops in value by 1 step!

If any patients in the City die due to neglect, distribute the Fatality tokens among players one at a time, starting with the player who has the highest Player Order token, followed by the player with the next highest and so on, until all fatalities have been assigned.

Example: In a 4-player game if 3 patients die then the players with the 3 highest Player Order tokens will each receive a Fatality token, but the First Player will not.

If more patients die than the number of players, give out the remaining Fatality tokens starting with the player who has the highest Player Order token again.

Example: In a 4-player game if 5 patients die then all players will receive one Fatality token and the player with Player Order token '4' will then receive one more, for a total of 2 Fatality tokens.

Remember: If an uncollected patient deteriorates from a value of 3 to a value of 2, draw a City Bonus token from the pile and place it face up on the City tile containing that patient.

City Phase 5 - Discharged Patients

This phase happens as described in the base game rulebook.

City Phase 6 - Shift Change

This phase happens as described in the base game rulebook.

City End Game Scoring

Unused City Bonus tokens are not worth any points at the end of the game.

Glossary: City Bonus Tokens

-2 token: During the Patient Intake Phase, discard this token to adjust your Player Intake marker on the Intake Tracker board by -2 points.
+1 token (single patient icon): During the Hospital Activation Phase, discard this token to heal any patient 1 step (this patient counts as treated).
Red token: During the Hospital Activation Phase, discard this token to heal any red patient 2 steps (this patient counts as treated).
Green token: During the Hospital Activation Phase, discard this token to heal any green patient 2 steps (this patient counts as treated).
Yellow token: During the Hospital Activation Phase, discard this token to heal any yellow patient 2 steps (this patient counts as treated).
Nurse token (1): During the Hospital Activation Phase, use this token as a one-use nurse meeple. At the end of the round in which you use this token, discard it.

The Investments Expansion

This expansion provides opportunities for players to customise their hospitals to create more efficient combinations of healing effects. Players have the chance to use one of their meeples each round to collect Investment tokens which are added to Department tiles to give them up to 2 extra healing effects. This expansion adds lots of new options for players, not only with the Investment tokens, but also the addition of new Departments and Specialists.

Investments Game Setup

Set up the game as normal with the following changes.

During Step 2: Place the Supplemental Intake board next to the two highest numbered ambulances. The side with 'Rounds 1-4' should be placed face up.

During Step 3: Place the Investment Action board within easy reach of all the players with the correct side for the number of players facing up. Separate the Investment tokens by colour into 3 piles (red, yellow, and green). Shuffle each pile separately and place them face down on the spaces shown in the matching colour rooms on the Investment Action board.

During Step 4: Shuffle the 8 new Department tiles from this expansion into the Department tile stack.

During Step 5: Shuffle the 8 new blue Specialist cards from this expansion into the Specialist deck.

During Steps 4 and 5: When dealing out the display of improvements, deal 1 additional Department and Specialist, so that they equal the number of players (except in a 5-player game where you still deal out 4 of each improvement).

During Step 10: Shuffle the 1 new Administrator card from this expansion into the Hospital Administrator deck.

Players	Departments	Specialists
2	2	2
3	3	3
4	4	4
5	4	4

Investments Game Sequence

The Investments Expansion plays over the same phases as the base game, with some notable changes. These rules concentrate on what is different from the base game. Where these rules contradict the rules of the base game, follow these rules.

Investments Phase 1 - Patient Intake

The Supplemental Intake board acts as an extension to the highest numbered ambulance(s), giving them extra space(s) for dice to be placed. These extra dice are still added to the ambulance(s) in order of lowest to highest as in the base game, but some ambulances will now act as if they have 4 spaces instead of 3.

During rounds 1-4:

Draw and roll 1 additional die.
After placing dice in all the ambulances (using the same rules as the base game), place the final die on the Supplemental Intake board.

At the start of round 5 flip over the Supplemental Intake board so the side with 'Rounds 5-8' is face up.

During rounds 5-8:

Draw and roll 2 additional dice.
After placing dice in all 3 spaces of the penultimate ambulance (using the same rules as the base game), place the next die on the Supplemental Intake board space adjacent to that ambulance. Then proceed to place dice in all 3 spaces of the highest number ambulance. Place the final remaining die on the Supplemental Intake board next to that last ambulance.

Example 1: In round 3 in a 2-player game, 1 extra die is drawn. One of the highest dice is placed on the Supplemental Intake board next to the highest value ambulance.

Example 2: In round 6 in a 4-player game, 2 extra dice are drawn. After filling the first 4 ambulances, one of the next highest dice is placed on the Supplemental Intake board next to ambulance 4. The next 3 dice are placed in ambulance 5 and the final die placed on the last space on the Supplemental Intake board.

As in the base game, where there is more than one possible colour of die to place in a space on the Supplemental Intake board, the player to the right of the first player decides which colour is placed there.

Any player who chooses an ambulance next to one of the spaces on the Supplemental Intake board must also take the additional die from the board and add it to their hospital.

Investments Phase 2 - Hospital Improvement

After taking their improvements as normal, a second step is added to the Hospital Improvement phase.

Invest: In player order (starting with the first player), each player may choose to place one of their meeples (nurse or Specialist) on an available space on the Investment Action board, to claim an Investment token. Each coloured space contains Investment tokens relating to that colour that will provide extra healing effects for those patients; see the Glossary: Investment Tokens below for details.

In a 2 or 3-player game, each Investment space can only be used by one player each round.

In a 4 or 5-player game, each Investment space may be used by up to two players each round.

After placing your meeple on an Investment space, draw and look at the top 2 tokens from that colour pile, choose 1 to keep, and return the other face down to the bottom of the pile.

After collecting an Investment token you must immediately place it on a Department in your hospital (unless you have the Trainee Specialist, which allows you to place an Investment token on an empty space of that Specialist card).

Each Department tile can have a maximum of 2 Investment tokens placed on it.

Once an Investment token has been placed, it cannot be moved, unless a game effect specifically allows it.

Note: If you trade a Department with any Investment tokens to the bank for a Blood Bag during the Hospital Improvement phase, you gain no additional benefit for any Investment tokens on that Department – the tokens are removed from play and cannot be moved to another Department.

Investments Phase 3 - Hospital Activation

The Hospital Activation Phase should be played as normal, noting the additional healing effects of any Investment tokens in play.

Healing effects must always be resolved in the following order:

The default healing effect of the activated Department.
Any Investment token effects on the activated Department (optional).
The default healing bonus of the acting Specialist (optional).
Any Investment token effects on the acting Specialist (optional).

Any healing effects that target patient value refer to the value of the patient before the nurse or Specialist was placed.

With the added complexity possible due to the combination of game effects in this expansion, it is recommended that for your first game, each player individually activates their hospital one at a time (in turn order) to reduce the possibility of making mistakes. As with the base game, once you are familiar with the expansion effects, the time required to play the full game can be reduced significantly if all players activate their hospitals simultaneously in this phase.

Example 1:

Department ability is activated to heal a red patient 3 steps.
Token ability is activated to heal another red patient of the starting value 1 step.

Example 2:

Department ability is activated to heal three yellow patients of consecutive values.
Token ability is used to heal a different green patient of value 1 greater than one of those yellow patients (before they were healed).
Token ability is used to heal a different red patient of the same value as one of those yellow patients (before they were healed).
Specialist ability is used to heal a different patient of any colour of the same value as one of those yellow patients (before they were healed).

Example 3:

Department ability is activated to heal three green patients of the same value.
Token ability on the Department is activated to heal one of these patients one additional step.
Token ability on the Trainee is used to heal a red patient, which has a value 1 less than the patients healed by the Department ability (before they were healed), by 1 step.
Specialist ability of Trainee is used to move a patient of any colour to the 'treated' area of a ward.

Investments Phase 4 - Neglected Patients

This phase happens as described in the base game rulebook.

Investments Phase 5 - Discharged Patients

Players who empty all four of their wards do not get the 5 bonus points, as described in the base game, when playing with the Investments expansion.

Investments Phase 6 - Shift Change

Each player moves all of their meeples from the Investment Action board, returning nurses to their Nurses' Station and all Specialist meeples back to their Specialist cards.

Investments End Game Scoring

There are no changes to the end of game scoring; this happens as described in the base game rulebook.

Glossary: Investment Departments

The rooms below are shown by icon in the printed rulebook; the bold labels are descriptive only.

Swap room (icon: meeple to nurse-and-Specialist swap): Place a meeple here to swap a nurse meeple you have not yet used for a Specialist meeple you have already used. You may use that Specialist meeple again this round.
Heal room (icon: red patient with two other dice): Place a meeple here to heal a red patient 2 steps, and to move two other dice of any colour so that they do not neglect in the Neglect Phase.

These rooms can be found in each colour, red, green, and yellow. There are two of each room in each colour.

Glossary: Investment Tokens

These tokens can be found in each colour, matching the colour of the Investment space. There are two of each token in each pile. The bold labels below are descriptive only; the printed rulebook shows each token by icon.

Same/+1/-1 token: Choose and heal a different patient of the same colour as the token, which also has a value the same as/1 greater than/1 less than one of the patients healed by this Department's default effect.
1-2 token: Choose and heal a different patient of the same colour as the token two steps, which also has a value of 1 or 2.
Cross token: Heal one of the patients targeted by this Department's default effect an additional step, if it is the same colour as the token. (Note that this token has no effect if placed on a Department that only targets patients of a different colour.)
Colour-change token: When this token is placed on a Department, the healing effect of that Department changes to affect the colour shown on the token instead of the colour shown on the room. Note: when this token is activated, whether by being placed directly on a Department or via a Specialist card, the effect of this token happens first, as an exception to the normal order in which effects resolve.
Nurse token: Do not place this token on the board; instead discard it to permanently gain an additional nurse meeple from the general supply.

Glossary: Investment Specialists

Investment Advisor: If you use this Specialist to take an Investment token, then in addition to looking at the pile of tokens in your space, you may also look at the top 2 tokens of a different pile. You may keep 1 token from the 4. Return the other 3 face down to the bottom of their respective piles.
Project Consultant: When you use this Specialist, you may use an Investment token on another Department.
Strategy Consultant: When you use this Specialist, you may activate one Investment token effect on the Department it has been placed on a second time.
Trainee: This Specialist's default ability is to move two dice from the top of a ward to the bottom (these dice are considered to be treated when considering neglect but are not healed and do not increase in value). However, you may place Investment tokens over the default ability of this card, which you may then activate instead whenever you place this Specialist.

Glossary: Investment Administrator

Hospital Strategist: When taking Investment tokens, draw one extra token from the pile in the Investment space where you placed your meeple (you still only keep 1, returning the others to the bottom of the pile).

The Maternity Expansion

This expansion includes 2 new patient types – Mothers and Infants, which will need medical care in your hospital – and adds a spatial element to gameplay. Each time you collect a Mother die you will also gain Infant dice based on the roll of the Midwife die. Infants will be placed in the new Paediatric wards under your player board. Mothers and Infants don't suffer neglect like normal dice but must be discharged together. More dice means more points up for grabs, especially using the new super-powerful Maternity Departments and Specialists!

Maternity Game Setup

Set up the game as normal with the following changes.

During Step 1: Each player should take an additional basic nurse so that they start the game with 4 nurses instead of 3. Each player also takes 4 Paediatric Ward Chevron tiles and places 1 face down below each of the wards on their Hospital board.

After Step 5: Shuffle the 18 Maternity Specialists to create a separate face down pile. Shuffle the 16 Maternity Departments to create a separate face down pile.

In a 2-player game, draw 1 Maternity Specialist and 1 Maternity Department to add to the display of normal Specialists and Departments.

In a 3, 4, or 5-player game, draw 2 Maternity Specialists and 2 Maternity Departments to add to the display of normal Specialists and Departments.

After Step 7: Add the nurse meeples and all Maternity dice to the general supply. Pink dice are not placed in the bag!

After Step 9: In addition to the normal 3 starting patients, each player should also take a Mother die, set it to value 4, and place it in a ward without any other patients. They should flip the Paediatric Ward Chevron tile underneath the ward containing the Mother face up, and place 1 Infant die, set to value 4, in it.

Mother and Infant dice are separate patients and healing effects target each die individually. Pink dice may be targeted by any healing effect which references their value or colour, including effects which target any colour.

After Step 10: Shuffle the new Administrator cards with those from the base game. For details see the Glossary: Maternity Administrators below.

Maternity Game Sequence

The Maternity Expansion plays over the same phases as the base game, with some changes. These rules concentrate on what is different from the base game. Where these rules contradict the rules of the base game, follow these rules.

Maternity Phase 1 - Patient Intake

When drawing dice from the bag to fill ambulances, draw fewer red/yellow/green dice than in the base game and also take a number of Mother dice from the supply depending on player count, as per the following table:

Players	Ambulances	Red/Yellow/Green dice	Pink Mother dice
2	3	7	2
3	4	10	2
4	5	12	3
5	6*	15	3

*For the 6th Ambulance, use the Helicopter as ambulance '0'.

Roll all of these dice and place them in ambulances from lowest to highest as in the base game, but with the added restriction that there can be, at most, one Mother die in each ambulance. If 2 Mother dice were due to be placed in the same ambulance, based on their value, the player placing the dice must place one in an adjacent ambulance, either higher or lower. This may result in a (non-pink) die already placed moving into a higher numbered ambulance. Non-pink dice should always be placed in ascending order, so moving one pink die may result in moving a number of other dice.

Example (diagram): the second Mother of value 3 is placed in ambulance #3, to separate her from the Mother already placed in ambulance #2. Alternatively, it could have been placed in ambulance #1.

If you collect a Mother die it must be placed in a ward which does not contain any other Mothers. You are not allowed to have more than 4 Mothers in your hospital at any time. If you already have 4 Mothers, then you are not allowed to select an ambulance that contains a Mother. If this situation is unavoidable because all available ambulances contain Mothers, then you must take one of these ambulances and substitute the Mother die for a die of another colour, selected randomly from the bag, which should be set to the same value.

Each time you collect a Mother die you should flip over the Paediatric Ward Chevron tile underneath the ward containing the new Mother. These tiles will be flipped face down when the Mother is discharged.

For each Mother die you have added to your hospital, roll the Midwife die. Based on the result shown on the die you must collect either 1 or 2 Infants (twins!) from the general supply. Place these Infants, set to value 4, in the Paediatric ward below the ward containing the new Mother.

As stated in the base game, if there are insufficient spaces to take all of the new patients, you must remove existing patients (which become fatalities) to accommodate this round's new intake. You may never remove Mother or Infant (i.e. pink) dice in this way.

IMPORTANT: When using this expansion, dice cannot be moved between wards at any point in the game, as the position of a Mother die affects whether it suffers neglect: see Maternity Phase 4 below. However, there is one exception to this rule: when you place a Mother in a hospital ward which already contains 3 patients, you may move one of those patients to another ward (instead of removing it to become a fatality) providing you have space to do so.

Maternity Phase 2 - Hospital Improvement

Maternity Improvements may be taken from the display and added to your hospital in the usual way. Players may only select one Improvement per round as per base game rules (for example; one Maternity or one Standard Improvement, not both).

Maternity Phase 3 - Hospital Activation

Paediatric Wards: Each Paediatric Ward Chevron tile includes a meeple placement effect which can be used during the Activation Phase. A meeple may be placed on each Chevron tile once each round to heal a single pink die (Mother or Infant) 1 step. If the meeple is a Specialist, then resolve their special ability as normal.

Discharging Pink Dice: IMPORTANT: Although a Mother and their Infant(s) are healed separately, to be discharged they must all be healed to 7 or higher in the same round and placed in the Discharge Lounge together. You should temporarily place any Mothers or Infants that are fully healed below the Chevron tile until the other paired pink dice are also fully healed. If the paired pink dice are not also healed to value 7 or higher by the end of the round, then they are all moved back to their wards and are not discharged. They instead remain on value 6 and must be healed to a value of 7 again next round in order to be discharged.

Example (diagram): This Mother has been healed to value 7, and is temporarily moved below the Chevron tile to show that they are ready to be discharged. If the Infant die is also healed, both are moved to the Discharge Lounge, but if not the Mother is returned to the ward at value 6.

Colour Changes: You may not change the colour of any die to or from pink; you can only change to or from red, yellow, and green.

Maternity Phase 4 - Neglected Patients

Unhealed Mother dice only drop in value due to neglect when sharing wards with other patients, but do not drop below value 1, so they never become fatalities.

Remember: You are not allowed to move dice in your hospital wards unless they are making room for a new Mother die. Managing your available space is key to avoiding Mothers suffering neglect.

Infants never drop in value due to neglect (or for any other reason), and never become fatalities.

Maternity Phase 5 - Discharged Patients

All dice discharged during a round are scored normally, counting all pink dice towards the total.

Remember: Mothers and their Infants must be discharged together.

It is now possible to discharge up to 20 dice per round! Please see the scoring chart below for additional scoring.

When using the Maternity expansion you must empty your entire hospital – including all Paediatric Ward Chevron tiles – to score the 5 bonus points.

Discharged Mother and Infant dice are returned to the general supply.

Example (diagram): the player discharges 4 patients in total, including 1 Mother and 1 Infant. They score 7 points for this, as per the normal rules.

Discharge scoring chart (patients discharged in one round, and points scored):

Patients discharged	Points
1	1
2	3
3	5
4	7
5	9
6	11
7	14
8	17
9	21
10	25
11	30
12	35
13

Maternity Phase 6 - Shift Change

If any Paediatric Ward Chevron tile no longer contains Infant dice (since they have been discharged with their Mother in the previous phase), flip it face down. The healing effect of this tile cannot be used until it is flipped back when the ward is again occupied by one or more Infant dice.

Maternity End Game Scoring

There are no changes to the end of game scoring; this happens as described in the base game rulebook.

Glossary: Maternity Administrators

The printed glossary shows these by icon; the bold labels are descriptive only.

Infant choice: Each time you take in a new Mother, instead of rolling the Midwife die you may choose whether they have a single Infant or twins.
Discharge bonus (2 Mothers and 2 Infants): When you discharge 2 Mothers and 2 Infants, score an extra 3 points.

Glossary: Maternity Specialists

The printed glossary shows these by icon, without names; the bold labels are descriptive only.

Heal +2: If this Specialist heals a Mother or Infant, then that patient heals 2 additional steps.
Heal pink +1 and equal value +1: If this Specialist heals a Mother or Infant, then you may heal one other pink patient 1 step and one patient of equal value of any colour 1 step.
Heal two pink +1: If this Specialist heals a Mother or Infant, then you may heal two other pink patients 1 step each.
Heal equal value +2: If this Specialist heals a Mother or Infant, then you may heal one other patient of equal value 2 steps.
Heal two equal value +1: If this Specialist heals a Mother or Infant, then you may heal two other patients of equal value 1 step each.
Heal other pink +2: If this Specialist heals a Mother or Infant, then you may heal a different Mother or Infant 2 steps.
Heal any other +1: If this Specialist heals a Mother or Infant, then you may heal any other patient 1 step.
Discharge bonus: If this Specialist discharges a Mother or Infant during the Activation Phase, then immediately gain 2 Blood Bags.

Glossary: Maternity Departments

The printed glossary shows these by icon; the descriptions are transcribed in printed order and the bold labels are descriptive only.

Triple of equal value: Place a meeple here to heal exactly 3 patients of the same value, one of which must be a pink die. The pink die heals 3 steps, and the other dice heal 1 step each.
Pink 3 with any 2: Place a meeple here to heal a patient of any colour 2 steps, and a different pink die of equal value 3 steps.
Four equal value, Mother and Infant: Place a meeple here to heal four patients of equal value 1 step each. One of these patients must be a Mother and one of these patients must be an Infant. The other two patients can be dice of any colour.
Consecutive, pink lowest: Place a meeple here to heal 3 patients of consecutive values (e.g. 4, 5, 6) where the lowest value is a pink patient. The pink die heals 3 steps, and the other dice heal 1 step.
Consecutive, pink middle: Place a meeple here to heal 3 patients of consecutive values (e.g. 4, 5, 6) where the middle value is a pink patient. The pink die heals 3 steps, and the other dice heal 1 step.
Consecutive, pink highest: Place a meeple here to heal 3 patients of consecutive values (e.g. 4, 5, 6) where the highest value is a pink patient. The pink die heals 3 steps, and the other dice heal 1 step.
Pink 3 and move two: Place a meeple here to heal 1 pink patient 3 steps and move two other dice down on a ward (these dice are considered to be treated when considering neglect but are not healed and do not increase in value).
Pink 2 and re-roll: Place a meeple here to heal 1 pink patient 2 steps and re-roll any other die.

Combinations

The rules for each expansion should be followed except when replaced by the changes explained below.

City & Investments

Game Setup: Set up the City and Investments expansions as described in their sections above, with one exception: do not use the Supplemental Intake board when combining the City and Investments modules.

Phase 2 - Hospital Improvement: Players will gain an Improvement and may place one of their meeples at an Investment space in player order as shown by the Player Order tokens.

City & Maternity

Game Setup: Set up the City and Maternity expansions as described in their sections above, adjusting the City setup as follows.

Find the 4 City tiles with the pink die placement spots on one side. When placing the City tiles, use these tiles in the pink spaces shown in the printed layout diagrams for each player count (2 players, 3 players, and 4-5 players, printed on page 27), with the pink die placement spots face up. Return any unused tiles to the box.

The pink-space positions are shown only in those printed diagrams and are not reproduced in this text.

When you are familiar with this combination of expansions, these tiles can be randomly placed; still use the number of tiles with face-up pink die placement spots for the number of players in the game, as shown in the diagrams.

Whenever you would add a die to one of these tiles, instead of drawing one from the bag, roll and add a pink Mother die from the supply.

Game Sequence - Phase 1 - Patient Intake: When collecting dice, you may only collect one pink die each round. If, and only if, you are in a situation where a pink die is the only patient available for you to collect, and you already have a pink die, you may pass over it as if it were an empty City tile.

When refilling rows or columns where you would add a die to one of the City tiles with a pink die placement spot, instead of drawing one from the bag, roll and add a pink Mother die from the supply.

Game Sequence - Phase 4 - Neglected Patients: Mother dice suffer neglect in the City like any other dice, but they never drop below a value of 1.

Investments & Maternity

Additional Components: The Maternity Investment Action board and 14 Maternity Investment tokens.

Game Setup: Set up the Investments and Maternity expansions as described in their sections above. In addition, place the Maternity Investment Action board beneath the Investment Action board with the correct side for the number of players facing up, and place the Maternity Investment tokens on the board in the same way as with the other colours.

Do not start with a 4th nurse in this combination; only use 3 nurse meeples per player.

Game Sequence - Phase 2 - Hospital Improvement: Investment tokens cannot be placed on Maternity Ward Chevron tiles.

All Expansions

As long as the combinations above are taken into account, there are no additional changes to this combination; the phases happen as described in the expansion sections of this rulebook.

Solo Automa

You play against a robotic team of doctors, collectively called the "Automa". You will play the game like a normal 2-player game, with the Automa playing against you to restrict your choices, and you need to beat the Automa's score to win. The Automa scores slightly differently to a normal player, however, so you will need your wits about you to defeat it!

Components: 12 Automa Decision cards, 12 Automa Hospital cards, 8 Automa First Player tiles.

Automa Game Setup

The solo mode can only be played with the base game.

Set up the game as a 2-player game, except that the Automa does not need a board, and does not get 3 starting patients. Reserve part of the play area for the Automa.

Shuffle the Automa Decision cards and place them face down to form the Decision deck.
Sort the Automa Hospital cards into 3 decks, based on the complexity level indicated in the top-right of each card (the printed rulebook shows these as Simple, Normal and Difficult icons). Shuffle each deck separately, and draw 3 cards from each. Return the remaining Automa Hospital cards to the box; they will not be used in this game.
Shuffle the 9 selected cards together to form a single Hospital deck.
Deal out each card from the Hospital deck, face down, to form a row of 9 cards.
Turn the left-most card face up. There should now be 8 face-down cards remaining, one for each round of play.
You start as the first player, so place the First Player token in front of you.
Place the Automa First Player tiles nearby to form a supply.

Automa Card Anatomy

The printed rulebook shows the card layout as a diagram; the numbered key is transcribed here.

Hospital cards:

Chosen improvement.
Dice spots.
VP earned when the above spots are filled.
This section may be covered by a First Player tile.

Decision cards:

Chosen improvement to be added to the display.
Chosen ambulance number.

Automa Game Sequence

You play the game as normal, but the Automa follows a slightly amended set of rules. Any base game rules not expressly overridden here are considered to still be in effect.

Note: Whenever the Automa's Decision deck runs out, shuffle the discarded cards to form a new Decision deck.

Automa Phase 1 - Patient Intake

Place the rolled dice onto the ambulances as usual, except you always choose where any tied-value dice are placed, even if you are first player.

When choosing which ambulance to draft:

If the Automa is first player, flip over the next card from its Decision deck to see which ambulance it wants – the left-hand number is its choice. After it has chosen, you may choose your ambulance.
If you are first player, choose your ambulance, then flip over the next card from the Automa's Decision deck to see which ambulance it takes – the left-hand number is its first choice; if you have already taken that numbered ambulance, the Automa's choice is the right-hand number.

The printed rulebook labels these as the Automa First Choice (left-hand number) and Automa Second Choice (right-hand number).

Place the Automa's claimed dice near its play area for now. Do not assign the Automa's dice to its card(s) yet; this is done in Phase 3.

Assign the first player as usual, remembering to give the Automa a Blood Bag token if it takes or remains first player for the round.

Automa Phase 2 - Hospital Improvement

If the Automa is first player:

Flip the left-most face-down Automa Hospital card face up.
The top of the card will show which Improvement the Automa removes. Discard that Improvement from the selection. You may then choose your own Improvement for this round.
Then, place an Automa First Player tile over the lower-right-hand side of the Hospital card you have just revealed, covering the red area. This will cover some dice spots (these spots no longer need to be filled to complete the card; see Automa Phase 5 - Discharged Patients).

If you are first player:

Choose your own Improvement, then discard the two remaining Improvements.
Then, flip the left-most face-down Automa Hospital card face up.

Automa Phase 3 - Hospital Activation

The Automa assigns dice to its face-up Hospital cards, as follows:

Starting from the left-most face-up Hospital card, see if any of the uncovered dice placement spots on the card can be covered by any dice of the same colour from the ones the Automa has drafted this round, as well as from unused ones from previous rounds.
If so, place a matching die on the dice placement spot, as follows:
- If multiple spots match a die colour, place the die on the leftmost of those spots.
- If multiple dice match a coloured spot, pick any one of the matching dice to be placed there (it doesn't matter which die value goes in a spot).
Grey dice placement spots on cards are "wild" and can be covered by any die colour. Place dice on grey dice spots only after all other possible non-grey spots have been filled on the card in question.
- If multiple coloured dice could go on a grey dice spot, pick a die randomly from the dice available to place on the grey spot.
Once all possible dice are assigned to the left-most card, move on to the next face-up Hospital card in the line and repeat the above checks, assigning any dice that match empty spots.
Continue along the line until all possible dice have been assigned to face-up Hospital cards.

Example (diagram): the dice on the left-hand card and the bottom 3 dice of the middle card have been placed in the previous round. This round, the Automa has drafted a red die, a yellow die, and a green die. The red die is placed on the available red spot. There are 2 green spots available so the green die is placed on the left-most green spot. There are no yellow spots so the yellow die is placed on the grey spot.

Then, if the Automa has any Blood Bag tokens available, it uses them as "wild" dice: place them on empty dice spots (spot colour is ignored) on the Automa's cards, again going from the left-most Hospital card along the row.

Blood Bag tokens can go on grey spots, but the Automa will place them on coloured spots first, if any are still empty on the card in question.
Continue along the line until all possible Blood Bag tokens have been assigned to cards.

Automa Phase 4 - Neglected Patients

Patients of the Automa do not suffer neglect. The Automa's robotic doctors never leave a patient untended to!

Automa Phase 5 - Discharged Patients

The Automa discharges patients from Hospital cards that have all their dice spots covered (either by dice or Blood Bag tokens, or both). Note that if a card has an Automa First Player tile on it, only the dice spots on its left-hand side need to be covered. If any cards do have all their dice spots covered:

The Automa scores the number of points shown on the bottom of the card, including the bonus shown on the right-hand side, if that side of the card is not covered by an Automa First Player tile.
Return all dice on the scored card back to the dice bag, and return any Blood Bag tokens on the card back to the general supply. If a First Player tile was on the card, discard it back to the game box.
Discard the scored card back to the game box.

Example (diagram): the Automa scores 5 points from the left-hand card and 14 points from the right-hand card, having used a Blood Bag token to cover one dice spot.

Victory points are printed as star icons in the rulebook; they are transcribed here as points.

Automa Phase 6 - Shift Change

If the Automa is first player:

When drawing new tiles and cards for the next round's Improvements, flip over the next card from the Automa's Decision deck. The top of the card will show which type of Improvement it wants to add as the 3rd Improvement in the selection. Draw that type and place it next to the already drawn Department tile and Specialist card.

Automa End Game Scoring

The game ends at the end of round 8, just as a multiplayer game does.

Calculate final scores for you and the Automa as usual, adding 1 point for each leftover Blood Bag token you or the Automa have, and subtracting 2 points for each Fatality token you have (the Automa won't have any Fatality tokens).

Automa Difficulty Levels

You can adjust the difficulty of the Automa by adding in one or more of the following individual changes.

For an easier game:

Include all 4 Simple and only 2 Difficult (as well as 3 Normal) Hospital cards in the initial Automa deck setup.
Do not place Blood Bag tokens on any grey dice spots on Hospital cards, even if all coloured spots have been filled first.
Don't use Blood Bag tokens as wild dice on any spots at all for the Automa (they instead just score 1 each as normal at game end).

For a harder game:

Include all 4 Difficult and only 2 Simple (as well as 3 Normal) Hospital cards in the initial Automa deck setup.
Whenever the Automa gains a First Player tile, it immediately scores 1 point.
The Automa scores 1 point per die left on any incomplete Hospital cards at the end of the game.
The Automa scores 1 point for each of its unused dice remaining at the end of the game, i.e. which the Automa did not get to assign to any of its Hospital cards.

Victory points are printed as star icons in this section; they are transcribed here as points.