Schema CompromiseandRelease.xsd


attribute form default:  unqualified
element form default:  qualified
targetNamespace:  http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
 
Elements  Complex types 
CandR  ApplicationSection 
DisabilityIndemnityPaid 
DisabilitySection 
EmployerSection 
HeaderSection 
Initials 
InitialsSection 
Payable 
PermanentDisability 
TotalMedicalBillsPaid 


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 CandR
diagram CompromiseandRelease_p1.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
properties
content complex
children HeaderSection ApplicationSection InjuredWorkerSection EmployerSection InjuredWorkerAttorneyorAuthorizedRepSection DefendantsAttorneyOrAuthorizedRepSection InsuranceCarrierSection ClaimsAdministratorInformationSection DisabilitySection InitialsSection Comments
annotation
documentation
Compromise and Release Form
source <xs:element name="CandR">
 
<xs:annotation>
   
<xs:documentation>Compromise and Release Form </xs:documentation>
 
</xs:annotation>
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="HeaderSection" type="HeaderSection"/>
     
<xs:element name="ApplicationSection">
       
<xs:complexType>
         
<xs:complexContent>
           
<xs:extension base="ApplicationSection"/>
         
</xs:complexContent>
       
</xs:complexType>
     
</xs:element>
     
<xs:element name="InjuredWorkerSection" type="CD:PersonInformation"/>
     
<xs:element name="EmployerSection">
       
<xs:complexType>
         
<xs:complexContent>
           
<xs:extension base="EmployerSection"/>
         
</xs:complexContent>
       
</xs:complexType>
     
</xs:element>
     
<xs:element name="InjuredWorkerAttorneyorAuthorizedRepSection" type="CD:AttorneyorRep" minOccurs="0">
       
<xs:annotation>
         
<xs:documentation>Injured Workes's Attornery/Representation type, first and last name of represenative, the lasw firm number and name and it's address</xs:documentation>
       
</xs:annotation>
     
</xs:element>
     
<xs:element name="DefendantsAttorneyOrAuthorizedRepSection" type="CD:AttorneyorRep" minOccurs="0">
       
<xs:annotation>
         
<xs:documentation>Defendant Attornery/Representation type, first and last name of represenative, the lasw firm number and name and it's address</xs:documentation>
       
</xs:annotation>
     
</xs:element>
     
<xs:element name="InsuranceCarrierSection" type="CD:OrganizationInformation" minOccurs="0">
       
<xs:annotation>
         
<xs:documentation>Insurance Carrier name and address</xs:documentation>
       
</xs:annotation>
     
</xs:element>
     
<xs:element name="ClaimsAdministratorInformationSection" type="CD:OrganizationInformation" minOccurs="0">
       
<xs:annotation>
         
<xs:documentation>Claims Administrator name and address</xs:documentation>
       
</xs:annotation>
     
</xs:element>
     
<xs:element name="DisabilitySection">
       
<xs:annotation>
         
<xs:documentation>Information regarding the disability payments.</xs:documentation>
       
</xs:annotation>
       
<xs:complexType>
         
<xs:complexContent>
           
<xs:extension base="DisabilitySection"/>
         
</xs:complexContent>
       
</xs:complexType>
     
</xs:element>
     
<xs:element name="InitialsSection" minOccurs="0">
       
<xs:annotation>
         
<xs:documentation>Applicant and Defendand sign off</xs:documentation>
       
</xs:annotation>
       
<xs:complexType>
         
<xs:complexContent>
           
<xs:extension base="InitialsSection"/>
         
</xs:complexContent>
       
</xs:complexType>
     
</xs:element>
     
<xs:element name="Comments" minOccurs="0">
       
<xs:simpleType>
         
<xs:restriction base="xs:string">
           
<xs:maxLength value="503"/>
           
<xs:whiteSpace value="collapse"/>
         
</xs:restriction>
       
</xs:simpleType>
     
</xs:element>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element CandR/HeaderSection
diagram CompromiseandRelease_p2.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type HeaderSection
properties
isRef 0
content complex
children VersionNumber
source <xs:element name="HeaderSection" type="HeaderSection"/>

element CandR/ApplicationSection
diagram CompromiseandRelease_p3.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type extension of ApplicationSection
properties
isRef 0
content complex
children SocialSecurityNumber Venue DateOfBirth Occupation InjuryInformation
source <xs:element name="ApplicationSection">
 
<xs:complexType>
   
<xs:complexContent>
     
<xs:extension base="ApplicationSection"/>
   
</xs:complexContent>
 
</xs:complexType>
</xs:element>

element CandR/InjuredWorkerSection
diagram CompromiseandRelease_p4.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type PersonInformation
properties
isRef 0
content complex
children Name Address
source <xs:element name="InjuredWorkerSection" type="CD:PersonInformation"/>

element CandR/EmployerSection
diagram CompromiseandRelease_p5.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type extension of EmployerSection
properties
isRef 0
content complex
children EmployerRoleTypeCode EmployerName Address
source <xs:element name="EmployerSection">
 
<xs:complexType>
   
<xs:complexContent>
     
<xs:extension base="EmployerSection"/>
   
</xs:complexContent>
 
</xs:complexType>
</xs:element>

element CandR/InjuredWorkerAttorneyorAuthorizedRepSection
diagram CompromiseandRelease_p6.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type AttorneyorRep
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children AttorneyorAuthRepTypeCode EmployerName LawFirmNumber Name Address
annotation
documentation
Injured Workes's Attornery/Representation type, first and last name of represenative, the lasw firm number and name and it's address
source <xs:element name="InjuredWorkerAttorneyorAuthorizedRepSection" type="CD:AttorneyorRep" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Injured Workes's Attornery/Representation type, first and last name of represenative, the lasw firm number and name and it's address</xs:documentation>
 
</xs:annotation>
</xs:element>

element CandR/DefendantsAttorneyOrAuthorizedRepSection
diagram CompromiseandRelease_p7.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type AttorneyorRep
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children AttorneyorAuthRepTypeCode EmployerName LawFirmNumber Name Address
annotation
documentation
Defendant Attornery/Representation type, first and last name of represenative, the lasw firm number and name and it's address
source <xs:element name="DefendantsAttorneyOrAuthorizedRepSection" type="CD:AttorneyorRep" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Defendant Attornery/Representation type, first and last name of represenative, the lasw firm number and name and it's address</xs:documentation>
 
</xs:annotation>
</xs:element>

element CandR/InsuranceCarrierSection
diagram CompromiseandRelease_p8.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type OrganizationInformation
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children EmployerName Address
annotation
documentation
Insurance Carrier name and address
source <xs:element name="InsuranceCarrierSection" type="CD:OrganizationInformation" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Insurance Carrier name and address</xs:documentation>
 
</xs:annotation>
</xs:element>

element CandR/ClaimsAdministratorInformationSection
diagram CompromiseandRelease_p9.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type OrganizationInformation
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children EmployerName Address
annotation
documentation
Claims Administrator name and address
source <xs:element name="ClaimsAdministratorInformationSection" type="CD:OrganizationInformation" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Claims Administrator name and address</xs:documentation>
 
</xs:annotation>
</xs:element>

element CandR/DisabilitySection
diagram CompromiseandRelease_p10.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type extension of DisabilitySection
properties
isRef 0
content complex
children EarningsAtTimeOfInjury TemporaryDisability PermanentDisability TotalMedicalBillsPaid SettlementAmount PermanentDisabilityAdvances TempIndemnityOverPaymentAmount PayableTo RequestedApplicantAttorneryFee LeavingABalanceOf LiensNotMentioned
annotation
documentation
Information regarding the disability payments.
source <xs:element name="DisabilitySection">
 
<xs:annotation>
   
<xs:documentation>Information regarding the disability payments.</xs:documentation>
 
</xs:annotation>
 
<xs:complexType>
   
<xs:complexContent>
     
<xs:extension base="DisabilitySection"/>
   
</xs:complexContent>
 
</xs:complexType>
</xs:element>

element CandR/InitialsSection
diagram CompromiseandRelease_p11.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type extension of InitialsSection
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Earnings TemporaryDisability Jurisdiction Apportionment Employment InjuryAOE_COE SeriousAndWillfulMisconduct Discrimination StatueOfLimitations FutureMedicalTreatment Other PermanentDisablilty SelfProcuredMedicalTreatment VocationalRehabilitationBenefits
annotation
documentation
Applicant and Defendand sign off
source <xs:element name="InitialsSection" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Applicant and Defendand sign off</xs:documentation>
 
</xs:annotation>
 
<xs:complexType>
   
<xs:complexContent>
     
<xs:extension base="InitialsSection"/>
   
</xs:complexContent>
 
</xs:complexType>
</xs:element>

element CandR/Comments
diagram CompromiseandRelease_p12.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 503 
whiteSpace collapse 
source <xs:element name="Comments" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="503"/>
     
<xs:whiteSpace value="collapse"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

complexType ApplicationSection
diagram CompromiseandRelease_p13.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
children SocialSecurityNumber Venue DateOfBirth Occupation InjuryInformation
used by
element CandR/ApplicationSection
source <xs:complexType name="ApplicationSection">
 
<xs:sequence>
   
<xs:element name="SocialSecurityNumber" type="FF:socialSecurityNumber" minOccurs="0"/>
   
<xs:element name="Venue" type="CD:VenueInformation"/>
   
<xs:element name="DateOfBirth" type="CF:ptsDate"/>
   
<xs:element name="Occupation" type="FF:occupationText" minOccurs="0"/>
   
<xs:element name="InjuryInformation" minOccurs="0">
     
<xs:annotation>
       
<xs:documentation>Contains the case number, injury type (S, C), injury start date, the body parts and address of where the injury occurred.</xs:documentation>
     
</xs:annotation>
     
<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:sequence>
</xs:complexType>

element ApplicationSection/SocialSecurityNumber
diagram CompromiseandRelease_p14.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
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/Venue
diagram CompromiseandRelease_p15.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type VenueInformation
properties
isRef 0
content complex
children VenueLocationCode VenueOfficeCode
source <xs:element name="Venue" type="CD:VenueInformation"/>

element ApplicationSection/DateOfBirth
diagram CompromiseandRelease_p16.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
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="DateOfBirth" type="CF:ptsDate"/>

element ApplicationSection/Occupation
diagram CompromiseandRelease_p17.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type occupationText
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 56 
whiteSpace preserve 
source <xs:element name="Occupation" type="FF:occupationText" minOccurs="0"/>

element ApplicationSection/InjuryInformation
diagram CompromiseandRelease_p18.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type extension of InjuryInformation
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children InjuryType DateOfInjuryStart DateOfInjuryEnd BodyPartInformation Address
annotation
documentation
Contains the case number, injury type (S, C), injury start date, the body parts and address of where the injury occurred.
source <xs:element name="InjuryInformation" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Contains the case number, injury type (S, C), injury start date, the body parts and address of where the injury occurred.</xs:documentation>
 
</xs:annotation>
 
<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 CompromiseandRelease_p19.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Address
properties
isRef 0
content complex
children AddressLine1 City State Zip5Code
source <xs:element name="Address" type="CD:Address"/>

complexType DisabilityIndemnityPaid
diagram CompromiseandRelease_p20.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
children DisabilityIndemnityPaid WeeklyRate DatesDisabilityPaid
used by
elements DisabilitySection/PermanentDisability DisabilitySection/TemporaryDisability
annotation
documentation
Weekly rate,  Start and Stop Date
source <xs:complexType name="DisabilityIndemnityPaid">
 
<xs:annotation>
   
<xs:documentation>Weekly rate,  Start and Stop Date</xs:documentation>
 
</xs:annotation>
 
<xs:sequence>
   
<xs:element name="DisabilityIndemnityPaid" type="FF:amount" minOccurs="0"/>
   
<xs:element name="WeeklyRate" type="FF:amount" minOccurs="0"/>
   
<xs:element name="DatesDisabilityPaid" type="CD:StartAndEndDate" minOccurs="0"/>
 
</xs:sequence>
</xs:complexType>

element DisabilityIndemnityPaid/DisabilityIndemnityPaid
diagram CompromiseandRelease_p21.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
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="DisabilityIndemnityPaid" type="FF:amount" minOccurs="0"/>

element DisabilityIndemnityPaid/WeeklyRate
diagram CompromiseandRelease_p22.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
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 DisabilityIndemnityPaid/DatesDisabilityPaid
diagram CompromiseandRelease_p23.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type StartAndEndDate
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children DateStarts DateEnds
source <xs:element name="DatesDisabilityPaid" type="CD:StartAndEndDate" minOccurs="0"/>

complexType DisabilitySection
diagram CompromiseandRelease_p24.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
children EarningsAtTimeOfInjury TemporaryDisability PermanentDisability TotalMedicalBillsPaid SettlementAmount PermanentDisabilityAdvances TempIndemnityOverPaymentAmount PayableTo RequestedApplicantAttorneryFee LeavingABalanceOf LiensNotMentioned
used by
element CandR/DisabilitySection
source <xs:complexType name="DisabilitySection">
 
<xs:sequence>
   
<xs:element name="EarningsAtTimeOfInjury" type="FF:amount" minOccurs="0"/>
   
<xs:element name="TemporaryDisability" type="DisabilityIndemnityPaid" minOccurs="0"/>
   
<xs:element name="PermanentDisability" type="DisabilityIndemnityPaid" minOccurs="0">
     
<xs:annotation>
       
<xs:documentation>Not required</xs:documentation>
     
</xs:annotation>
   
</xs:element>
   
<xs:element name="TotalMedicalBillsPaid" type="TotalMedicalBillsPaid" minOccurs="0"/>
   
<xs:element name="SettlementAmount" type="FF:amount">
     
<xs:annotation>
       
<xs:documentation>Agreed upon payment</xs:documentation>
     
</xs:annotation>
   
</xs:element>
   
<xs:element name="PermanentDisabilityAdvances" type="PermanentDisability" minOccurs="0"/>
   
<xs:element name="TempIndemnityOverPaymentAmount" type="FF:amount" minOccurs="0"/>
   
<xs:element name="PayableTo" type="Payable" minOccurs="0" maxOccurs="4"/>
   
<xs:element name="RequestedApplicantAttorneryFee" type="FF:amount" minOccurs="0"/>
   
<xs:element name="LeavingABalanceOf" type="FF:amount" minOccurs="0"/>
   
<xs:element name="LiensNotMentioned" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="xs:string">
         
<xs:maxLength value="1673"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element DisabilitySection/EarningsAtTimeOfInjury
diagram CompromiseandRelease_p25.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
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="EarningsAtTimeOfInjury" type="FF:amount" minOccurs="0"/>

element DisabilitySection/TemporaryDisability
diagram CompromiseandRelease_p26.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type DisabilityIndemnityPaid
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children DisabilityIndemnityPaid WeeklyRate DatesDisabilityPaid
source <xs:element name="TemporaryDisability" type="DisabilityIndemnityPaid" minOccurs="0"/>

element DisabilitySection/PermanentDisability
diagram CompromiseandRelease_p27.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type DisabilityIndemnityPaid
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children DisabilityIndemnityPaid WeeklyRate DatesDisabilityPaid
annotation
documentation
Not required
source <xs:element name="PermanentDisability" type="DisabilityIndemnityPaid" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Not required</xs:documentation>
 
</xs:annotation>
</xs:element>

element DisabilitySection/TotalMedicalBillsPaid
diagram CompromiseandRelease_p28.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type TotalMedicalBillsPaid
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children TotalMedicalBillsPaid TotalUnpaidMedicalBillsPaidBy
source <xs:element name="TotalMedicalBillsPaid" type="TotalMedicalBillsPaid" minOccurs="0"/>

element DisabilitySection/SettlementAmount
diagram CompromiseandRelease_p29.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type amount
properties
isRef 0
content simple
facets
Kind Value annotation 
minInclusive 0.00 
maxInclusive 9999999999999.99 
annotation
documentation
Agreed upon payment
source <xs:element name="SettlementAmount" type="FF:amount">
 
<xs:annotation>
   
<xs:documentation>Agreed upon payment</xs:documentation>
 
</xs:annotation>
</xs:element>

element DisabilitySection/PermanentDisabilityAdvances
diagram CompromiseandRelease_p30.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type PermanentDisability
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Amount DatePermanentDisabilityAdvancesThrough
source <xs:element name="PermanentDisabilityAdvances" type="PermanentDisability" minOccurs="0"/>

element DisabilitySection/TempIndemnityOverPaymentAmount
diagram CompromiseandRelease_p31.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
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="TempIndemnityOverPaymentAmount" type="FF:amount" minOccurs="0"/>

element DisabilitySection/PayableTo
diagram CompromiseandRelease_p32.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Payable
properties
isRef 0
minOcc 0
maxOcc 4
content complex
children PayableAmount PayableTo
source <xs:element name="PayableTo" type="Payable" minOccurs="0" maxOccurs="4"/>

element DisabilitySection/RequestedApplicantAttorneryFee
diagram CompromiseandRelease_p33.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
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="RequestedApplicantAttorneryFee" type="FF:amount" minOccurs="0"/>

element DisabilitySection/LeavingABalanceOf
diagram CompromiseandRelease_p34.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
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="LeavingABalanceOf" type="FF:amount" minOccurs="0"/>

element DisabilitySection/LiensNotMentioned
diagram CompromiseandRelease_p35.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 1673 
source <xs:element name="LiensNotMentioned" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="1673"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

complexType EmployerSection
diagram CompromiseandRelease_p36.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
children EmployerRoleTypeCode EmployerName Address
used by
element CandR/EmployerSection
annotation
documentation
Contains the Employer Role Type (I, S,L, U) the Employer name and address
source <xs:complexType name="EmployerSection">
 
<xs:annotation>
   
<xs:documentation>Contains the Employer Role Type (I, S,L, U) the Employer name and address</xs:documentation>
 
</xs:annotation>
 
<xs:sequence>
   
<xs:element name="EmployerRoleTypeCode" type="FF:employerRoleTypeCode"/>
   
<xs:element name="EmployerName" type="FF:employerName"/>
   
<xs:element name="Address" type="CD:Address"/>
 
</xs:sequence>
</xs:complexType>

element EmployerSection/EmployerRoleTypeCode
diagram CompromiseandRelease_p37.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type employerRoleTypeCode
properties
isRef 0
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
enumeration 
enumeration 
source <xs:element name="EmployerRoleTypeCode" type="FF:employerRoleTypeCode"/>

element EmployerSection/EmployerName
diagram CompromiseandRelease_p38.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type employerName
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 56 
pattern ([A-Z0-9 ])* 
source <xs:element name="EmployerName" type="FF:employerName"/>

element EmployerSection/Address
diagram CompromiseandRelease_p39.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Address
properties
isRef 0
content complex
children AddressLine1 City State Zip5Code
source <xs:element name="Address" type="CD:Address"/>

complexType HeaderSection
diagram CompromiseandRelease_p40.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
children VersionNumber
used by
element CandR/HeaderSection
source <xs:complexType name="HeaderSection">
 
<xs:sequence>
   
<xs:element name="VersionNumber" type="CF:versionNumber" fixed="1.1"/>
 
</xs:sequence>
</xs:complexType>

element HeaderSection/VersionNumber
diagram CompromiseandRelease_p41.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type versionNumber
properties
isRef 0
content simple
fixed 1.1
source <xs:element name="VersionNumber" type="CF:versionNumber" fixed="1.1"/>

complexType Initials
diagram CompromiseandRelease_p42.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
children Applicant Defendant
used by
elements InitialsSection/Apportionment InitialsSection/Discrimination InitialsSection/Earnings InitialsSection/Employment InitialsSection/FutureMedicalTreatment InitialsSection/InjuryAOE_COE InitialsSection/Jurisdiction InitialsSection/Other InitialsSection/PermanentDisablilty InitialsSection/SelfProcuredMedicalTreatment InitialsSection/SeriousAndWillfulMisconduct InitialsSection/StatueOfLimitations InitialsSection/TemporaryDisability InitialsSection/VocationalRehabilitationBenefits
annotation
documentation
the Applicant and Defendent initials.  Used in the initials section
source <xs:complexType name="Initials">
 
<xs:annotation>
   
<xs:documentation>the Applicant and Defendent initials.  Used in the initials section</xs:documentation>
 
</xs:annotation>
 
<xs:sequence>
   
<xs:element name="Applicant" type="CD:CheckBox"/>
   
<xs:element name="Defendant" type="CD:CheckBox"/>
 
</xs:sequence>
</xs:complexType>

element Initials/Applicant
diagram CompromiseandRelease_p43.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type CheckBox
properties
isRef 0
content complex
children Checkbox
source <xs:element name="Applicant" type="CD:CheckBox"/>

element Initials/Defendant
diagram CompromiseandRelease_p44.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type CheckBox
properties
isRef 0
content complex
children Checkbox
source <xs:element name="Defendant" type="CD:CheckBox"/>

complexType InitialsSection
diagram CompromiseandRelease_p45.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
children Earnings TemporaryDisability Jurisdiction Apportionment Employment InjuryAOE_COE SeriousAndWillfulMisconduct Discrimination StatueOfLimitations FutureMedicalTreatment Other PermanentDisablilty SelfProcuredMedicalTreatment VocationalRehabilitationBenefits
used by
element CandR/InitialsSection
annotation
documentation
Contains all information on temp or perm disability payments
source <xs:complexType name="InitialsSection">
 
<xs:annotation>
   
<xs:documentation>Contains all information on temp or perm disability payments</xs:documentation>
 
</xs:annotation>
 
<xs:sequence>
   
<xs:element name="Earnings" type="Initials" minOccurs="0"/>
   
<xs:element name="TemporaryDisability" type="Initials" minOccurs="0"/>
   
<xs:element name="Jurisdiction" type="Initials" minOccurs="0"/>
   
<xs:element name="Apportionment" type="Initials" minOccurs="0"/>
   
<xs:element name="Employment" type="Initials" minOccurs="0"/>
   
<xs:element name="InjuryAOE_COE" type="Initials" minOccurs="0"/>
   
<xs:element name="SeriousAndWillfulMisconduct" type="Initials" minOccurs="0"/>
   
<xs:element name="Discrimination" type="Initials" minOccurs="0"/>
   
<xs:element name="StatueOfLimitations" type="Initials" minOccurs="0"/>
   
<xs:element name="FutureMedicalTreatment" type="Initials" minOccurs="0"/>
   
<xs:element name="Other" minOccurs="0">
     
<xs:complexType>
       
<xs:complexContent>
         
<xs:extension base="Initials">
           
<xs:sequence>
             
<xs:element name="Description" minOccurs="0">
               
<xs:simpleType>
                 
<xs:restriction base="xs:string">
                   
<xs:maxLength value="44"/>
                 
</xs:restriction>
               
</xs:simpleType>
             
</xs:element>
           
</xs:sequence>
         
</xs:extension>
       
</xs:complexContent>
     
</xs:complexType>
   
</xs:element>
   
<xs:element name="PermanentDisablilty" minOccurs="0">
     
<xs:complexType>
       
<xs:complexContent>
         
<xs:extension base="Initials">
           
<xs:sequence>
             
<xs:element name="Description" minOccurs="0">
               
<xs:simpleType>
                 
<xs:restriction base="xs:string">
                   
<xs:maxLength value="44"/>
                 
</xs:restriction>
               
</xs:simpleType>
             
</xs:element>
           
</xs:sequence>
         
</xs:extension>
       
</xs:complexContent>
     
</xs:complexType>
   
</xs:element>
   
<xs:element name="SelfProcuredMedicalTreatment" type="Initials" minOccurs="0"/>
   
<xs:element name="VocationalRehabilitationBenefits" type="Initials" minOccurs="0"/>
 
</xs:sequence>
</xs:complexType>

element InitialsSection/Earnings
diagram CompromiseandRelease_p46.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Initials
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Applicant Defendant
source <xs:element name="Earnings" type="Initials" minOccurs="0"/>

element InitialsSection/TemporaryDisability
diagram CompromiseandRelease_p47.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Initials
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Applicant Defendant
source <xs:element name="TemporaryDisability" type="Initials" minOccurs="0"/>

element InitialsSection/Jurisdiction
diagram CompromiseandRelease_p48.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Initials
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Applicant Defendant
source <xs:element name="Jurisdiction" type="Initials" minOccurs="0"/>

element InitialsSection/Apportionment
diagram CompromiseandRelease_p49.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Initials
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Applicant Defendant
source <xs:element name="Apportionment" type="Initials" minOccurs="0"/>

element InitialsSection/Employment
diagram CompromiseandRelease_p50.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Initials
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Applicant Defendant
source <xs:element name="Employment" type="Initials" minOccurs="0"/>

element InitialsSection/InjuryAOE_COE
diagram CompromiseandRelease_p51.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Initials
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Applicant Defendant
source <xs:element name="InjuryAOE_COE" type="Initials" minOccurs="0"/>

element InitialsSection/SeriousAndWillfulMisconduct
diagram CompromiseandRelease_p52.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Initials
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Applicant Defendant
source <xs:element name="SeriousAndWillfulMisconduct" type="Initials" minOccurs="0"/>

element InitialsSection/Discrimination
diagram CompromiseandRelease_p53.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Initials
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Applicant Defendant
source <xs:element name="Discrimination" type="Initials" minOccurs="0"/>

element InitialsSection/StatueOfLimitations
diagram CompromiseandRelease_p54.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Initials
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Applicant Defendant
source <xs:element name="StatueOfLimitations" type="Initials" minOccurs="0"/>

element InitialsSection/FutureMedicalTreatment
diagram CompromiseandRelease_p55.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Initials
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Applicant Defendant
source <xs:element name="FutureMedicalTreatment" type="Initials" minOccurs="0"/>

element InitialsSection/Other
diagram CompromiseandRelease_p56.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type extension of Initials
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Applicant Defendant Description
source <xs:element name="Other" minOccurs="0">
 
<xs:complexType>
   
<xs:complexContent>
     
<xs:extension base="Initials">
       
<xs:sequence>
         
<xs:element name="Description" minOccurs="0">
           
<xs:simpleType>
             
<xs:restriction base="xs:string">
               
<xs:maxLength value="44"/>
             
</xs:restriction>
           
</xs:simpleType>
         
</xs:element>
       
</xs:sequence>
     
</xs:extension>
   
</xs:complexContent>
 
</xs:complexType>
</xs:element>

element InitialsSection/Other/Description
diagram CompromiseandRelease_p57.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 44 
source <xs:element name="Description" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="44"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element InitialsSection/PermanentDisablilty
diagram CompromiseandRelease_p58.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type extension of Initials
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Applicant Defendant Description
source <xs:element name="PermanentDisablilty" minOccurs="0">
 
<xs:complexType>
   
<xs:complexContent>
     
<xs:extension base="Initials">
       
<xs:sequence>
         
<xs:element name="Description" minOccurs="0">
           
<xs:simpleType>
             
<xs:restriction base="xs:string">
               
<xs:maxLength value="44"/>
             
</xs:restriction>
           
</xs:simpleType>
         
</xs:element>
       
</xs:sequence>
     
</xs:extension>
   
</xs:complexContent>
 
</xs:complexType>
</xs:element>

element InitialsSection/PermanentDisablilty/Description
diagram CompromiseandRelease_p59.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 44 
source <xs:element name="Description" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="44"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element InitialsSection/SelfProcuredMedicalTreatment
diagram CompromiseandRelease_p60.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Initials
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Applicant Defendant
source <xs:element name="SelfProcuredMedicalTreatment" type="Initials" minOccurs="0"/>

element InitialsSection/VocationalRehabilitationBenefits
diagram CompromiseandRelease_p61.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type Initials
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Applicant Defendant
source <xs:element name="VocationalRehabilitationBenefits" type="Initials" minOccurs="0"/>

complexType Payable
diagram CompromiseandRelease_p62.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
children PayableAmount PayableTo
used by
element DisabilitySection/PayableTo
annotation
documentation
Amount payable and payable to fields used to deduct from the settlement amount
source <xs:complexType name="Payable">
 
<xs:annotation>
   
<xs:documentation>Amount payable and payable to fields used to deduct from the settlement amount</xs:documentation>
 
</xs:annotation>
 
<xs:sequence>
   
<xs:element name="PayableAmount" type="FF:amount" minOccurs="0"/>
   
<xs:element name="PayableTo" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="xs:string">
         
<xs:maxLength value="36"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element Payable/PayableAmount
diagram CompromiseandRelease_p63.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
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="PayableAmount" type="FF:amount" minOccurs="0"/>

element Payable/PayableTo
diagram CompromiseandRelease_p64.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 36 
source <xs:element name="PayableTo" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="36"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

complexType PermanentDisability
diagram CompromiseandRelease_p65.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
children Amount DatePermanentDisabilityAdvancesThrough
used by
element DisabilitySection/PermanentDisabilityAdvances
source <xs:complexType name="PermanentDisability">
 
<xs:sequence>
   
<xs:element name="Amount" type="FF:amount" minOccurs="0"/>
   
<xs:element name="DatePermanentDisabilityAdvancesThrough" type="CF:ptsDate" minOccurs="0"/>
 
</xs:sequence>
</xs:complexType>

element PermanentDisability/Amount
diagram CompromiseandRelease_p66.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
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="Amount" type="FF:amount" minOccurs="0"/>

element PermanentDisability/DatePermanentDisabilityAdvancesThrough
diagram CompromiseandRelease_p67.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
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="DatePermanentDisabilityAdvancesThrough" type="CF:ptsDate" minOccurs="0"/>

complexType TotalMedicalBillsPaid
diagram CompromiseandRelease_p68.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
children TotalMedicalBillsPaid TotalUnpaidMedicalBillsPaidBy
used by
element DisabilitySection/TotalMedicalBillsPaid
source <xs:complexType name="TotalMedicalBillsPaid">
 
<xs:sequence>
   
<xs:element name="TotalMedicalBillsPaid" type="FF:amount" minOccurs="0"/>
   
<xs:element name="TotalUnpaidMedicalBillsPaidBy" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="xs:string">
         
<xs:maxLength value="10"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element TotalMedicalBillsPaid/TotalMedicalBillsPaid
diagram CompromiseandRelease_p69.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
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="TotalMedicalBillsPaid" type="FF:amount" minOccurs="0"/>

element TotalMedicalBillsPaid/TotalUnpaidMedicalBillsPaidBy
diagram CompromiseandRelease_p70.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/CandR
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 10 
source <xs:element name="TotalUnpaidMedicalBillsPaidBy" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="10"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

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
element AddressGroup/AddressLine1
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 PermanentDisability/Amount DisabilityIndemnityPaid/DisabilityIndemnityPaid EarningAmountGroup/EarningsAmount DisabilitySection/EarningsAtTimeOfInjury DisabilitySection/LeavingABalanceOf Payable/PayableAmount DisabilitySection/RequestedApplicantAttorneryFee DisabilitySection/SettlementAmount DisabilitySection/TempIndemnityOverPaymentAmount TotalMedicalBillsPaid/TotalMedicalBillsPaid DisabilityIndemnityPaid/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 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
element AddressGroup/City
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 EmployerSection/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 EmployerSection/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
element DeclarantSignatureGroup/DeclarantOrLawFirmName
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
element 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
element EmployerName/EmployerName
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 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 
enumeration SBA 
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
'SBA' - Santa Barbara (Added since Sept. 2014)
 
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
'SBA' - Santa Barbara (Added since Sept. 2014)
 
</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="SBA"/>
   
<!--  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 CompromiseandRelease_p71.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children AddressLine1 City State Zip5Code
used by
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 CompromiseandRelease_p72.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 CompromiseandRelease_p73.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 CompromiseandRelease_p74.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 CompromiseandRelease_p75.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 CompromiseandRelease_p76.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 CompromiseandRelease_p77.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 CompromiseandRelease_p78.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 CompromiseandRelease_p79.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 CompromiseandRelease_p80.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 CompromiseandRelease_p81.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 CompromiseandRelease_p82.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 CompromiseandRelease_p83.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 CompromiseandRelease_p84.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 CompromiseandRelease_p85.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 CompromiseandRelease_p86.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 CompromiseandRelease_p87.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 CompromiseandRelease_p88.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 CompromiseandRelease_p89.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 CompromiseandRelease_p90.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 CompromiseandRelease_p91.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 CompromiseandRelease_p92.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 CompromiseandRelease_p93.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 CompromiseandRelease_p94.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 CompromiseandRelease_p95.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 CompromiseandRelease_p96.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 CompromiseandRelease_p97.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 CompromiseandRelease_p98.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 CompromiseandRelease_p99.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 CompromiseandRelease_p100.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 CompromiseandRelease_p101.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 CompromiseandRelease_p102.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 CompromiseandRelease_p103.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 CompromiseandRelease_p104.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 
enumeration 
enumeration 
source <xs:element name="VenueLocationCode" type="FF:venueLocationTypeCode"/>

element VenueInformationGroup/VenueOfficeCode
diagram CompromiseandRelease_p105.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type venueOfficeCode
properties
isRef 0
content simple
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 
enumeration SBA 
source <xs:element name="VenueOfficeCode" type="FF:venueOfficeCode"/>

complexType Address
diagram CompromiseandRelease_p106.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children AddressLine1 City State Zip5Code
used by
elements ApplicationSection/InjuryInformation/Address EmployerSection/Address AttorneyorRep/Address AttorneyorRepWithoutNumber/Address OrganizationInformation/Address PersonInformation/Address
source <xs:complexType name="Address">
 
<xs:group ref="AddressGroup"/>
</xs:complexType>

complexType AttorneyorRep
diagram CompromiseandRelease_p107.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children AttorneyorAuthRepTypeCode EmployerName LawFirmNumber Name Address
used by
elements CandR/DefendantsAttorneyOrAuthorizedRepSection CandR/InjuredWorkerAttorneyorAuthorizedRepSection
source <xs:complexType name="AttorneyorRep">
 
<xs:sequence>
   
<xs:element name="AttorneyorAuthRepTypeCode" type="FF:attorneyorAuthRepTypeCode"/>
   
<xs:element name="EmployerName" type="FF:employerName"/>
   
<xs:element name="LawFirmNumber" type="FF:lawFirmNumber" minOccurs="0"/>
   
<xs:element name="Name" type="PersonName" minOccurs="0"/>
   
<xs:element name="Address" type="Address"/>
 
</xs:sequence>
</xs:complexType>

element AttorneyorRep/AttorneyorAuthRepTypeCode
diagram CompromiseandRelease_p108.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
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 AttorneyorRep/EmployerName
diagram CompromiseandRelease_p109.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type employerName
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 56 
pattern ([A-Z0-9 ])* 
source <xs:element name="EmployerName" type="FF:employerName"/>

element AttorneyorRep/LawFirmNumber
diagram CompromiseandRelease_p110.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
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"/>

element AttorneyorRep/Name
diagram CompromiseandRelease_p111.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type PersonName
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children FirstName MiddleInitial LastName
source <xs:element name="Name" type="PersonName" minOccurs="0"/>

element AttorneyorRep/Address
diagram CompromiseandRelease_p112.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type Address
properties
isRef 0
content complex
children AddressLine1 City State Zip5Code
source <xs:element name="Address" type="Address"/>

complexType AttorneyorRepWithoutNumber
diagram CompromiseandRelease_p113.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children AttorneyorAuthRepTypeCode EmployerName Name Address PhoneNumber
source <xs:complexType name="AttorneyorRepWithoutNumber">
 
<xs:sequence>
   
<xs:element name="AttorneyorAuthRepTypeCode" type="FF:attorneyorAuthRepTypeCode"/>
   
<xs:element name="EmployerName" type="FF:employerName"/>
   
<xs:element name="Name" type="PersonName" minOccurs="0"/>
   
<xs:element name="Address" type="Address"/>
   
<xs:element name="PhoneNumber" type="FF:phoneNumber" minOccurs="0"/>
 
</xs:sequence>
</xs:complexType>

element AttorneyorRepWithoutNumber/AttorneyorAuthRepTypeCode
diagram CompromiseandRelease_p114.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
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 AttorneyorRepWithoutNumber/EmployerName
diagram CompromiseandRelease_p115.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type employerName
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 56 
pattern ([A-Z0-9 ])* 
source <xs:element name="EmployerName" type="FF:employerName"/>

element AttorneyorRepWithoutNumber/Name
diagram CompromiseandRelease_p116.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type PersonName
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children FirstName MiddleInitial LastName
source <xs:element name="Name" type="PersonName" minOccurs="0"/>

element AttorneyorRepWithoutNumber/Address
diagram CompromiseandRelease_p117.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type Address
properties
isRef 0
content complex
children AddressLine1 City State Zip5Code
source <xs:element name="Address" type="Address"/>

element AttorneyorRepWithoutNumber/PhoneNumber
diagram CompromiseandRelease_p118.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type 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="PhoneNumber" type="FF:phoneNumber" minOccurs="0"/>

complexType CheckBox
diagram CompromiseandRelease_p119.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children Checkbox
used by
elements Initials/Applicant Initials/Defendant
source <xs:complexType name="CheckBox">
 
<xs:sequence>
   
<xs:element name="Checkbox" type="CF:checkBox" default="false"/>
 
</xs:sequence>
</xs:complexType>

element CheckBox/Checkbox
diagram CompromiseandRelease_p120.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type checkBox
properties
isRef 0
content simple
default false
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="Checkbox" type="CF:checkBox" default="false"/>

complexType DateRangeMandatory
diagram CompromiseandRelease_p121.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children DateFrom DateTo
source <xs:complexType name="DateRangeMandatory">
 
<xs:sequence>
   
<xs:element name="DateFrom" type="CF:ptsDate"/>
   
<xs:element name="DateTo" type="CF:ptsDate"/>
 
</xs:sequence>
</xs:complexType>

element DateRangeMandatory/DateFrom
diagram CompromiseandRelease_p122.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="DateFrom" type="CF:ptsDate"/>

element DateRangeMandatory/DateTo
diagram CompromiseandRelease_p123.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="DateTo" type="CF:ptsDate"/>

complexType DoctorInformation
diagram CompromiseandRelease_p124.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children Doctor DateOfDoctorReport
source <xs:complexType name="DoctorInformation">
 
<xs:sequence>
   
<xs:element name="Doctor">
     
<xs:simpleType>
       
<xs:restriction base="xs:string">
         
<xs:maxLength value="56"/>
         
<xs:minLength value="1"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="DateOfDoctorReport" type="CF:ptsDate"/>
 
</xs:sequence>
</xs:complexType>

element DoctorInformation/Doctor
diagram CompromiseandRelease_p125.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type restriction of xs:string
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 56 
source <xs:element name="Doctor">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="56"/>
     
<xs:minLength value="1"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element DoctorInformation/DateOfDoctorReport
diagram CompromiseandRelease_p126.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="DateOfDoctorReport" type="CF:ptsDate"/>

complexType EmployerName
diagram CompromiseandRelease_p127.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children EmployerName
used by
complexType OrganizationInformation
source <xs:complexType name="EmployerName">
 
<xs:sequence>
   
<xs:element name="EmployerName">
     
<xs:simpleType>
       
<xs:restriction base="FF:sftField">
         
<xs:maxLength value="40"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element EmployerName/EmployerName