Schema AppForADJ.xsd


attribute form default:  unqualified
element form default:  qualified
targetNamespace:  http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
 
Elements  Complex types  Simple types 
AppForADJ  ActualEarningsSection  earningsPayPeriod 
ApplicantAttorneyOrRepSection  organizationTypeCode 
ApplicationSection 
Compensation 
DisagreementRegardingLiabilitySection 
Employer 
EmployerInformation 
HeaderSection 
InjuredWorkerInformation 
InjuryCausedDisability 
MedicalTreatmentSection 
NonInjuredWorkerApplicantInformation 
SignatureSection 


attribute form default:  unqualified
element form default:  qualified
targetNamespace:  http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
 
Simple types 
addressLine 
amount 
attorneyorAuthRepTypeCode 
bodyPart 
city 
claimNumber 
employerName 
employerRoleTypeCode 
fileOnBehalfTypeCode 
filerRoleTypeCode 
firstName 
fullAddress 
fullLongName 
fullName 
hearingTypeCode 
initialCheckBox 
injuryTypeCode 
laborAdjustmentTypeCode 
lastName 
lawFirmNumber 
lienUnemploymentCompensationType 
middleInitial 
occupationText 
organizationName 
phoneNumber 
prefix 
sftField 
signature 
socialSecurityNumber 
state 
venueLocationTypeCode 
venueOfficeCode 
zip4Code 
zip5Code 


attribute form default:  unqualified
element form default:  qualified
targetNamespace:  http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
 
Groups  Complex types 
AddressGroup  Address 
DeclarantSignatureGroup  AttorneyorRep 
EarningAmountGroup  AttorneyorRepWithoutNumber 
EmployerRoleTypeGroup  CheckBox 
InjuryInformationGroup  DateRangeMandatory 
InjuryTypeAndDates  DoctorInformation 
PersonNameGroup  EmployerName 
RoleTypeGroup  InjuryInformation 
SignatureAddressGroup  OrganizationInformation 
VenueInformationGroup  PersonInformation 
PersonName 
SelectionType126 
SelectionType129 
SelectionType84 
SelectionType85 
Signature 
Signatures 
StartAndEndDate 
VenueInformation 


attribute form default:  unqualified
element form default:  qualified
targetNamespace:  http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/CommonFields
 
Simple types 
caseNumber 
checkBox 
ptsDate 
typeCode1 
typeCode3 
versionNumber 


element AppForADJ
diagram AppForADJ_p1.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
properties
content complex
children HeaderSection ApplicationSection InjuredWorkerSection NonInjuredWorkerApplicantSection EmployerSection InsuranceCarrierSection ClaimsAdminstratorSection ActualEarningsSection InjuryCausedDisabilitySection CompensationSection MedicalTreatmentSection OtherCaseNumbersSection DisagreementRegardingLiabilitySection ApplicantAttorneyOrRepSection SignatureSection
annotation
documentation
Application for Adjudication
source <xs:element name="AppForADJ">
 
<xs:annotation>
   
<xs:documentation>Application for Adjudication</xs:documentation>
 
</xs:annotation>
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="HeaderSection" type="HeaderSection"/>
     
<xs:element name="ApplicationSection" type="ApplicationSection">
       
<xs:annotation>
         
<xs:documentation>Information from the cover sheet.</xs:documentation>
       
</xs:annotation>
     
</xs:element>
     
<xs:element name="InjuredWorkerSection" type="InjuredWorkerInformation">
       
<xs:annotation>
         
<xs:documentation>Injured worker's name and address -- required</xs:documentation>
       
</xs:annotation>
     
</xs:element>
     
<xs:element name="NonInjuredWorkerApplicantSection" type="NonInjuredWorkerApplicantInformation" minOccurs="0">
       
<xs:annotation>
         
<xs:documentation>If the applicant is NOT the injured worker complete this section.</xs:documentation>
       
</xs:annotation>
     
</xs:element>
     
<xs:element name="EmployerSection">
       
<xs:complexType>
         
<xs:complexContent>
           
<xs:extension base="EmployerInformation"/>
         
</xs:complexContent>
       
</xs:complexType>
     
</xs:element>
     
<xs:element name="InsuranceCarrierSection" type="CD:OrganizationInformation" minOccurs="0"/>
     
<xs:element name="ClaimsAdminstratorSection" type="CD:OrganizationInformation" minOccurs="0"/>
     
<xs:element name="ActualEarningsSection" type="ActualEarningsSection" minOccurs="0"/>
     
<xs:element name="InjuryCausedDisabilitySection" type="InjuryCausedDisability" minOccurs="0"/>
     
<xs:element name="CompensationSection" type="Compensation" minOccurs="0"/>
     
<xs:element name="MedicalTreatmentSection" type="MedicalTreatmentSection" minOccurs="0"/>
     
<xs:element name="OtherCaseNumbersSection" minOccurs="0">
       
<xs:complexType>
         
<xs:sequence>
           
<xs:element name="CaseNumber" type="CF:caseNumber" minOccurs="0" maxOccurs="4"/>
         
</xs:sequence>
       
</xs:complexType>
     
</xs:element>
     
<xs:element name="DisagreementRegardingLiabilitySection" type="DisagreementRegardingLiabilitySection" minOccurs="0"/>
     
<xs:element name="ApplicantAttorneyOrRepSection" type="CD:AttorneyorRep" minOccurs="0"/>
     
<xs:element name="SignatureSection" type="SignatureSection"/>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element AppForADJ/HeaderSection
diagram AppForADJ_p2.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type HeaderSection
properties
isRef 0
content complex
children VersionNumber
source <xs:element name="HeaderSection" type="HeaderSection"/>

element AppForADJ/ApplicationSection
diagram AppForADJ_p3.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type ApplicationSection
properties
isRef 0
content complex
children SocialSecurityNumber AmendedApplication Venue DateOfBirth Occupation InjuryInformation InjuryOccuredAsFollows
annotation
documentation
Information from the cover sheet.
source <xs:element name="ApplicationSection" type="ApplicationSection">
 
<xs:annotation>
   
<xs:documentation>Information from the cover sheet.</xs:documentation>
 
</xs:annotation>
</xs:element>

element AppForADJ/InjuredWorkerSection
diagram AppForADJ_p4.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type InjuredWorkerInformation
properties
isRef 0
content complex
children Name Address
annotation
documentation
Injured worker's name and address -- required
source <xs:element name="InjuredWorkerSection" type="InjuredWorkerInformation">
 
<xs:annotation>
   
<xs:documentation>Injured worker's name and address -- required</xs:documentation>
 
</xs:annotation>
</xs:element>

element AppForADJ/NonInjuredWorkerApplicantSection
diagram AppForADJ_p5.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type NonInjuredWorkerApplicantInformation
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children NonInjuredWorkerApplicantTypeCode EmployerName Address
annotation
documentation
If the applicant is NOT the injured worker complete this section.
source <xs:element name="NonInjuredWorkerApplicantSection" type="NonInjuredWorkerApplicantInformation" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>If the applicant is NOT the injured worker complete this section.</xs:documentation>
 
</xs:annotation>
</xs:element>

element AppForADJ/EmployerSection
diagram AppForADJ_p6.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type extension of EmployerInformation
properties
isRef 0
content complex
children EmployerRoleTypeCode EmployerName Address
source <xs:element name="EmployerSection">
 
<xs:complexType>
   
<xs:complexContent>
     
<xs:extension base="EmployerInformation"/>
   
</xs:complexContent>
 
</xs:complexType>
</xs:element>

element AppForADJ/InsuranceCarrierSection
diagram AppForADJ_p7.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type OrganizationInformation
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children EmployerName Address
source <xs:element name="InsuranceCarrierSection" type="CD:OrganizationInformation" minOccurs="0"/>

element AppForADJ/ClaimsAdminstratorSection
diagram AppForADJ_p8.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type OrganizationInformation
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children EmployerName Address
source <xs:element name="ClaimsAdminstratorSection" type="CD:OrganizationInformation" minOccurs="0"/>

element AppForADJ/ActualEarningsSection
diagram AppForADJ_p9.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type ActualEarningsSection
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children RegularEarnings Tips HoursWorkedPerWeek
source <xs:element name="ActualEarningsSection" type="ActualEarningsSection" minOccurs="0"/>

element AppForADJ/InjuryCausedDisabilitySection
diagram AppForADJ_p10.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type InjuryCausedDisability
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children LastDayOffWorkDueToInjury FirstPeriodOfDisability SecondPeriodOfDisability
source <xs:element name="InjuryCausedDisabilitySection" type="InjuryCausedDisability" minOccurs="0"/>

element AppForADJ/CompensationSection
diagram AppForADJ_p11.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type Compensation
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children WasCompensationPaid TotalPaid WeeklyRate DateOfLastPayment WasUnemploymentReceived
source <xs:element name="CompensationSection" type="Compensation" minOccurs="0"/>

element AppForADJ/MedicalTreatmentSection
diagram AppForADJ_p12.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type MedicalTreatmentSection
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children MedicalTreatmentWasReceived AllTreatmentWasFurnishedByInsuranceCarrierOrEmployer DateOfLastTreatment OtherTreamentWasProvidedBy DidMedi-CalPay NameOfDoctorHospitalClinic
source <xs:element name="MedicalTreatmentSection" type="MedicalTreatmentSection" minOccurs="0"/>

element AppForADJ/OtherCaseNumbersSection
diagram AppForADJ_p13.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children CaseNumber
source <xs:element name="OtherCaseNumbersSection" minOccurs="0">
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="CaseNumber" type="CF:caseNumber" minOccurs="0" maxOccurs="4"/>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element AppForADJ/OtherCaseNumbersSection/CaseNumber
diagram AppForADJ_p14.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type caseNumber
properties
isRef 0
minOcc 0
maxOcc 4
content simple
facets
Kind Value annotation 
minLength 
maxLength 20 
pattern [A-Z][A-Z][A-Z]([0-9])* 
source <xs:element name="CaseNumber" type="CF:caseNumber" minOccurs="0" maxOccurs="4"/>

element AppForADJ/DisagreementRegardingLiabilitySection
diagram AppForADJ_p15.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type DisagreementRegardingLiabilitySection
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children TemporaryDisabilityIndemnity ReimbursementForMedicalExpense MedicalTreatment CompensationAtProperRate PermanentDisabilityIndemnity Rehabilitation SupplementalJobDisplacement OtherText
source <xs:element name="DisagreementRegardingLiabilitySection" type="DisagreementRegardingLiabilitySection" minOccurs="0"/>

element AppForADJ/ApplicantAttorneyOrRepSection
diagram AppForADJ_p16.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type AttorneyorRep
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children AttorneyorAuthRepTypeCode EmployerName LawFirmNumber Name Address
source <xs:element name="ApplicantAttorneyOrRepSection" type="CD:AttorneyorRep" minOccurs="0"/>

element AppForADJ/SignatureSection
diagram AppForADJ_p17.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type SignatureSection
properties
isRef 0
content complex
children AttorneyRepSignature ApplicantSignature SignedAtCity DateOfSignature
source <xs:element name="SignatureSection" type="SignatureSection"/>

complexType ActualEarningsSection
diagram AppForADJ_p18.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
children RegularEarnings Tips HoursWorkedPerWeek
used by
element AppForADJ/ActualEarningsSection
source <xs:complexType name="ActualEarningsSection">
 
<xs:sequence>
   
<xs:element name="RegularEarnings" minOccurs="0">
     
<xs:complexType>
       
<xs:sequence>
         
<xs:element name="RateOfPay" type="FF:amount" minOccurs="0"/>
         
<xs:element name="EarningsPayPeriod" type="earningsPayPeriod" minOccurs="0">
           
<xs:annotation>
             
<xs:documentation>M - Monthly, W - Weekly, H - Hourly</xs:documentation>
           
</xs:annotation>
         
</xs:element>
       
</xs:sequence>
     
</xs:complexType>
   
</xs:element>
   
<xs:element name="Tips" minOccurs="0">
     
<xs:complexType>
       
<xs:sequence>
         
<xs:element name="ValueOfTips" type="FF:amount" minOccurs="0"/>
         
<xs:element name="TipsPayPeriod" type="earningsPayPeriod" minOccurs="0">
           
<xs:annotation>
             
<xs:documentation>M - Monthly, W - Weekly, H - Hourly</xs:documentation>
           
</xs:annotation>
         
</xs:element>
       
</xs:sequence>
     
</xs:complexType>
   
</xs:element>
   
<xs:element name="HoursWorkedPerWeek" type="FF:amount" minOccurs="0"/>
 
</xs:sequence>
</xs:complexType>

element ActualEarningsSection/RegularEarnings
diagram AppForADJ_p19.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children RateOfPay EarningsPayPeriod
source <xs:element name="RegularEarnings" minOccurs="0">
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="RateOfPay" type="FF:amount" minOccurs="0"/>
     
<xs:element name="EarningsPayPeriod" type="earningsPayPeriod" minOccurs="0">
       
<xs:annotation>
         
<xs:documentation>M - Monthly, W - Weekly, H - Hourly</xs:documentation>
       
</xs:annotation>
     
</xs:element>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element ActualEarningsSection/RegularEarnings/RateOfPay
diagram AppForADJ_p20.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type amount
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minInclusive 0.00 
maxInclusive 9999999999999.99 
source <xs:element name="RateOfPay" type="FF:amount" minOccurs="0"/>

element ActualEarningsSection/RegularEarnings/EarningsPayPeriod
diagram AppForADJ_p21.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type earningsPayPeriod
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
enumeration 
annotation
documentation
M - Monthly, W - Weekly, H - Hourly
source <xs:element name="EarningsPayPeriod" type="earningsPayPeriod" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>M - Monthly, W - Weekly, H - Hourly</xs:documentation>
 
</xs:annotation>
</xs:element>

element ActualEarningsSection/Tips
diagram AppForADJ_p22.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children ValueOfTips TipsPayPeriod
source <xs:element name="Tips" minOccurs="0">
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="ValueOfTips" type="FF:amount" minOccurs="0"/>
     
<xs:element name="TipsPayPeriod" type="earningsPayPeriod" minOccurs="0">
       
<xs:annotation>
         
<xs:documentation>M - Monthly, W - Weekly, H - Hourly</xs:documentation>
       
</xs:annotation>
     
</xs:element>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element ActualEarningsSection/Tips/ValueOfTips
diagram AppForADJ_p23.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type amount
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minInclusive 0.00 
maxInclusive 9999999999999.99 
source <xs:element name="ValueOfTips" type="FF:amount" minOccurs="0"/>

element ActualEarningsSection/Tips/TipsPayPeriod
diagram AppForADJ_p24.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type earningsPayPeriod
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
enumeration 
annotation
documentation
M - Monthly, W - Weekly, H - Hourly
source <xs:element name="TipsPayPeriod" type="earningsPayPeriod" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>M - Monthly, W - Weekly, H - Hourly</xs:documentation>
 
</xs:annotation>
</xs:element>

element ActualEarningsSection/HoursWorkedPerWeek
diagram AppForADJ_p25.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type amount
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minInclusive 0.00 
maxInclusive 9999999999999.99 
source <xs:element name="HoursWorkedPerWeek" type="FF:amount" minOccurs="0"/>

complexType ApplicantAttorneyOrRepSection
diagram AppForADJ_p26.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
children ApplicantNotRepresented AttorneyOrRep
source <xs:complexType name="ApplicantAttorneyOrRepSection">
 
<xs:sequence>
   
<xs:element name="ApplicantNotRepresented" type="CD:CheckBox"/>
   
<xs:element name="AttorneyOrRep" minOccurs="0">
     
<xs:complexType>
       
<xs:sequence>
         
<xs:element name="AttorneyorAuthRepTypeCode" type="FF:attorneyorAuthRepTypeCode"/>
         
<xs:element name="EmployerName" type="FF:employerName" minOccurs="0"/>
         
<xs:element name="Name" type="CD:PersonName" minOccurs="0"/>
         
<xs:element name="Address" type="CD:Address"/>
         
<xs:element name="LawfirmNumber" type="FF:lawFirmNumber" minOccurs="0"/>
       
</xs:sequence>
     
</xs:complexType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element ApplicantAttorneyOrRepSection/ApplicantNotRepresented
diagram AppForADJ_p27.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type CheckBox
properties
isRef 0
content complex
children Checkbox
source <xs:element name="ApplicantNotRepresented" type="CD:CheckBox"/>

element ApplicantAttorneyOrRepSection/AttorneyOrRep
diagram AppForADJ_p28.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children AttorneyorAuthRepTypeCode EmployerName Name Address LawfirmNumber
source <xs:element name="AttorneyOrRep" minOccurs="0">
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="AttorneyorAuthRepTypeCode" type="FF:attorneyorAuthRepTypeCode"/>
     
<xs:element name="EmployerName" type="FF:employerName" minOccurs="0"/>
     
<xs:element name="Name" type="CD:PersonName" minOccurs="0"/>
     
<xs:element name="Address" type="CD:Address"/>
     
<xs:element name="LawfirmNumber" type="FF:lawFirmNumber" minOccurs="0"/>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element ApplicantAttorneyOrRepSection/AttorneyOrRep/AttorneyorAuthRepTypeCode
diagram AppForADJ_p29.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type attorneyorAuthRepTypeCode
properties
isRef 0
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
source <xs:element name="AttorneyorAuthRepTypeCode" type="FF:attorneyorAuthRepTypeCode"/>

element ApplicantAttorneyOrRepSection/AttorneyOrRep/EmployerName
diagram AppForADJ_p30.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type employerName
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 56 
pattern ([A-Z0-9 ])* 
source <xs:element name="EmployerName" type="FF:employerName" minOccurs="0"/>

element ApplicantAttorneyOrRepSection/AttorneyOrRep/Name
diagram AppForADJ_p31.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type PersonName
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children FirstName MiddleInitial LastName
source <xs:element name="Name" type="CD:PersonName" minOccurs="0"/>

element ApplicantAttorneyOrRepSection/AttorneyOrRep/Address
diagram AppForADJ_p32.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type Address
properties
isRef 0
content complex
children AddressLine1 City State Zip5Code
source <xs:element name="Address" type="CD:Address"/>

element ApplicantAttorneyOrRepSection/AttorneyOrRep/LawfirmNumber
diagram AppForADJ_p33.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type lawFirmNumber
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 10 
whiteSpace collapse 
source <xs:element name="LawfirmNumber" type="FF:lawFirmNumber" minOccurs="0"/>

complexType ApplicationSection
diagram AppForADJ_p34.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
children SocialSecurityNumber AmendedApplication Venue DateOfBirth Occupation InjuryInformation InjuryOccuredAsFollows
used by
element AppForADJ/ApplicationSection
annotation
documentation
Coversheet information
source <xs:complexType name="ApplicationSection">
 
<xs:annotation>
   
<xs:documentation>Coversheet information</xs:documentation>
 
</xs:annotation>
 
<xs:sequence>
   
<xs:element name="SocialSecurityNumber" type="FF:socialSecurityNumber" minOccurs="0"/>
   
<xs:element name="AmendedApplication" type="CF:checkBox" fixed="false"/>
   
<xs:element name="Venue" type="CD:VenueInformation"/>
   
<xs:element name="DateOfBirth" type="CF:ptsDate">
     
<xs:annotation>
       
<xs:documentation>DOB of injured worker</xs:documentation>
     
</xs:annotation>
   
</xs:element>
   
<xs:element name="Occupation" type="FF:occupationText" minOccurs="0">
     
<xs:annotation>
       
<xs:documentation>Injured worker's occupation at time of injury</xs:documentation>
     
</xs:annotation>
   
</xs:element>
   
<xs:element name="InjuryInformation">
     
<xs:complexType>
       
<xs:complexContent>
         
<xs:extension base="CD:InjuryInformation">
           
<xs:sequence>
             
<xs:element name="Address" type="CD:Address"/>
           
</xs:sequence>
         
</xs:extension>
       
</xs:complexContent>
     
</xs:complexType>
   
</xs:element>
   
<xs:element name="InjuryOccuredAsFollows" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="xs:string">
         
<xs:minLength value="0"/>
         
<xs:maxLength value="325"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element ApplicationSection/SocialSecurityNumber
diagram AppForADJ_p35.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type socialSecurityNumber
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
pattern ([0-9])* 
source <xs:element name="SocialSecurityNumber" type="FF:socialSecurityNumber" minOccurs="0"/>

element ApplicationSection/AmendedApplication
diagram AppForADJ_p36.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type checkBox
properties
isRef 0
content simple
fixed false
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="AmendedApplication" type="CF:checkBox" fixed="false"/>

element ApplicationSection/Venue
diagram AppForADJ_p37.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type VenueInformation
properties
isRef 0
content complex
children VenueLocationCode VenueOfficeCode
source <xs:element name="Venue" type="CD:VenueInformation"/>

element ApplicationSection/DateOfBirth
diagram AppForADJ_p38.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type ptsDate
properties
isRef 0
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
annotation
documentation
DOB of injured worker
source <xs:element name="DateOfBirth" type="CF:ptsDate">
 
<xs:annotation>
   
<xs:documentation>DOB of injured worker</xs:documentation>
 
</xs:annotation>
</xs:element>

element ApplicationSection/Occupation
diagram AppForADJ_p39.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type occupationText
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 56 
whiteSpace preserve 
annotation
documentation
Injured worker's occupation at time of injury
source <xs:element name="Occupation" type="FF:occupationText" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Injured worker's occupation at time of injury</xs:documentation>
 
</xs:annotation>
</xs:element>

element ApplicationSection/InjuryInformation
diagram AppForADJ_p40.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type extension of InjuryInformation
properties
isRef 0
content complex
children InjuryType DateOfInjuryStart DateOfInjuryEnd BodyPartInformation Address
source <xs:element name="InjuryInformation">
 
<xs:complexType>
   
<xs:complexContent>
     
<xs:extension base="CD:InjuryInformation">
       
<xs:sequence>
         
<xs:element name="Address" type="CD:Address"/>
       
</xs:sequence>
     
</xs:extension>
   
</xs:complexContent>
 
</xs:complexType>
</xs:element>

element ApplicationSection/InjuryInformation/Address
diagram AppForADJ_p41.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type Address
properties
isRef 0
content complex
children AddressLine1 City State Zip5Code
source <xs:element name="Address" type="CD:Address"/>

element ApplicationSection/InjuryOccuredAsFollows
diagram AppForADJ_p42.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 325 
source <xs:element name="InjuryOccuredAsFollows" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:minLength value="0"/>
     
<xs:maxLength value="325"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

complexType Compensation
diagram AppForADJ_p43.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
children WasCompensationPaid TotalPaid WeeklyRate DateOfLastPayment WasUnemploymentReceived
used by
element AppForADJ/CompensationSection
source <xs:complexType name="Compensation">
 
<xs:sequence>
   
<xs:element name="WasCompensationPaid" type="CD:CheckBox"/>
   
<xs:element name="TotalPaid" type="FF:amount" minOccurs="0"/>
   
<xs:element name="WeeklyRate" type="FF:amount" minOccurs="0"/>
   
<xs:element name="DateOfLastPayment" type="CF:ptsDate" minOccurs="0"/>
   
<xs:element name="WasUnemploymentReceived" type="CF:checkBox" minOccurs="0"/>
 
</xs:sequence>
</xs:complexType>

element Compensation/WasCompensationPaid
diagram AppForADJ_p44.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type CheckBox
properties
isRef 0
content complex
children Checkbox
source <xs:element name="WasCompensationPaid" type="CD:CheckBox"/>

element Compensation/TotalPaid
diagram AppForADJ_p45.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type amount
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minInclusive 0.00 
maxInclusive 9999999999999.99 
source <xs:element name="TotalPaid" type="FF:amount" minOccurs="0"/>

element Compensation/WeeklyRate
diagram AppForADJ_p46.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type amount
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minInclusive 0.00 
maxInclusive 9999999999999.99 
source <xs:element name="WeeklyRate" type="FF:amount" minOccurs="0"/>

element Compensation/DateOfLastPayment
diagram AppForADJ_p47.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type ptsDate
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="DateOfLastPayment" type="CF:ptsDate" minOccurs="0"/>

element Compensation/WasUnemploymentReceived
diagram AppForADJ_p48.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type checkBox
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="WasUnemploymentReceived" type="CF:checkBox" minOccurs="0"/>

complexType DisagreementRegardingLiabilitySection
diagram AppForADJ_p49.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
children TemporaryDisabilityIndemnity ReimbursementForMedicalExpense MedicalTreatment CompensationAtProperRate PermanentDisabilityIndemnity Rehabilitation SupplementalJobDisplacement OtherText
used by
element AppForADJ/DisagreementRegardingLiabilitySection
source <xs:complexType name="DisagreementRegardingLiabilitySection">
 
<xs:sequence>
   
<xs:element name="TemporaryDisabilityIndemnity" type="CD:CheckBox"/>
   
<xs:element name="ReimbursementForMedicalExpense" type="CD:CheckBox"/>
   
<xs:element name="MedicalTreatment" type="CD:CheckBox"/>
   
<xs:element name="CompensationAtProperRate" type="CD:CheckBox"/>
   
<xs:element name="PermanentDisabilityIndemnity" type="CD:CheckBox"/>
   
<xs:element name="Rehabilitation" type="CD:CheckBox"/>
   
<xs:element name="SupplementalJobDisplacement" type="CD:CheckBox"/>
   
<xs:element name="OtherText" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="xs:string">
         
<xs:maxLength value="20"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element DisagreementRegardingLiabilitySection/TemporaryDisabilityIndemnity
diagram AppForADJ_p50.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type CheckBox
properties
isRef 0
content complex
children Checkbox
source <xs:element name="TemporaryDisabilityIndemnity" type="CD:CheckBox"/>

element DisagreementRegardingLiabilitySection/ReimbursementForMedicalExpense
diagram AppForADJ_p51.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type CheckBox
properties
isRef 0
content complex
children Checkbox
source <xs:element name="ReimbursementForMedicalExpense" type="CD:CheckBox"/>

element DisagreementRegardingLiabilitySection/MedicalTreatment
diagram AppForADJ_p52.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type CheckBox
properties
isRef 0
content complex
children Checkbox
source <xs:element name="MedicalTreatment" type="CD:CheckBox"/>

element DisagreementRegardingLiabilitySection/CompensationAtProperRate
diagram AppForADJ_p53.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type CheckBox
properties
isRef 0
content complex
children Checkbox
source <xs:element name="CompensationAtProperRate" type="CD:CheckBox"/>

element DisagreementRegardingLiabilitySection/PermanentDisabilityIndemnity
diagram AppForADJ_p54.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type CheckBox
properties
isRef 0
content complex
children Checkbox
source <xs:element name="PermanentDisabilityIndemnity" type="CD:CheckBox"/>

element DisagreementRegardingLiabilitySection/Rehabilitation
diagram AppForADJ_p55.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type CheckBox
properties
isRef 0
content complex
children Checkbox
source <xs:element name="Rehabilitation" type="CD:CheckBox"/>

element DisagreementRegardingLiabilitySection/SupplementalJobDisplacement
diagram AppForADJ_p56.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type CheckBox
properties
isRef 0
content complex
children Checkbox
source <xs:element name="SupplementalJobDisplacement" type="CD:CheckBox"/>

element DisagreementRegardingLiabilitySection/OtherText
diagram AppForADJ_p57.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 20 
source <xs:element name="OtherText" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="20"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

complexType Employer
diagram AppForADJ_p58.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
children EmployerNameAndAddress
source <xs:complexType name="Employer">
 
<xs:sequence>
   
<xs:element name="EmployerNameAndAddress" type="CD:OrganizationInformation"/>
 
</xs:sequence>
</xs:complexType>

element Employer/EmployerNameAndAddress
diagram AppForADJ_p59.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type OrganizationInformation
properties
isRef 0
content complex
children EmployerName Address
source <xs:element name="EmployerNameAndAddress" type="CD:OrganizationInformation"/>

complexType EmployerInformation
diagram AppForADJ_p60.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
children EmployerRoleTypeCode EmployerName Address
used by
element AppForADJ/EmployerSection
source <xs:complexType name="EmployerInformation">
 
<xs:sequence>
   
<xs:element name="EmployerRoleTypeCode" type="FF:employerRoleTypeCode">
     
<xs:annotation>
       
<xs:documentation>I - Insured, S - Self-Insured, L -Legally Uninsured, U - Uninsured</xs:documentation>
     
</xs:annotation>
   
</xs:element>
   
<xs:element name="EmployerName">
     
<xs:simpleType>
       
<xs:restriction base="FF:fullName">
         
<xs:maxLength value="56"/>
         
<xs:minLength value="2"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="Address" type="CD:Address"/>
 
</xs:sequence>
</xs:complexType>

element EmployerInformation/EmployerRoleTypeCode
diagram AppForADJ_p61.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type employerRoleTypeCode
properties
isRef 0
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
enumeration 
enumeration 
annotation
documentation
I - Insured, S - Self-Insured, L -Legally Uninsured, U - Uninsured
source <xs:element name="EmployerRoleTypeCode" type="FF:employerRoleTypeCode">
 
<xs:annotation>
   
<xs:documentation>I - Insured, S - Self-Insured, L -Legally Uninsured, U - Uninsured</xs:documentation>
 
</xs:annotation>
</xs:element>

element EmployerInformation/EmployerName
diagram AppForADJ_p62.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type restriction of fullName
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 56 
pattern ([A-Z 0-9])* 
source <xs:element name="EmployerName">
 
<xs:simpleType>
   
<xs:restriction base="FF:fullName">
     
<xs:maxLength value="56"/>
     
<xs:minLength value="2"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element EmployerInformation/Address
diagram AppForADJ_p63.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type Address
properties
isRef 0
content complex
children AddressLine1 City State Zip5Code
source <xs:element name="Address" type="CD:Address"/>

complexType HeaderSection
diagram AppForADJ_p64.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
children VersionNumber
used by
element AppForADJ/HeaderSection
source <xs:complexType name="HeaderSection">
 
<xs:sequence>
   
<xs:element name="VersionNumber" type="CF:versionNumber" fixed="1.4"/>
 
</xs:sequence>
</xs:complexType>

element HeaderSection/VersionNumber
diagram AppForADJ_p65.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type versionNumber
properties
isRef 0
content simple
fixed 1.4
source <xs:element name="VersionNumber" type="CF:versionNumber" fixed="1.4"/>

complexType InjuredWorkerInformation
diagram AppForADJ_p66.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
children Name Address
used by
element AppForADJ/InjuredWorkerSection
source <xs:complexType name="InjuredWorkerInformation">
 
<xs:sequence>
   
<xs:element name="Name" type="CD:PersonName"/>
   
<xs:element name="Address">
     
<xs:annotation>
       
<xs:documentation>Address of the injured worker</xs:documentation>
     
</xs:annotation>
     
<xs:complexType>
       
<xs:sequence>
         
<xs:group ref="CD:AddressGroup"/>
         
<xs:choice>
           
<xs:element name="AddressLine2" type="FF:addressLine" minOccurs="0"/>
           
<xs:element name="International" type="FF:addressLine" minOccurs="0"/>
         
</xs:choice>
       
</xs:sequence>
     
</xs:complexType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element InjuredWorkerInformation/Name
diagram AppForADJ_p67.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type PersonName
properties
isRef 0
content complex
children FirstName MiddleInitial LastName
source <xs:element name="Name" type="CD:PersonName"/>

element InjuredWorkerInformation/Address
diagram AppForADJ_p68.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
properties
isRef 0
content complex
children AddressLine1 City State Zip5Code AddressLine2 International
annotation
documentation
Address of the injured worker
source <xs:element name="Address">
 
<xs:annotation>
   
<xs:documentation>Address of the injured worker</xs:documentation>
 
</xs:annotation>
 
<xs:complexType>
   
<xs:sequence>
     
<xs:group ref="CD:AddressGroup"/>
     
<xs:choice>
       
<xs:element name="AddressLine2" type="FF:addressLine" minOccurs="0"/>
       
<xs:element name="International" type="FF:addressLine" minOccurs="0"/>
     
</xs:choice>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element InjuredWorkerInformation/Address/AddressLine2
diagram AppForADJ_p69.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type addressLine
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 40 
whiteSpace preserve 
pattern ([A-Z0-9 ])* 
source <xs:element name="AddressLine2" type="FF:addressLine" minOccurs="0"/>

element InjuredWorkerInformation/Address/International
diagram AppForADJ_p70.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type addressLine
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 40 
whiteSpace preserve 
pattern ([A-Z0-9 ])* 
source <xs:element name="International" type="FF:addressLine" minOccurs="0"/>

complexType InjuryCausedDisability
diagram AppForADJ_p71.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
children LastDayOffWorkDueToInjury FirstPeriodOfDisability SecondPeriodOfDisability
used by
element AppForADJ/InjuryCausedDisabilitySection
source <xs:complexType name="InjuryCausedDisability">
 
<xs:sequence>
   
<xs:element name="LastDayOffWorkDueToInjury" type="CF:ptsDate" minOccurs="0"/>
   
<xs:element name="FirstPeriodOfDisability" type="CD:StartAndEndDate" minOccurs="0"/>
   
<xs:element name="SecondPeriodOfDisability" type="CD:StartAndEndDate" minOccurs="0"/>
 
</xs:sequence>
</xs:complexType>

element InjuryCausedDisability/LastDayOffWorkDueToInjury
diagram AppForADJ_p72.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type ptsDate
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="LastDayOffWorkDueToInjury" type="CF:ptsDate" minOccurs="0"/>

element InjuryCausedDisability/FirstPeriodOfDisability
diagram AppForADJ_p73.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type StartAndEndDate
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children DateStarts DateEnds
source <xs:element name="FirstPeriodOfDisability" type="CD:StartAndEndDate" minOccurs="0"/>

element InjuryCausedDisability/SecondPeriodOfDisability
diagram AppForADJ_p74.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type StartAndEndDate
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children DateStarts DateEnds
source <xs:element name="SecondPeriodOfDisability" type="CD:StartAndEndDate" minOccurs="0"/>

complexType MedicalTreatmentSection
diagram AppForADJ_p75.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
children MedicalTreatmentWasReceived AllTreatmentWasFurnishedByInsuranceCarrierOrEmployer DateOfLastTreatment OtherTreamentWasProvidedBy DidMedi-CalPay NameOfDoctorHospitalClinic
used by
element AppForADJ/MedicalTreatmentSection
source <xs:complexType name="MedicalTreatmentSection">
 
<xs:sequence>
   
<xs:element name="MedicalTreatmentWasReceived" type="CF:checkBox" minOccurs="0"/>
   
<xs:element name="AllTreatmentWasFurnishedByInsuranceCarrierOrEmployer" type="CF:checkBox" minOccurs="0"/>
   
<xs:element name="DateOfLastTreatment" type="CF:ptsDate" minOccurs="0"/>
   
<xs:element name="OtherTreamentWasProvidedBy" type="FF:sftField" minOccurs="0"/>
   
<xs:element name="DidMedi-CalPay" type="CF:checkBox" minOccurs="0"/>
   
<xs:element name="NameOfDoctorHospitalClinic" type="FF:sftField" minOccurs="0" maxOccurs="2"/>
 
</xs:sequence>
</xs:complexType>

element MedicalTreatmentSection/MedicalTreatmentWasReceived
diagram AppForADJ_p76.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type checkBox
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="MedicalTreatmentWasReceived" type="CF:checkBox" minOccurs="0"/>

element MedicalTreatmentSection/AllTreatmentWasFurnishedByInsuranceCarrierOrEmployer
diagram AppForADJ_p77.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type checkBox
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="AllTreatmentWasFurnishedByInsuranceCarrierOrEmployer" type="CF:checkBox" minOccurs="0"/>

element MedicalTreatmentSection/DateOfLastTreatment
diagram AppForADJ_p78.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type ptsDate
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="DateOfLastTreatment" type="CF:ptsDate" minOccurs="0"/>

element MedicalTreatmentSection/OtherTreamentWasProvidedBy
diagram AppForADJ_p79.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type sftField
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
pattern ([A-Z0-9 ])* 
source <xs:element name="OtherTreamentWasProvidedBy" type="FF:sftField" minOccurs="0"/>

element MedicalTreatmentSection/DidMedi-CalPay
diagram AppForADJ_p80.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type checkBox
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="DidMedi-CalPay" type="CF:checkBox" minOccurs="0"/>

element MedicalTreatmentSection/NameOfDoctorHospitalClinic
diagram AppForADJ_p81.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type sftField
properties
isRef 0
minOcc 0
maxOcc 2
content simple
facets
Kind Value annotation 
pattern ([A-Z0-9 ])* 
source <xs:element name="NameOfDoctorHospitalClinic" type="FF:sftField" minOccurs="0" maxOccurs="2"/>

complexType NonInjuredWorkerApplicantInformation
diagram AppForADJ_p82.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
children NonInjuredWorkerApplicantTypeCode EmployerName Address
used by
element AppForADJ/NonInjuredWorkerApplicantSection
source <xs:complexType name="NonInjuredWorkerApplicantInformation">
 
<xs:sequence>
   
<xs:element name="NonInjuredWorkerApplicantTypeCode" type="organizationTypeCode">
     
<xs:annotation>
       
<xs:documentation>I - Insurance Carrier, E - Employer, L -Lien Claimant</xs:documentation>
     
</xs:annotation>
   
</xs:element>
   
<xs:element name="EmployerName">
     
<xs:simpleType>
       
<xs:restriction base="FF:fullName">
         
<xs:maxLength value="56"/>
         
<xs:minLength value="2"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="Address">
     
<xs:complexType>
       
<xs:sequence>
         
<xs:group ref="CD:AddressGroup"/>
         
<xs:element name="AddressLine2" type="FF:addressLine" minOccurs="0"/>
       
</xs:sequence>
     
</xs:complexType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element NonInjuredWorkerApplicantInformation/NonInjuredWorkerApplicantTypeCode
diagram AppForADJ_p83.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type organizationTypeCode
properties
isRef 0
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
enumeration 
annotation
documentation
I - Insurance Carrier, E - Employer, L -Lien Claimant
source <xs:element name="NonInjuredWorkerApplicantTypeCode" type="organizationTypeCode">
 
<xs:annotation>
   
<xs:documentation>I - Insurance Carrier, E - Employer, L -Lien Claimant</xs:documentation>
 
</xs:annotation>
</xs:element>

element NonInjuredWorkerApplicantInformation/EmployerName
diagram AppForADJ_p84.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type restriction of fullName
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 56 
pattern ([A-Z 0-9])* 
source <xs:element name="EmployerName">
 
<xs:simpleType>
   
<xs:restriction base="FF:fullName">
     
<xs:maxLength value="56"/>
     
<xs:minLength value="2"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element NonInjuredWorkerApplicantInformation/Address
diagram AppForADJ_p85.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
properties
isRef 0
content complex
children AddressLine1 City State Zip5Code AddressLine2
source <xs:element name="Address">
 
<xs:complexType>
   
<xs:sequence>
     
<xs:group ref="CD:AddressGroup"/>
     
<xs:element name="AddressLine2" type="FF:addressLine" minOccurs="0"/>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element NonInjuredWorkerApplicantInformation/Address/AddressLine2
diagram AppForADJ_p86.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type addressLine
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 40 
whiteSpace preserve 
pattern ([A-Z0-9 ])* 
source <xs:element name="AddressLine2" type="FF:addressLine" minOccurs="0"/>

complexType SignatureSection
diagram AppForADJ_p87.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
children AttorneyRepSignature ApplicantSignature SignedAtCity DateOfSignature
used by
element AppForADJ/SignatureSection
source <xs:complexType name="SignatureSection">
 
<xs:sequence>
   
<xs:element name="AttorneyRepSignature" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="FF:signature">
         
<xs:minLength value="1"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="ApplicantSignature" minOccurs="0">
     
<xs:annotation>
       
<xs:documentation>Limited to 40 characters</xs:documentation>
     
</xs:annotation>
     
<xs:simpleType>
       
<xs:restriction base="FF:signature">
         
<xs:minLength value="1"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="SignedAtCity" type="FF:city" minOccurs="0"/>
   
<xs:element name="DateOfSignature">
     
<xs:simpleType>
       
<xs:restriction base="CF:ptsDate"/>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element SignatureSection/AttorneyRepSignature
diagram AppForADJ_p88.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type restriction of signature
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 82 
whiteSpace preserve 
source <xs:element name="AttorneyRepSignature" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="FF:signature">
     
<xs:minLength value="1"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element SignatureSection/ApplicantSignature
diagram AppForADJ_p89.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type restriction of signature
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 82 
whiteSpace preserve 
annotation
documentation
Limited to 40 characters
source <xs:element name="ApplicantSignature" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Limited to 40 characters</xs:documentation>
 
</xs:annotation>
 
<xs:simpleType>
   
<xs:restriction base="FF:signature">
     
<xs:minLength value="1"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element SignatureSection/SignedAtCity
diagram AppForADJ_p90.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type city
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 25 
whiteSpace preserve 
pattern ([A-Z' ])* 
source <xs:element name="SignedAtCity" type="FF:city" minOccurs="0"/>

element SignatureSection/DateOfSignature
diagram AppForADJ_p91.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type restriction of ptsDate
properties
isRef 0
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="DateOfSignature">
 
<xs:simpleType>
   
<xs:restriction base="CF:ptsDate"/>
 
</xs:simpleType>
</xs:element>

simpleType earningsPayPeriod
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type restriction of typeCode1
properties
base CF:typeCode1
used by
elements ActualEarningsSection/RegularEarnings/EarningsPayPeriod ActualEarningsSection/Tips/TipsPayPeriod
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
enumeration 
annotation
documentation
Earnings Type
Valid Values
'M' - Monthly
'W' - Weekly
'H' - Hourly
source <xs:simpleType name="earningsPayPeriod">
 
<xs:annotation>
   
<xs:documentation> Earnings Type
Valid Values
'M' - Monthly
'W' - Weekly
'H' - Hourly
</xs:documentation>
 
</xs:annotation>
 
<xs:restriction base="CF:typeCode1">
   
<xs:enumeration value="M"/>
   
<xs:enumeration value="W"/>
   
<xs:enumeration value="H"/>
 
</xs:restriction>
</xs:simpleType>

simpleType organizationTypeCode
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/AppForADJ
type restriction of typeCode1
properties
base CF:typeCode1
used by
element NonInjuredWorkerApplicantInformation/NonInjuredWorkerApplicantTypeCode
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
enumeration 
annotation
documentation
Organization Type
Valid Values
'I' - Insurance Carrier
'E' - Employer
'L' - Lien Claimant
source <xs:simpleType name="organizationTypeCode">
 
<xs:annotation>
   
<xs:documentation> Organization Type
Valid Values
'I' - Insurance Carrier
'E' - Employer
'L' - Lien Claimant
</xs:documentation>
 
</xs:annotation>
 
<xs:restriction base="CF:typeCode1">
   
<xs:enumeration value="I"/>
   
<xs:enumeration value="E"/>
   
<xs:enumeration value="L"/>
 
</xs:restriction>
</xs:simpleType>

simpleType addressLine
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
elements AddressGroup/AddressLine1 InjuredWorkerInformation/Address/AddressLine2 NonInjuredWorkerApplicantInformation/Address/AddressLine2 InjuredWorkerInformation/Address/International
facets
Kind Value annotation 
minLength 
maxLength 40 
whiteSpace preserve 
pattern ([A-Z0-9 ])* 
source <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>

simpleType amount
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:double
properties
base xs:double
used by
elements EarningAmountGroup/EarningsAmount ActualEarningsSection/HoursWorkedPerWeek ActualEarningsSection/RegularEarnings/RateOfPay Compensation/TotalPaid ActualEarningsSection/Tips/ValueOfTips Compensation/WeeklyRate
facets
Kind Value annotation 
minInclusive 0.00 
maxInclusive 9999999999999.99 
source <xs:simpleType name="amount">
 
<xs:restriction base="xs:double">
   
<xs:maxInclusive value="9999999999999.99"/>
   
<xs:minInclusive value="0.00"/>
 
</xs:restriction>
</xs:simpleType>

simpleType attorneyorAuthRepTypeCode
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of typeCode1
properties
base CF:typeCode1
used by
elements ApplicantAttorneyOrRepSection/AttorneyOrRep/AttorneyorAuthRepTypeCode AttorneyorRep/AttorneyorAuthRepTypeCode AttorneyorRepWithoutNumber/AttorneyorAuthRepTypeCode
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
annotation
documentation
Attorney or Authorized Representative
Valid Values
'A' - Attorney
'R' - AuthorizedRepresentative
source <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>

simpleType bodyPart
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of typeCode3
properties
base CF:typeCode3
used by
element InjuryInformationGroup/BodyPartInformation/BodyPart
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 100 
enumeration 110 
enumeration 120 
enumeration 121 
enumeration 124 
enumeration 130 
enumeration 140 
enumeration 141 
enumeration 144 
enumeration 145 
enumeration 146 
enumeration 148 
enumeration 149 
enumeration 150 
enumeration 160 
enumeration 198 
enumeration 200 
enumeration 300 
enumeration 310 
enumeration 311 
enumeration 313 
enumeration 315 
enumeration 318 
enumeration 319 
enumeration 320 
enumeration 330 
enumeration 340 
enumeration 398 
enumeration 400 
enumeration 410 
enumeration 411 
enumeration 420 
enumeration 430 
enumeration 440 
enumeration 450 
enumeration 498 
enumeration 500 
enumeration 510 
enumeration 511 
enumeration 513 
enumeration 515 
enumeration 518 
enumeration 519 
enumeration 520 
enumeration 530 
enumeration 540 
enumeration 598 
enumeration 700 
enumeration 800 
enumeration 801 
enumeration 802 
enumeration 810 
enumeration 820 
enumeration 830 
enumeration 840 
enumeration 841 
enumeration 842 
enumeration 850 
enumeration 860 
enumeration 870 
enumeration 880 
enumeration 999 
annotation
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
source <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>

simpleType city
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
elements AddressGroup/City SignatureSection/SignedAtCity
facets
Kind Value annotation 
minLength 
maxLength 25 
whiteSpace preserve 
pattern ([A-Z' ])* 
source <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>

simpleType claimNumber
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
facets
Kind Value annotation 
minLength 
maxLength 20 
pattern ([A-Z0-9 ])* 
source <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>

simpleType employerName
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of fullName
properties
base fullName
used by
elements ApplicantAttorneyOrRepSection/AttorneyOrRep/EmployerName AttorneyorRep/EmployerName AttorneyorRepWithoutNumber/EmployerName
facets
Kind Value annotation 
minLength 
maxLength 56 
pattern ([A-Z0-9 ])* 
source <xs:simpleType name="employerName">
 
<xs:restriction base="fullName">
   
<xs:pattern value="([A-Z0-9 ])*"/>
 
</xs:restriction>
</xs:simpleType>

simpleType employerRoleTypeCode
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of typeCode1
properties
base CF:typeCode1
used by
elements EmployerInformation/EmployerRoleTypeCode EmployerRoleTypeGroup/EmployerRoleTypeCode
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
enumeration 
enumeration 
annotation
documentation
Employer Role Type
Valid Values
'I' - Insured
'S' - Self Insured
'L' - Legally Uninsured
'U' - Uninsured
source <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>

simpleType fileOnBehalfTypeCode
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of typeCode1
properties
base CF:typeCode1
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
enumeration 
annotation
documentation
File On Behalf Type
Valid Values
'E' - Employer
'I' - Insurance Carrier
'B' - Both

source <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>

simpleType filerRoleTypeCode
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of typeCode1
properties
base CF:typeCode1
used by
element RoleTypeGroup/RoleTypeCode
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
enumeration 
enumeration 
annotation
documentation
Filer Role Type
Valid Values
'E' - Employee
'A' - Applicant
'D' - Defendant
'L' - LienClaimnt
source <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>

simpleType firstName
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
element PersonNameGroup/FirstName
facets
Kind Value annotation 
minLength 
maxLength 25 
whiteSpace preserve 
pattern ([A-Z ])* 
source <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>

simpleType fullAddress
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
element DeclarantSignatureGroup/DeclarantOrLawFirmAddress
facets
Kind Value annotation 
minLength 
maxLength 56 
whiteSpace preserve 
pattern ([A-Z0-9 ])* 
source <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>

simpleType fullLongName
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
facets
Kind Value annotation 
minLength 
maxLength 80 
pattern ([A-Z ])* 
source <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>

simpleType fullName
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
elements DeclarantSignatureGroup/DeclarantOrLawFirmName EmployerInformation/EmployerName NonInjuredWorkerApplicantInformation/EmployerName
simpleType employerName
facets
Kind Value annotation 
minLength 
maxLength 56 
pattern ([A-Z 0-9])* 
source <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>

simpleType hearingTypeCode
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of typeCode1
properties
base CF:typeCode1
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
enumeration 
enumeration 
enumeration 
annotation
documentation
Hearing Type
Valid Values
'M' - Mandatory Settlement Conference
'S' - Status Conference
'R' - Rating MSC
'P' - Priority Conference
'L' -  Lien Conference
source <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>

simpleType initialCheckBox
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type checkBox
properties
base CF:checkBox
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:simpleType name="initialCheckBox">
 
<xs:restriction base="CF:checkBox"/>
</xs:simpleType>

simpleType injuryTypeCode
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of typeCode1
properties
base CF:typeCode1
used by
element InjuryTypeAndDates/InjuryType
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
annotation
documentation
Injury Type
Valid Values
'I' - Specific Injury Date
'C' - Cumulative Injury
source <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>

simpleType laborAdjustmentTypeCode
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of typeCode1
properties
base CF:typeCode1
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
annotation
documentation
Labor Adjustment Code
Valid Values
'I' - Increase rate
'D' - Decrease rate
source <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>

simpleType lastName
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
element PersonNameGroup/LastName
facets
Kind Value annotation 
minLength 
maxLength 25 
whiteSpace preserve 
pattern ([A-Z ])* 
source <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>

simpleType lawFirmNumber
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
elements ApplicantAttorneyOrRepSection/AttorneyOrRep/LawfirmNumber AttorneyorRep/LawFirmNumber
facets
Kind Value annotation 
minLength 
maxLength 10 
whiteSpace collapse 
source <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>

simpleType lienUnemploymentCompensationType
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of typeCode3
properties
base CF:typeCode3
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration PFL 
enumeration SDI 
annotation
documentation
Lien Unemployment Compensation Type 
Valid Values
'PFL' - Paid Family Leave
'SDI' - State Disability Insurance
source <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>

simpleType middleInitial
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
final <empty>
base xs:string
used by
element PersonNameGroup/MiddleInitial
facets
Kind Value annotation 
minLength 
maxLength 
whiteSpace collapse 
pattern [A-Z] 
source <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>

simpleType occupationText
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
element ApplicationSection/Occupation
facets
Kind Value annotation 
minLength 
maxLength 56 
whiteSpace preserve 
annotation
documentation
Occupation of injured worker at time of injury
source <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>

simpleType organizationName
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
facets
Kind Value annotation 
minLength 
maxLength 56 
pattern ([A-Z ])* 
source <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>

simpleType phoneNumber
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
elements DeclarantSignatureGroup/DeclarantOrLawFirmPhoneNumber AttorneyorRepWithoutNumber/PhoneNumber
facets
Kind Value annotation 
maxLength 10 
pattern \d\d\d\d\d\d\d\d\d\d 
annotation
documentation
10 digits (0 - 9)
source <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>

simpleType prefix
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
facets
Kind Value annotation 
enumeration Mr 
enumeration Ms 
enumeration Mrs 
annotation
documentation
Employee Name Prefix
Valid Values
'Mr.' 'Ms.' 'Mrs'
source <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>

simpleType sftField
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
elements EmployerName/EmployerName MedicalTreatmentSection/NameOfDoctorHospitalClinic MedicalTreatmentSection/OtherTreamentWasProvidedBy
facets
Kind Value annotation 
pattern ([A-Z0-9 ])* 
source <xs:simpleType name="sftField">
 
<xs:restriction base="xs:string">
   
<xs:pattern value="([A-Z0-9 ])*"/>
 
</xs:restriction>
</xs:simpleType>

simpleType signature
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
elements SignatureSection/ApplicantSignature SignatureSection/AttorneyRepSignature Signature/DeclarantSignature SignatureAddressGroup/DeclarantSignature DeclarantSignatureGroup/DeclarantSignature
facets
Kind Value annotation 
maxLength 82 
whiteSpace preserve 
source <xs:simpleType name="signature">
 
<xs:restriction base="xs:string">
   
<xs:maxLength value="82"/>
   
<xs:whiteSpace value="preserve"/>
 
</xs:restriction>
</xs:simpleType>

simpleType socialSecurityNumber
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
element ApplicationSection/SocialSecurityNumber
facets
Kind Value annotation 
length 
whiteSpace collapse 
pattern ([0-9])* 
source <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>

simpleType state
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
element AddressGroup/State
facets
Kind Value annotation 
minLength 
maxLength 
whiteSpace preserve 
pattern ([A-Z])* 
source <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>

simpleType venueLocationTypeCode
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of typeCode1
properties
base CF:typeCode1
used by
element VenueInformationGroup/VenueLocationCode
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
enumeration 
annotation
documentation
'R' - Residence Location, 'I' - Injury Location, 'B' - Business Location 
source <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>

simpleType venueOfficeCode
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of typeCode3
properties
base CF:typeCode3
used by
element VenueInformationGroup/VenueOfficeCode
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration STK 
enumeration SFO 
enumeration SAC 
enumeration LBO 
enumeration VNO 
enumeration SAL 
enumeration OAK 
enumeration SDO 
enumeration MDR 
enumeration OXN 
enumeration EUR 
enumeration SRO 
enumeration SBR 
enumeration AHM 
enumeration RIV 
enumeration FRE 
enumeration LAO 
enumeration POM 
enumeration SJO 
enumeration ANA 
enumeration BAK 
enumeration GRO 
enumeration RDG 
enumeration SLO 
annotation
documentation
Venue Office Code
'STK'  - Stockton       
'SFO'  - San Francisco  
'SAC'  - Sacramento     
'GOL'  - Goleta (Closed since Jan. 2014)
'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    
 
source <xs:simpleType name="venueOfficeCode">
 
<xs:annotation>
   
<xs:documentation> Venue Office Code
'STK'  - Stockton       
'SFO'  - San Francisco  
'SAC'  - Sacramento     
'GOL'  - Goleta (Closed since Jan. 2014)
'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="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:enumeration value="GOL"/ -->
 
</xs:restriction>
</xs:simpleType>

simpleType zip4Code
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
facets
Kind Value annotation 
length 
whiteSpace collapse 
pattern \d\d\d\d 
source <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>

simpleType zip5Code
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
element AddressGroup/Zip5Code
facets
Kind Value annotation 
length 
whiteSpace collapse 
pattern \d\d\d\d\d 
source <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>

group AddressGroup
diagram AppForADJ_p92.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children AddressLine1 City State Zip5Code
used by
elements InjuredWorkerInformation/Address NonInjuredWorkerApplicantInformation/Address
complexType Address
source <xs:group name="AddressGroup">
 
<xs:sequence>
   
<xs:element name="AddressLine1" type="FF:addressLine"/>
   
<xs:element name="City" type="FF:city"/>
   
<xs:element name="State">
     
<xs:simpleType>
       
<xs:restriction base="FF:state"/>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="Zip5Code">
     
<xs:simpleType>
       
<xs:restriction base="FF:zip5Code">
         
<xs:whiteSpace value="collapse"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:group>

element AddressGroup/AddressLine1
diagram AppForADJ_p93.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type addressLine
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 40 
whiteSpace preserve 
pattern ([A-Z0-9 ])* 
source <xs:element name="AddressLine1" type="FF:addressLine"/>

element AddressGroup/City
diagram AppForADJ_p94.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type city
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 25 
whiteSpace preserve 
pattern ([A-Z' ])* 
source <xs:element name="City" type="FF:city"/>

element AddressGroup/State
diagram AppForADJ_p95.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type restriction of state
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 
whiteSpace preserve 
pattern ([A-Z])* 
source <xs:element name="State">
 
<xs:simpleType>
   
<xs:restriction base="FF:state"/>
 
</xs:simpleType>
</xs:element>

element AddressGroup/Zip5Code
diagram AppForADJ_p96.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type restriction of zip5Code
properties
isRef 0
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
pattern \d\d\d\d\d 
source <xs:element name="Zip5Code">
 
<xs:simpleType>
   
<xs:restriction base="FF:zip5Code">
     
<xs:whiteSpace value="collapse"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

group DeclarantSignatureGroup
diagram AppForADJ_p97.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children DeclarantSignature DeclarantOrLawFirmName DeclarantOrLawFirmAddress DeclarantOrLawFirmPhoneNumber DateOfSignature
source <xs:group name="DeclarantSignatureGroup">
 
<xs:sequence>
   
<xs:element name="DeclarantSignature">
     
<xs:simpleType>
       
<xs:restriction base="FF:signature">
         
<xs:minLength value="1"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="DeclarantOrLawFirmName">
     
<xs:simpleType>
       
<xs:restriction base="FF:fullName">
         
<xs:minLength value="2"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="DeclarantOrLawFirmAddress">
     
<xs:simpleType>
       
<xs:restriction base="FF:fullAddress">
         
<xs:whiteSpace value="preserve"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="DeclarantOrLawFirmPhoneNumber" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="FF:phoneNumber"/>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="DateOfSignature" type="CF:ptsDate"/>
 
</xs:sequence>
</xs:group>

element DeclarantSignatureGroup/DeclarantSignature
diagram AppForADJ_p98.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type restriction of signature
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 82 
whiteSpace preserve 
source <xs:element name="DeclarantSignature">
 
<xs:simpleType>
   
<xs:restriction base="FF:signature">
     
<xs:minLength value="1"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element DeclarantSignatureGroup/DeclarantOrLawFirmName
diagram AppForADJ_p99.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type restriction of fullName
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 56 
pattern ([A-Z 0-9])* 
source <xs:element name="DeclarantOrLawFirmName">
 
<xs:simpleType>
   
<xs:restriction base="FF:fullName">
     
<xs:minLength value="2"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element DeclarantSignatureGroup/DeclarantOrLawFirmAddress
diagram AppForADJ_p100.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type restriction of fullAddress
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 56 
whiteSpace preserve 
pattern ([A-Z0-9 ])* 
source <xs:element name="DeclarantOrLawFirmAddress">
 
<xs:simpleType>
   
<xs:restriction base="FF:fullAddress">
     
<xs:whiteSpace value="preserve"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element DeclarantSignatureGroup/DeclarantOrLawFirmPhoneNumber
diagram AppForADJ_p101.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type restriction of phoneNumber
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 10 
pattern \d\d\d\d\d\d\d\d\d\d 
source <xs:element name="DeclarantOrLawFirmPhoneNumber" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="FF:phoneNumber"/>
 
</xs:simpleType>
</xs:element>

element DeclarantSignatureGroup/DateOfSignature
diagram AppForADJ_p102.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type ptsDate
properties
isRef 0
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="DateOfSignature" type="CF:ptsDate"/>

group EarningAmountGroup
diagram AppForADJ_p103.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children EarningsAmount
source <xs:group name="EarningAmountGroup">
 
<xs:sequence>
   
<xs:element name="EarningsAmount" type="FF:amount" minOccurs="0"/>
 
</xs:sequence>
</xs:group>

element EarningAmountGroup/EarningsAmount
diagram AppForADJ_p104.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type amount
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minInclusive 0.00 
maxInclusive 9999999999999.99 
source <xs:element name="EarningsAmount" type="FF:amount" minOccurs="0"/>

group EmployerRoleTypeGroup
diagram AppForADJ_p105.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children EmployerRoleTypeCode
source <xs:group name="EmployerRoleTypeGroup">
 
<xs:sequence>
   
<xs:element name="EmployerRoleTypeCode">
     
<xs:simpleType>
       
<xs:restriction base="FF:employerRoleTypeCode"/>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:group>

element EmployerRoleTypeGroup/EmployerRoleTypeCode
diagram AppForADJ_p106.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type restriction of employerRoleTypeCode
properties
isRef 0
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
enumeration 
enumeration 
source <xs:element name="EmployerRoleTypeCode">
 
<xs:simpleType>
   
<xs:restriction base="FF:employerRoleTypeCode"/>
 
</xs:simpleType>
</xs:element>

group InjuryInformationGroup
diagram AppForADJ_p107.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children InjuryType DateOfInjuryStart DateOfInjuryEnd BodyPartInformation
used by
complexType InjuryInformation
source <xs:group name="InjuryInformationGroup">
 
<xs:sequence>
   
<xs:group ref="InjuryTypeAndDates"/>
   
<xs:element name="BodyPartInformation">
     
<xs:complexType>
       
<xs:sequence>
         
<xs:element name="BodyPart" maxOccurs="5">
           
<xs:simpleType>
             
<xs:restriction base="FF:bodyPart"/>
           
</xs:simpleType>
         
</xs:element>
       
</xs:sequence>
     
</xs:complexType>
   
</xs:element>
 
</xs:sequence>
</xs:group>

element InjuryInformationGroup/BodyPartInformation
diagram AppForADJ_p108.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
properties
isRef 0
content complex
children BodyPart
source <xs:element name="BodyPartInformation">
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="BodyPart" maxOccurs="5">
       
<xs:simpleType>
         
<xs:restriction base="FF:bodyPart"/>
       
</xs:simpleType>
     
</xs:element>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element InjuryInformationGroup/BodyPartInformation/BodyPart
diagram AppForADJ_p109.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type restriction of bodyPart
properties
isRef 0
minOcc 1
maxOcc 5
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 100 
enumeration 110 
enumeration 120 
enumeration 121 
enumeration 124 
enumeration 130 
enumeration 140 
enumeration 141 
enumeration 144 
enumeration 145 
enumeration 146 
enumeration 148 
enumeration 149 
enumeration 150 
enumeration 160 
enumeration 198 
enumeration 200 
enumeration 300 
enumeration 310 
enumeration 311 
enumeration 313 
enumeration 315 
enumeration 318 
enumeration 319 
enumeration 320 
enumeration 330 
enumeration 340 
enumeration 398 
enumeration 400 
enumeration 410 
enumeration 411 
enumeration 420 
enumeration 430 
enumeration 440 
enumeration 450 
enumeration 498 
enumeration 500 
enumeration 510 
enumeration 511 
enumeration 513 
enumeration 515 
enumeration 518 
enumeration 519 
enumeration 520 
enumeration 530 
enumeration 540 
enumeration 598 
enumeration 700 
enumeration 800 
enumeration 801 
enumeration 802 
enumeration 810 
enumeration 820 
enumeration 830 
enumeration 840 
enumeration 841 
enumeration 842 
enumeration 850 
enumeration 860 
enumeration 870 
enumeration 880 
enumeration 999 
source <xs:element name="BodyPart" maxOccurs="5">
 
<xs:simpleType>
   
<xs:restriction base="FF:bodyPart"/>
 
</xs:simpleType>
</xs:element>

group InjuryTypeAndDates
diagram AppForADJ_p110.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children InjuryType DateOfInjuryStart DateOfInjuryEnd
used by
group InjuryInformationGroup
source <xs:group name="InjuryTypeAndDates">
 
<xs:sequence>
   
<xs:element name="InjuryType" type="FF:injuryTypeCode"/>
   
<xs:element name="DateOfInjuryStart" type="CF:ptsDate"/>
   
<xs:element name="DateOfInjuryEnd" type="CF:ptsDate" nillable="true" minOccurs="0"/>
 
</xs:sequence>
</xs:group>

element InjuryTypeAndDates/InjuryType
diagram AppForADJ_p111.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type injuryTypeCode
properties
isRef 0
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
source <xs:element name="InjuryType" type="FF:injuryTypeCode"/>

element InjuryTypeAndDates/DateOfInjuryStart
diagram AppForADJ_p112.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type ptsDate
properties
isRef 0
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="DateOfInjuryStart" type="CF:ptsDate"/>

element InjuryTypeAndDates/DateOfInjuryEnd
diagram AppForADJ_p113.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type ptsDate
properties
isRef 0
minOcc 0
maxOcc 1
content simple
nillable true
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="DateOfInjuryEnd" type="CF:ptsDate" nillable="true" minOccurs="0"/>

group PersonNameGroup
diagram AppForADJ_p114.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children FirstName MiddleInitial LastName
used by
complexType PersonName
source <xs:group name="PersonNameGroup">
 
<xs:sequence>
   
<xs:element name="FirstName" type="FF:firstName"/>
   
<xs:element name="MiddleInitial" type="FF:middleInitial" minOccurs="0"/>
   
<xs:element name="LastName" type="FF:lastName"/>
 
</xs:sequence>
</xs:group>

element PersonNameGroup/FirstName
diagram AppForADJ_p115.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type firstName
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 25 
whiteSpace preserve 
pattern ([A-Z ])* 
source <xs:element name="FirstName" type="FF:firstName"/>

element PersonNameGroup/MiddleInitial
diagram AppForADJ_p116.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type middleInitial
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 
whiteSpace collapse 
pattern [A-Z] 
source <xs:element name="MiddleInitial" type="FF:middleInitial" minOccurs="0"/>

element PersonNameGroup/LastName
diagram AppForADJ_p117.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type lastName
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 25 
whiteSpace preserve 
pattern ([A-Z ])* 
source <xs:element name="LastName" type="FF:lastName"/>

group RoleTypeGroup
diagram AppForADJ_p118.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children RoleTypeCode
source <xs:group name="RoleTypeGroup">
 
<xs:sequence>
   
<xs:element name="RoleTypeCode" type="FF:filerRoleTypeCode"/>
 
</xs:sequence>
</xs:group>

element RoleTypeGroup/RoleTypeCode
diagram AppForADJ_p119.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type filerRoleTypeCode
properties
isRef 0
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
enumeration 
enumeration 
source <xs:element name="RoleTypeCode" type="FF:filerRoleTypeCode"/>

group SignatureAddressGroup
diagram AppForADJ_p120.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children DateOfSignature Firm DeclarantSignature
used by
complexType Signatures
source <xs:group name="SignatureAddressGroup">
 
<xs:sequence>
   
<xs:element name="DateOfSignature" type="CF:ptsDate"/>
   
<xs:element name="Firm" type="OrganizationInformation"/>
   
<xs:element name="DeclarantSignature">
     
<xs:simpleType>
       
<xs:restriction base="FF:signature">
         
<xs:minLength value="1"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:group>

element SignatureAddressGroup/DateOfSignature
diagram AppForADJ_p121.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type ptsDate
properties
isRef 0
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="DateOfSignature" type="CF:ptsDate"/>

element SignatureAddressGroup/Firm
diagram AppForADJ_p122.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type OrganizationInformation
properties
isRef 0
content complex
children EmployerName Address
source <xs:element name="Firm" type="OrganizationInformation"/>

element SignatureAddressGroup/DeclarantSignature
diagram AppForADJ_p123.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type restriction of signature
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 82 
whiteSpace preserve 
source <xs:element name="DeclarantSignature">
 
<xs:simpleType>
   
<xs:restriction base="FF:signature">
     
<xs:minLength value="1"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

group VenueInformationGroup
diagram AppForADJ_p124.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children VenueLocationCode VenueOfficeCode
used by
complexType VenueInformation
source <xs:group name="VenueInformationGroup">
 
<xs:sequence>
   
<xs:element name="VenueLocationCode" type="FF:venueLocationTypeCode"/>
   
<xs:element name="VenueOfficeCode" type="FF:venueOfficeCode"/>
 
</xs:sequence>
</xs:group>

element VenueInformationGroup/VenueLocationCode
diagram AppForADJ_p125.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type venueLocationTypeCode
properties
isRef 0
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration