<?xml version="1.0" encoding="UTF-8"?>
<!-- edited with XMLSpy v2010 rel. 2 (http://www.altova.com) by Nina Thayer (CA Dept. of Industrial Relations) -->
<xs:schema xmlns="http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:CF="http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/CommonFields" targetNamespace="http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields" elementFormDefault="qualified" attributeFormDefault="unqualified">
	<xs:import namespace="http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/CommonFields" schemaLocation="../CommonFields/CommonFields.xsd"/>
	<xs:simpleType name="lienUnemploymentCompensationType">
		<xs:annotation>
			<xs:documentation>Lien Unemployment Compensation Type  
			Valid Values
			'PFL' - Paid Family Leave
			'SDI' - State Disability Insurance
			</xs:documentation>
		</xs:annotation>
		<xs:restriction base="CF:typeCode3">
			<xs:enumeration value="PFL"/>
			<xs:enumeration value="SDI"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="amount">
		<xs:restriction base="xs:double">
			<xs:maxInclusive value="9999999999999.99"/>
			<xs:minInclusive value="0.00"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="addressLine">
		<xs:restriction base="xs:string">
			<xs:maxLength value="40"/>
			<xs:minLength value="1"/>
			<xs:whiteSpace value="preserve"/>
			<xs:pattern value="([A-Z0-9 ])*"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="attorneyorAuthRepTypeCode">
		<xs:annotation>
			<xs:documentation> Attorney or Authorized Representative 
			Valid Values 
				'A' - Attorney 
				'R' - AuthorizedRepresentative
			</xs:documentation>
		</xs:annotation>
		<xs:restriction base="CF:typeCode1">
			<xs:enumeration value="A"/>
			<xs:enumeration value="R"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="bodyPart">
		<xs:annotation>
			<xs:documentation> Body Parts 
			Valid Values 
				'100' - 100 HEAD - not specified
				'110' - 110 BRAIN
				'120' - 120 EAR - not specified
				'121' - 121 EAR - external
				'124' - 124 EAR - internal (including hearing)
				'130' - 130 EYE - (including optic nerves and vision)
				'140' - 140 FACE - not specified
				'141' - 141 JAW - (including chin and mandible)
				'144' - 144 MOUTH - (including lips, tongue, throat and taste)
				'145' - 145 TEETH
				'146' - 146 NOSE - (including nasal passages, sinus and smell)
				'148' - 148 FACE - multiple parts (any combination of above parts)
				'149' - 149 FACE - forehead, cheeks, eyelids
				'150' - 150 SCALP
				'160' - 160 SKULL
				'198' - 198 HEAD - multiple injury (any combination of above parts)
				'200' - 200 NECK
				'300' - 300 UPPER EXTREMITIES - not specified
				'310' - 310 ARM - above wrist (not specified)
				'311' - 311 ARM - upper arm (humerus)
				'313' - 313 ARM - elbow (head of radius)
				'315' - 315 ARM - forearm (radius and ulna)
				'318' - 318 ARM - multiple parts (any combination of above parts)
				'319' - 319 ARM - not specified
				'320' - 320 WRIST
				'330' - 330 HAND - (not wrist or fingers)
				'340' - 340 FINGER(s)
				'398' - 398 UPPER EXTREMITIES - multiple parts (any combination of above parts)
				'400' - 400 TRUNK - not specified'
				'410' - 410 ABDOMEN - including internal organs and groin
				'411' - 411 HERNIA
				'420' - 420 BACK - including back muscles, spine and spinal cord
				'430' - 430 CHEST - including ribs, breast bone and internal organs of the chest
				'440' - 440 HIP(s) - including pelvis, pelvic organs, tailbone, coccyx and buttocks
				'450' - 450 SHOULDER(s) - (scapula and clavicle)
				'498' - 498 TRUNK - use for side; multiple parts (any combination of above parts)
				'500' - 500 LOWER EXTREMITIES - not specified
				'510' - 510 LEGS - above ankles, not specified
				'511' - 511 THIGH (femur)
				'513' - 513 KNEE (Patella)
				'515' - 515 LOWER LEG (tibia and fibula)
				'518' - 518 LEG - multiple parts (any combination of above parts)
				'519' - 519 LEG - not specified
				'520' - 520 ANKLE (malleolus)
				'530' - 530 FOOT (not ankle or toe)
				'540' - 540 TOE(s)
				'598' - 598 LOWER EXTREMITIES - multiple parts (any combination of above parts)
				'700' - 700 MULITPLE PARTS (more than five major parts) (use only in fifth position of listing of body parts)
				'800' - 800 BODY SYSTEM - not specific
				'801' - 801 CIRCULATORY SYSTEM - (heart - other than heart attack, blood, arteries, veins, etc.)
				'802' - 802 CIRCULATORY SYTEM - Heart attack
				'810' - 810 DIGESTIVE SYSTEM - (stomach)
				'820' - 820 EXCRETORY SYSTEM - (kidneys, bladder, intestines, etc.)
				'830' - 830 MUSCULO-SKELETAL SYSTEM - (bones, joints, tendons, muscles, etc.)
				'840' - 840 NERVOUS SYSTEM - not specified
				'841' - 841 NERVOUS SYSTEM - Stress
				'842' - 842 NERVOUS SYSTEM - Psychiatric/psych
				'850' - 850 RESPIRATORY SYSTEM - (lungs, trachea, etc.)
				'860' - 860 SKIN (dermititis, etc.)
				'870' - 870 REPRODUCTIVE SYSTEMS
				'880' - 880 OTHER BODY SYSTEMS
				'999' - 999 UNCLASSIFIED - insufficient information to identify body parts
			</xs:documentation>
		</xs:annotation>
		<xs:restriction base="CF:typeCode3">
			<xs:enumeration value="100"/>
			<xs:enumeration value="110"/>
			<xs:enumeration value="120"/>
			<xs:enumeration value="121"/>
			<xs:enumeration value="124"/>
			<xs:enumeration value="130"/>
			<xs:enumeration value="140"/>
			<xs:enumeration value="141"/>
			<xs:enumeration value="144"/>
			<xs:enumeration value="145"/>
			<xs:enumeration value="146"/>
			<xs:enumeration value="148"/>
			<xs:enumeration value="149"/>
			<xs:enumeration value="150"/>
			<xs:enumeration value="160"/>
			<xs:enumeration value="198"/>
			<xs:enumeration value="200"/>
			<xs:enumeration value="300"/>
			<xs:enumeration value="310"/>
			<xs:enumeration value="311"/>
			<xs:enumeration value="313"/>
			<xs:enumeration value="315"/>
			<xs:enumeration value="318"/>
			<xs:enumeration value="319"/>
			<xs:enumeration value="320"/>
			<xs:enumeration value="330"/>
			<xs:enumeration value="340"/>
			<xs:enumeration value="398"/>
			<xs:enumeration value="400"/>
			<xs:enumeration value="410"/>
			<xs:enumeration value="411"/>
			<xs:enumeration value="420"/>
			<xs:enumeration value="430"/>
			<xs:enumeration value="440"/>
			<xs:enumeration value="450"/>
			<xs:enumeration value="498"/>
			<xs:enumeration value="500"/>
			<xs:enumeration value="510"/>
			<xs:enumeration value="511"/>
			<xs:enumeration value="513"/>
			<xs:enumeration value="515"/>
			<xs:enumeration value="518"/>
			<xs:enumeration value="519"/>
			<xs:enumeration value="520"/>
			<xs:enumeration value="530"/>
			<xs:enumeration value="540"/>
			<xs:enumeration value="598"/>
			<xs:enumeration value="700"/>
			<xs:enumeration value="800"/>
			<xs:enumeration value="801"/>
			<xs:enumeration value="802"/>
			<xs:enumeration value="810"/>
			<xs:enumeration value="820"/>
			<xs:enumeration value="830"/>
			<xs:enumeration value="840"/>
			<xs:enumeration value="841"/>
			<xs:enumeration value="842"/>
			<xs:enumeration value="850"/>
			<xs:enumeration value="860"/>
			<xs:enumeration value="870"/>
			<xs:enumeration value="880"/>
			<xs:enumeration value="999"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="city">
		<xs:restriction base="xs:string">
			<xs:maxLength value="25"/>
			<xs:minLength value="1"/>
			<xs:whiteSpace value="preserve"/>
			<xs:pattern value="([A-Z' ])*"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="employerName">
		<xs:restriction base="fullName">
			<xs:pattern value="([A-Z0-9 ])*"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="employerRoleTypeCode">
		<xs:annotation>
			<xs:documentation> Employer Role Type 
			Valid Values 
				'I' - Insured 
				'S' - Self Insured
				'L' - Legally Uninsured
				'U' - Uninsured
			</xs:documentation>
		</xs:annotation>
		<xs:restriction base="CF:typeCode1">
			<xs:enumeration value="I"/>
			<xs:enumeration value="S"/>
			<xs:enumeration value="L"/>
			<xs:enumeration value="U"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="filerRoleTypeCode">
		<xs:annotation>
			<xs:documentation> Filer Role Type 
			Valid Values 
				'E' - Employee 
				'A' - Applicant
				'D' - Defendant
				'L' - LienClaimnt
			</xs:documentation>
		</xs:annotation>
		<xs:restriction base="CF:typeCode1">
			<xs:enumeration value="E"/>
			<xs:enumeration value="A"/>
			<xs:enumeration value="D"/>
			<xs:enumeration value="L"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="fileOnBehalfTypeCode">
		<xs:annotation>
			<xs:documentation> File On Behalf Type 
			Valid Values 
				'E' - Employer 
				'I' - Insurance Carrier
				'B' - Both
		
			</xs:documentation>
		</xs:annotation>
		<xs:restriction base="CF:typeCode1">
			<xs:enumeration value="E"/>
			<xs:enumeration value="I"/>
			<xs:enumeration value="B"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="firstName">
		<xs:restriction base="xs:string">
			<xs:maxLength value="25"/>
			<xs:whiteSpace value="preserve"/>
			<xs:minLength value="1"/>
			<xs:pattern value="([A-Z ])*"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="fullAddress">
		<xs:restriction base="xs:string">
			<xs:maxLength value="56"/>
			<xs:minLength value="1"/>
			<xs:whiteSpace value="preserve"/>
			<xs:pattern value="([A-Z0-9 ])*"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="fullName">
		<xs:restriction base="xs:string">
			<xs:maxLength value="56"/>
			<xs:minLength value="2"/>
			<xs:pattern value="([A-Z 0-9])*"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="fullLongName">
		<xs:restriction base="xs:string">
			<xs:maxLength value="80"/>
			<xs:minLength value="1"/>
			<xs:pattern value="([A-Z ])*"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="hearingTypeCode">
		<xs:annotation>
			<xs:documentation> Hearing Type 
			Valid Values 
				'M' - Mandatory Settlement Conference 
				'S' - Status Conference
				'R' - Rating MSC
				'P' - Priority Conference
				'L' -  Lien Conference
			</xs:documentation>
		</xs:annotation>
		<xs:restriction base="CF:typeCode1">
			<xs:enumeration value="M"/>
			<xs:enumeration value="S"/>
			<xs:enumeration value="R"/>
			<xs:enumeration value="P"/>
			<xs:enumeration value="L"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="initialCheckBox">
		<xs:restriction base="CF:checkBox"/>
	</xs:simpleType>
	<xs:simpleType name="injuryTypeCode">
		<xs:annotation>
			<xs:documentation> Injury Type 
			Valid Values 
				'I' - Specific Injury Date 
				'C' - Cumulative Injury
			</xs:documentation>
		</xs:annotation>
		<xs:restriction base="CF:typeCode1">
			<xs:enumeration value="I"/>
			<xs:enumeration value="C"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="laborAdjustmentTypeCode">
		<xs:annotation>
			<xs:documentation> Labor Adjustment Code
			Valid Values 
				'I' - Increase rate 
				'D' - Decrease rate 
			</xs:documentation>
		</xs:annotation>
		<xs:restriction base="CF:typeCode1">
			<xs:enumeration value="I"/>
			<xs:enumeration value="D"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="lastName">
		<xs:restriction base="xs:string">
			<xs:maxLength value="25"/>
			<xs:minLength value="1"/>
			<xs:whiteSpace value="preserve"/>
			<xs:pattern value="([A-Z ])*"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="lawFirmNumber">
		<xs:restriction base="xs:string">
			<xs:maxLength value="10"/>
			<xs:minLength value="1"/>
			<xs:whiteSpace value="collapse"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="middleInitial" final="">
		<xs:restriction base="xs:string">
			<xs:whiteSpace value="collapse"/>
			<xs:maxLength value="1"/>
			<xs:minLength value="1"/>
			<xs:pattern value="[A-Z]"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="occupationText">
		<xs:annotation>
			<xs:documentation>Occupation of injured worker at time of injury</xs:documentation>
		</xs:annotation>
		<xs:restriction base="xs:string">
			<xs:maxLength value="56"/>
			<xs:minLength value="1"/>
			<xs:whiteSpace value="preserve"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="organizationName">
		<xs:restriction base="xs:string">
			<xs:maxLength value="56"/>
			<xs:minLength value="1"/>
			<xs:pattern value="([A-Z ])*"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="phoneNumber">
		<xs:annotation>
			<xs:documentation>10 digits (0 - 9)</xs:documentation>
		</xs:annotation>
		<xs:restriction base="xs:string">
			<xs:maxLength value="10"/>
			<xs:pattern value="\d\d\d\d\d\d\d\d\d\d"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="signature">
		<xs:restriction base="xs:string">
			<xs:maxLength value="82"/>
			<xs:whiteSpace value="preserve"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="socialSecurityNumber">
		<xs:restriction base="xs:string">
			<xs:length value="9"/>
			<xs:whiteSpace value="collapse"/>
			<xs:pattern value="([0-9])*"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="state">
		<xs:restriction base="xs:string">
			<xs:whiteSpace value="preserve"/>
			<xs:minLength value="2"/>
			<xs:maxLength value="2"/>
			<xs:pattern value="([A-Z])*"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="venueLocationTypeCode">
		<xs:annotation>
			<xs:documentation>'R' - Residence Location, 'I' - Injury Location, 'B' - Business Location  
			</xs:documentation>
		</xs:annotation>
		<xs:restriction base="CF:typeCode1">
			<xs:whiteSpace value="collapse"/>
			<xs:enumeration value="R"/>
			<xs:enumeration value="I"/>
			<xs:enumeration value="B"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="venueOfficeCode">
		<xs:annotation>
			<xs:documentation> Venue Office Code 
'STK'  - Stockton        
'SFO'  - San Francisco   
'SAC'  - Sacramento      
'GOL'  - Goleta          
'LBO'  - Long Beach      
'VNO'  - Van Nuys        
'SAL'  -  Salinas         
'OAK'  - Oakland         
'SDO'  - San Diego       
'MDR'  - Marina Del Rey  
'OXN'  -  Oxnard          
'EUR'  -  Eureka          
'SRO'  - Santa Rosa      
'SBR'  -  San Bernardino  
'AHM' -  Anaheim         
'RIV'   -  Riverside       
'FRE'  -  Fresno          
'LAO'  -  Los Angeles     
'POM' -  Pomona          
'SJO'  -  San Jose        
'ANA'  -  Santa Ana       
'BAK'  -  Bakersfield     
'GRO'  - Grover Beach    
'RDG'  - Redding  
'SLO' - San Luis Obispo     
  	</xs:documentation>
		</xs:annotation>
		<xs:restriction base="CF:typeCode3">
			<xs:whiteSpace value="collapse"/>
			<xs:enumeration value="STK"/>
			<xs:enumeration value="SFO"/>
			<xs:enumeration value="SAC"/>
			<xs:enumeration value="GOL"/>
			<xs:enumeration value="LBO"/>
			<xs:enumeration value="VNO"/>
			<xs:enumeration value="SAL"/>
			<xs:enumeration value="OAK"/>
			<xs:enumeration value="SDO"/>
			<xs:enumeration value="MDR"/>
			<xs:enumeration value="OXN"/>
			<xs:enumeration value="EUR"/>
			<xs:enumeration value="SRO"/>
			<xs:enumeration value="SBR"/>
			<xs:enumeration value="AHM"/>
			<xs:enumeration value="RIV"/>
			<xs:enumeration value="FRE"/>
			<xs:enumeration value="LAO"/>
			<xs:enumeration value="POM"/>
			<xs:enumeration value="SJO"/>
			<xs:enumeration value="ANA"/>
			<xs:enumeration value="BAK"/>
			<xs:enumeration value="GRO"/>
			<xs:enumeration value="RDG"/>
			<xs:enumeration value="SLO"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="zip5Code">
		<xs:restriction base="xs:string">
			<xs:whiteSpace value="collapse"/>
			<xs:length value="5"/>
			<xs:pattern value="\d\d\d\d\d"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="zip4Code">
		<xs:restriction base="xs:string">
			<xs:length value="4" fixed="true"/>
			<xs:whiteSpace value="collapse"/>
			<xs:pattern value="\d\d\d\d"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="sftField">
		<xs:restriction base="xs:string">
			<xs:pattern value="([A-Z0-9 ])*"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="claimNumber">
		<xs:restriction base="xs:string">
			<xs:maxLength value="20"/>
			<xs:minLength value="0"/>
			<xs:pattern value="([A-Z0-9 ])*"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="prefix">
		<xs:annotation>
			<xs:documentation> Employee Name Prefix
			Valid Values 
				'Mr.' 'Ms.' 'Mrs'
			</xs:documentation>
		</xs:annotation>
		<xs:restriction base="xs:string">
			<xs:enumeration value="Mr"/>
			<xs:enumeration value="Ms"/>
			<xs:enumeration value="Mrs"/>
		</xs:restriction>
	</xs:simpleType>
</xs:schema>
