Abstract: An apparatus and method are disclosed for efficient communication between a caregiver and a patient that cannot communicate using normal speech or writing. The apparatus includes presentation panels joined to facilitate rapid access, such as being bound as a book, upon which are printed a plurality of concisely annotated pictograms, each of which conveys a specific message or message element. Each of the concisely annotated pictograms includes an easily recognized visual feature that conveys at least an approximation of the intended meaning, and a concise text annotation that, together with the visual feature, substantially reduces ambiguity. The concisely annotated pictograms are arranged hierarchically to enable pictograms to be quickly located. Modifying pictograms are included that indicate the degree, urgency, or severity of a need, desire, or condition that is being communicated. The method consists of locating and pointing to one or more of the pictograms to indicate a desired message.