We developed a clinical decision support system (CDSS) - Child Health Improvement through Computer Automation (CHICA) - to deliver patient specific guidance at the point of clinical care. CHICA captures structured data from families, physicians, and nursing, staff using a scannable paper user interface - Adaptive Turnaround Documents (ATD) while remaining sensitive to the workflow constraints of a busy outpatient pediatric practice. The system was deployed in November 2004 with an English language only user interface. In July 2005, we enhanced the user interface with a Spanish version of the pre-screening questionnaire to capture information from Spanish speaking families in our clinic. Subsequently, our results show an increase in rate of family responses to the pre-screening questionnaire by 36% (51% vs. 87%) in a four month time period before and after the Spanish interface deployment and up to 32% (51% vs. 83%) since November 2004. Furthermore, our results show that Spanish speaking families, on average, respond to the questionnaire more than English speaking families (85% vs. 49%). This paper describes the design, implementation challenges and our measure of success when trying to adapt a computer scannable paper interface to another language.