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The Women's 4x100m Medley Relay event at the 2003 Pan American Games took place on August 16, 2003 (Day 15 of the Games).
| Gold | Diana MacManus Staciana Stitts Dana Vollmer Amanda Weir  United States |
| Silver | Joanne Malar-Morreale Kathleen Stoody Audrey Lacroix Elizabeth Collins  Canada |
| Bronze | Danielle de Alba Adriana Marmolejo Atenas López Alejandra Galan  Mexico |
| World Record |  United States | 3:58.30 | 2000-09-23 |  Sydney, Australia |
| Pan Am Record | United States | 4:06.08 | 1999-08-06 | Winnipeg, Canada |
| Place | Nation | Swimmers | Heats | Final | |
|---|---|---|---|---|---|
| Time | Rank | Time | |||
| 1 | United States | ♦ Diana MacManus ♦ Staciana Stitts ♦ Dana Vollmer ♦ Amanda Weir | 4:09.80 | 1 | 4:05.92 GR |
| 2 |  Canada | ♦ Joanne Malar-Morreale ♦ Kathleen Stoody ♦ Audrey Lacroix ♦ Elizabeth Collins | 4:18.36 | 2 | 4:13.72 |
| 3 |  Mexico | ♦ Danielle de Alba ♦ Adriana Marmolejo ♦ Atenas López ♦ Alejandra Galan | 4:32.19 | 5 | 4:18.04 |
| 4 |  Brazil | ♦ Paula Baracho ♦ Patrícia Comini ♦ Ivi Monteiro ♦ Flávia Delaroli | 4:25.30 | 3 | 4:18.29 |
| 5 |  Peru | ♦ ♦ ♦ ♦ | 4:33.30 | 6 | 4:29.74 |
| 6 |  Trinidad and Tobago | ♦ ♦ ♦ ♦ | 4:34.24 | 7 | 4:31.47 |
| 7 |  Dominican Republic | ♦ ♦ ♦ ♦ | 4:39.92 | 8 | 4:40.05 |
| 8 |  Jamaica | ♦ ♦ ♦ ♦ | 4:30.39 | 4 | DQ |
| — |  Puerto Rico | ♦ ♦ ♦ ♦ | DQ | — | |
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