Most standardized reading assessments used with deaf and hard-of-hearing (d/Dhh) students do not accommodate their frequent lack of spoken language fluency. Such tests are rarely normed on d/Dhh individuals and do not adjust for potentially biased test items. Yet, accurate and valid measures of reading skills are essential for making appropriate instructional and programmatic decisions. The miscue analysis procedure is an individualized reading assessment using an authentic reading experience with systematic procedures for evaluating a reader's meaning-making processes. It has been used successfully with struggling, successful, bilingual, and diverse hearing readers to identify distinctive skill patterns. Its flexible and individualized procedures may lead to similar insights regarding the reading processes utilized by d/Dhh students. This manuscript describes adaptations of the reading miscue analysis for d/Dhh students who use spoken language, English-based sign systems, or American Sign Language. Similar to running record procedures, the miscue analysis utilizes a comprehensive analytic process. In addition, each miscue is categorized across graphophonic/visual, semantic, and syntactic aspects of the reading process to identify unique meaning making patterns. This type of comprehensive and authentic assessment can lead to an improved understanding of the strengths and needs of d/Dhh students that result in improved achievement.