Under rating threshold (hideshow) The game does not calculate medals after how many percent notes hit, but points. You need the max possible points on a song to perfect it. So you have to hit all the notes (do not hit any buttons beside that, because you will LOSE points) and you need to hold the sustained notes ALL THE WAY to the end. You can actually continue to hold a sustained note for longer than meant to, so you are 100% sure you got it. Please help keep this comment alive!
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