1. Give the patient a laminated copy of the REALM and score answers on an unlaminated copy that is attached to a clipboard. Hold the clipboard at an angle so that the patient is not distracted by your scoring procedure. Say:

    “I want to hear you read as many words as you can from this list. Begin with the first word on List 1 and read aloud. When you come to a word you cannot read, do the best you can or say “blank” and go on to the next word.”

  2. If the patient takes more than five seconds on a word, say “blank” and point to the next word, if necessary, to move the patient along. If the patient begins to miss every word, have him or her pronounce only known words.

  3. Count as an error any word not attempted or mispronounced. Score by marking a plus (+) after each correct word, a check () after each mispronounced word, and a minus (–) after words not attempted. Count as correct any self-corrected word.

  4. Count the number of correct words for each list and record the numbers in the “SCORE’ box. Total the numbers and match the total score with its grade equivalent in the table below (Table C-2).

TABLE C-2 Scores and Grade Equivalents for the REALM


Raw Score

Grade Range


3rd Grade and below

  • Will not be able to read most low literacy materials; will need repeated oral instructions, materials composed primarily of illustrations, or audio or videotapes


4th to 6th Grade

  • Will need low literacy materials; may not be able to read prescription labels


7th to 8th Grade

  • Will struggle with most patient education materials; will not be offended by low literacy materials


High School

  • Will be able to read most patient education materials

Excerpts taken from: Davis TC, Crouch MA, Long SW. 1993. Rapid Estimate of Adult Literacy in Medicine: A Shortened Screening Instrument. Louisiana State University. Reprinted with permission.

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