English to Spanish Medical Medical (general)

Se trata de un formulario de consentimiento para divulgación y publicación de información sobre el estado de salud de los pacientes, en el cual aparece lo siguiente:

INFORMATION MAY BE RELEASED TO THE FOLLOWING
PERSONS OR AGENCY(IES):
(Referring Agency: If you check a box marked “other,” please write the position of agency contact and name of the agency.)
I know that the service team includes the persons and/or agencies marked below (Please check all that apply to your child’s needs now and in the future.):

Pediatric Health Services (CUIDAR, For OC Kids NDC, EDAC, Asthma/Chronic Lung, Metabolic)
Nurse Practitioner
Physician
Social Worker
Psychologist
Family Support Worker

Gracias de antemano!