Schema NoticeandRequestofLien.xsd


attribute form default:  unqualified
element form default:  qualified
targetNamespace:  http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
 
Elements  Groups  Complex types  Simple types 
NoticeandRequestofLien  LienInformationSectionGroup  HeaderSection  exemptIndicator 
InjuryType  externalTransactionId 
LienAmount  lienReservationNumber 
LienClaimant  lienTypeCode 
LienClaimantAttorneyOrRep  otherLienText 
LienInformation  reasonForExempt 
NameGroup 
OtherLienInformation 
ReasonType 
Signature 


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 


attribute form default:  unqualified
element form default:  qualified
targetNamespace:  http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/PaymentTransaction
 
Elements  Complex types 
PaymentTransaction  AuthorizationDetails 
BankAccountDetailsReq 
BankAccountDetailsRes 
CardDetailsReq 
CardDetailsRes 
CustomerDetails 
PaymentRequest 
PaymentResponse 
ResponseDetails 


element NoticeandRequestofLien
diagram NoticeandRequestofLien_p1.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
properties
content complex
children LienActivation HeaderSection InjuryTypeSection LienInformationSection InjuredWorkerSection InjuredWorkerAttorneyOrRepSection LienClaimantSection LienClaimantAttorneyOrRepSection EmployerSection InsuranceCarrierOrClaimsAdministratorSection EmployerOrClaimsAdminAttorneySection LienAmount ReasonForLienSection ReasonForExemptSection SignatureSection LienPayment
annotation
documentation
Notice and Request of Lien Form
source <xs:element name="NoticeandRequestofLien">
 
<xs:annotation>
   
<xs:documentation>Notice and Request of Lien Form</xs:documentation>
 
</xs:annotation>
 
<xs:complexType>
   
<xs:sequence>
     
<xs:choice>
       
<!-- Start SB863 -->
       
<xs:element name="LienActivation">
         
<xs:complexType>
           
<xs:sequence>
             
<xs:element name="lienReservationNumber" type="lienReservationNumber"/>
           
</xs:sequence>
         
</xs:complexType>
       
</xs:element>
       
<!-- End SB863 -->
       
<xs:sequence>
         
<xs:element name="HeaderSection" type="HeaderSection"/>
         
<xs:element name="InjuryTypeSection" type="InjuryType"/>
         
<xs:element name="LienInformationSection" type="LienInformation"/>
         
<xs:element name="InjuredWorkerSection" type="CD:PersonInformation"/>
         
<xs:element name="InjuredWorkerAttorneyOrRepSection" type="CD:OrganizationInformation" minOccurs="0">
           
<xs:annotation>
             
<xs:documentation>The Injured Worker's Attorney or Representative</xs:documentation>
           
</xs:annotation>
         
</xs:element>
         
<xs:element name="LienClaimantSection" type="LienClaimant"/>
         
<xs:element name="LienClaimantAttorneyOrRepSection" minOccurs="0">
           
<xs:complexType>
             
<xs:complexContent>
               
<xs:extension base="CD:AttorneyorRep">
                 
<xs:sequence>
                   
<xs:element name="PhoneNumber" type="FF:phoneNumber" minOccurs="0"/>
                 
</xs:sequence>
               
</xs:extension>
             
</xs:complexContent>
           
</xs:complexType>
         
</xs:element>
         
<xs:element name="EmployerSection" type="CD:OrganizationInformation" minOccurs="0"/>
         
<xs:element name="InsuranceCarrierOrClaimsAdministratorSection" type="CD:OrganizationInformation" minOccurs="0"/>
         
<xs:element name="EmployerOrClaimsAdminAttorneySection" type="CD:OrganizationInformation" minOccurs="0"/>
         
<xs:element name="LienAmount" type="FF:amount"/>
         
<xs:element name="ReasonForLienSection" type="ReasonType"/>
         
<!-- Added DIR - ReasonForExemptSection to incorporate new schema form-->
         
<xs:element name="ReasonForExemptSection" type="reasonForExempt" minOccurs="0"/>
         
<xs:element name="SignatureSection" type="Signature"/>
       
</xs:sequence>
     
</xs:choice>
     
<!-- Start SB863 -->
     
<xs:element name="LienPayment" minOccurs="0">
       
<xs:complexType>
         
<xs:sequence>
           
<xs:element ref="PT:PaymentTransaction"/>
         
</xs:sequence>
       
</xs:complexType>
     
</xs:element>
     
<!-- End SB863 -->
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element NoticeandRequestofLien/LienActivation
diagram NoticeandRequestofLien_p2.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
properties
isRef 0
content complex
children lienReservationNumber
source <xs:element name="LienActivation">
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="lienReservationNumber" type="lienReservationNumber"/>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element NoticeandRequestofLien/LienActivation/lienReservationNumber
diagram NoticeandRequestofLien_p3.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type lienReservationNumber
properties
isRef 0
content simple
facets
Kind Value annotation 
maxLength 20 
source <xs:element name="lienReservationNumber" type="lienReservationNumber"/>

element NoticeandRequestofLien/HeaderSection
diagram NoticeandRequestofLien_p4.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type HeaderSection
properties
isRef 0
content complex
children VersionNumber
source <xs:element name="HeaderSection" type="HeaderSection"/>

element NoticeandRequestofLien/InjuryTypeSection
diagram NoticeandRequestofLien_p5.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type InjuryType
properties
isRef 0
content complex
children InjuryType DateOfInjuryStart DateOfInjuryEnd
source <xs:element name="InjuryTypeSection" type="InjuryType"/>

element NoticeandRequestofLien/LienInformationSection
diagram NoticeandRequestofLien_p6.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type LienInformation
properties
isRef 0
content complex
children DateOfOriginalLien LienType SocialSecurityNumber DateOfBirth XIE EXEMPT
source <xs:element name="LienInformationSection" type="LienInformation"/>

element NoticeandRequestofLien/InjuredWorkerSection
diagram NoticeandRequestofLien_p7.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type PersonInformation
properties
isRef 0
content complex
children Name Address
source <xs:element name="InjuredWorkerSection" type="CD:PersonInformation"/>

element NoticeandRequestofLien/InjuredWorkerAttorneyOrRepSection
diagram NoticeandRequestofLien_p8.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type OrganizationInformation
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children EmployerName Address
annotation
documentation
The Injured Worker's Attorney or Representative
source <xs:element name="InjuredWorkerAttorneyOrRepSection" type="CD:OrganizationInformation" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>The Injured Worker's Attorney or Representative</xs:documentation>
 
</xs:annotation>
</xs:element>

element NoticeandRequestofLien/LienClaimantSection
diagram NoticeandRequestofLien_p9.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type LienClaimant
properties
isRef 0
content complex
children Name EmployerName Address PhoneNumber
source <xs:element name="LienClaimantSection" type="LienClaimant"/>

element NoticeandRequestofLien/LienClaimantAttorneyOrRepSection
diagram NoticeandRequestofLien_p10.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type extension of AttorneyorRep
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children AttorneyorAuthRepTypeCode EmployerName LawFirmNumber Name Address PhoneNumber
source <xs:element name="LienClaimantAttorneyOrRepSection" minOccurs="0">
 
<xs:complexType>
   
<xs:complexContent>
     
<xs:extension base="CD:AttorneyorRep">
       
<xs:sequence>
         
<xs:element name="PhoneNumber" type="FF:phoneNumber" minOccurs="0"/>
       
</xs:sequence>
     
</xs:extension>
   
</xs:complexContent>
 
</xs:complexType>
</xs:element>

element NoticeandRequestofLien/LienClaimantAttorneyOrRepSection/PhoneNumber
diagram NoticeandRequestofLien_p11.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
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"/>

element NoticeandRequestofLien/EmployerSection
diagram NoticeandRequestofLien_p12.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type OrganizationInformation
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children EmployerName Address
source <xs:element name="EmployerSection" type="CD:OrganizationInformation" minOccurs="0"/>

element NoticeandRequestofLien/InsuranceCarrierOrClaimsAdministratorSection
diagram NoticeandRequestofLien_p13.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type OrganizationInformation
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children EmployerName Address
source <xs:element name="InsuranceCarrierOrClaimsAdministratorSection" type="CD:OrganizationInformation" minOccurs="0"/>

element NoticeandRequestofLien/EmployerOrClaimsAdminAttorneySection
diagram NoticeandRequestofLien_p14.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type OrganizationInformation
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children EmployerName Address
source <xs:element name="EmployerOrClaimsAdminAttorneySection" type="CD:OrganizationInformation" minOccurs="0"/>

element NoticeandRequestofLien/LienAmount
diagram NoticeandRequestofLien_p15.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type amount
properties
isRef 0
content simple
facets
Kind Value annotation 
minInclusive 0.00 
maxInclusive 9999999999999.99 
source <xs:element name="LienAmount" type="FF:amount"/>

element NoticeandRequestofLien/ReasonForLienSection
diagram NoticeandRequestofLien_p16.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type ReasonType
properties
isRef 0
content complex
children ReasonableAttorneyFee ReasonableExpense ClaimsOfCost ReasonableLivingExpenseDep ReasonableBurialExpenseRequestofLien ReasonableLivingExpenseSpouse IndemnificationAmount OtherLien OtherLienText
source <xs:element name="ReasonForLienSection" type="ReasonType"/>

element NoticeandRequestofLien/ReasonForExemptSection
diagram NoticeandRequestofLien_p17.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type reasonForExempt
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
source <xs:element name="ReasonForExemptSection" type="reasonForExempt" minOccurs="0"/>

element NoticeandRequestofLien/SignatureSection
diagram NoticeandRequestofLien_p18.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type Signature
properties
isRef 0
content complex
children LienDeliveredIndicator AttorneySignature LienClaimantSignature DateOfSignature
source <xs:element name="SignatureSection" type="Signature"/>

element NoticeandRequestofLien/LienPayment
diagram NoticeandRequestofLien_p19.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children tns:PaymentTransaction
source <xs:element name="LienPayment" minOccurs="0">
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element ref="PT:PaymentTransaction"/>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

group LienInformationSectionGroup
diagram NoticeandRequestofLien_p20.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
children DateOfOriginalLien LienType SocialSecurityNumber DateOfBirth XIE EXEMPT
used by
complexType LienInformation
source <xs:group name="LienInformationSectionGroup">
 
<xs:sequence>
   
<xs:element name="DateOfOriginalLien" type="CF:ptsDate"/>
   
<xs:element name="LienType" type="lienTypeCode" fixed="O"/>
   
<xs:element name="SocialSecurityNumber" type="FF:socialSecurityNumber" minOccurs="0"/>
   
<xs:element name="DateOfBirth" type="CF:ptsDate" minOccurs="0">
     
<xs:annotation>
       
<xs:documentation>DOB of injured worker</xs:documentation>
     
</xs:annotation>
   
</xs:element>
   
<!-- Start SB863 -->
   
<xs:element name="XIE" type="externalTransactionId" minOccurs="1"/>
   
<xs:element name="EXEMPT" type="exemptIndicator" default="0" minOccurs="1"/>
   
<!-- End SB863 -->
 
</xs:sequence>
</xs:group>

element LienInformationSectionGroup/DateOfOriginalLien
diagram NoticeandRequestofLien_p21.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
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="DateOfOriginalLien" type="CF:ptsDate"/>

element LienInformationSectionGroup/LienType
diagram NoticeandRequestofLien_p22.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type lienTypeCode
properties
isRef 0
content simple
fixed O
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
source <xs:element name="LienType" type="lienTypeCode" fixed="O"/>

element LienInformationSectionGroup/SocialSecurityNumber
diagram NoticeandRequestofLien_p23.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
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 LienInformationSectionGroup/DateOfBirth
diagram NoticeandRequestofLien_p24.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
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] 
annotation
documentation
DOB of injured worker
source <xs:element name="DateOfBirth" type="CF:ptsDate" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>DOB of injured worker</xs:documentation>
 
</xs:annotation>
</xs:element>

element LienInformationSectionGroup/XIE
diagram NoticeandRequestofLien_p25.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type externalTransactionId
properties
isRef 0
content simple
facets
Kind Value annotation 
maxLength 20 
source <xs:element name="XIE" type="externalTransactionId" minOccurs="1"/>

element LienInformationSectionGroup/EXEMPT
diagram NoticeandRequestofLien_p26.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type exemptIndicator
properties
isRef 0
content simple
default 0
facets
Kind Value annotation 
length 
enumeration 
enumeration 
source <xs:element name="EXEMPT" type="exemptIndicator" default="0" minOccurs="1"/>

complexType HeaderSection
diagram NoticeandRequestofLien_p27.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
children VersionNumber
used by
element NoticeandRequestofLien/HeaderSection
source <xs:complexType name="HeaderSection">
 
<xs:sequence>
   
<xs:element name="VersionNumber" type="CF:versionNumber" fixed="1.4"/>
 
</xs:sequence>
</xs:complexType>

element HeaderSection/VersionNumber
diagram NoticeandRequestofLien_p28.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type versionNumber
properties
isRef 0
content simple
fixed 1.4
source <xs:element name="VersionNumber" type="CF:versionNumber" fixed="1.4"/>

complexType InjuryType
diagram NoticeandRequestofLien_p29.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
children InjuryType DateOfInjuryStart DateOfInjuryEnd
used by
element NoticeandRequestofLien/InjuryTypeSection
source <xs:complexType name="InjuryType">
 
<xs:group ref="CD:InjuryTypeAndDates"/>
</xs:complexType>

complexType LienAmount
diagram NoticeandRequestofLien_p30.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
children LienAmount
source <xs:complexType name="LienAmount">
 
<xs:sequence>
   
<xs:element name="LienAmount" type="FF:amount"/>
 
</xs:sequence>
</xs:complexType>

element LienAmount/LienAmount
diagram NoticeandRequestofLien_p31.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type amount
properties
isRef 0
content simple
facets
Kind Value annotation 
minInclusive 0.00 
maxInclusive 9999999999999.99 
source <xs:element name="LienAmount" type="FF:amount"/>

complexType LienClaimant
diagram NoticeandRequestofLien_p32.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
children Name EmployerName Address PhoneNumber
used by
element NoticeandRequestofLien/LienClaimantSection
source <xs:complexType name="LienClaimant">
 
<xs:sequence>
   
<xs:choice>
     
<xs:element name="Name" type="CD:PersonName"/>
     
<xs:element name="EmployerName" type="FF:employerName"/>
   
</xs:choice>
   
<xs:element name="Address" type="CD:Address"/>
   
<xs:element name="PhoneNumber" type="FF:phoneNumber" minOccurs="0"/>
 
</xs:sequence>
</xs:complexType>

element LienClaimant/Name
diagram NoticeandRequestofLien_p33.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type PersonName
properties
isRef 0
content complex
children FirstName MiddleInitial LastName
source <xs:element name="Name" type="CD:PersonName"/>

element LienClaimant/EmployerName
diagram NoticeandRequestofLien_p34.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
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 LienClaimant/Address
diagram NoticeandRequestofLien_p35.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type Address
properties
isRef 0
content complex
children AddressLine1 City State Zip5Code
source <xs:element name="Address" type="CD:Address"/>

element LienClaimant/PhoneNumber
diagram NoticeandRequestofLien_p36.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
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 LienClaimantAttorneyOrRep
diagram NoticeandRequestofLien_p37.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
children LienClaimantNotRepresented AttorneyOrRep
source <xs:complexType name="LienClaimantAttorneyOrRep">
 
<xs:sequence>
   
<xs:element name="LienClaimantNotRepresented" type="CD:CheckBox"/>
   
<xs:element name="AttorneyOrRep" minOccurs="0">
     
<xs:complexType>
       
<xs:sequence>
         
<xs:element name="AttorneyorAuthRepTypeCode" type="FF:attorneyorAuthRepTypeCode"/>
         
<xs:element name="EmployerName" type="FF:employerName" minOccurs="0"/>
         
<xs:element name="Name" type="CD:PersonName"/>
         
<xs:element name="Address" type="CD:Address"/>
         
<xs:element name="PhoneNumber" type="FF:phoneNumber" minOccurs="0"/>
       
</xs:sequence>
     
</xs:complexType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element LienClaimantAttorneyOrRep/LienClaimantNotRepresented
diagram NoticeandRequestofLien_p38.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type CheckBox
properties
isRef 0
content complex
children Checkbox
source <xs:element name="LienClaimantNotRepresented" type="CD:CheckBox"/>

element LienClaimantAttorneyOrRep/AttorneyOrRep
diagram NoticeandRequestofLien_p39.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children AttorneyorAuthRepTypeCode EmployerName Name Address PhoneNumber
source <xs:element name="AttorneyOrRep" minOccurs="0">
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="AttorneyorAuthRepTypeCode" type="FF:attorneyorAuthRepTypeCode"/>
     
<xs:element name="EmployerName" type="FF:employerName" minOccurs="0"/>
     
<xs:element name="Name" type="CD:PersonName"/>
     
<xs:element name="Address" type="CD:Address"/>
     
<xs:element name="PhoneNumber" type="FF:phoneNumber" minOccurs="0"/>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element LienClaimantAttorneyOrRep/AttorneyOrRep/AttorneyorAuthRepTypeCode
diagram NoticeandRequestofLien_p40.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
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 LienClaimantAttorneyOrRep/AttorneyOrRep/EmployerName
diagram NoticeandRequestofLien_p41.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type employerName
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 56 
pattern ([A-Z0-9 ])* 
source <xs:element name="EmployerName" type="FF:employerName" minOccurs="0"/>

element LienClaimantAttorneyOrRep/AttorneyOrRep/Name
diagram NoticeandRequestofLien_p42.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type PersonName
properties
isRef 0
content complex
children FirstName MiddleInitial LastName
source <xs:element name="Name" type="CD:PersonName"/>

element LienClaimantAttorneyOrRep/AttorneyOrRep/Address
diagram NoticeandRequestofLien_p43.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type Address
properties
isRef 0
content complex
children AddressLine1 City State Zip5Code
source <xs:element name="Address" type="CD:Address"/>

element LienClaimantAttorneyOrRep/AttorneyOrRep/PhoneNumber
diagram NoticeandRequestofLien_p44.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
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 LienInformation
diagram NoticeandRequestofLien_p45.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
children DateOfOriginalLien LienType SocialSecurityNumber DateOfBirth XIE EXEMPT
used by
element NoticeandRequestofLien/LienInformationSection
source <xs:complexType name="LienInformation">
 
<xs:group ref="LienInformationSectionGroup"/>
</xs:complexType>

complexType NameGroup
diagram NoticeandRequestofLien_p46.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
children FirstName MiddleInitial LastName EmployerName
source <xs:complexType name="NameGroup">
 
<xs:sequence>
   
<xs:group ref="CD:PersonNameGroup" minOccurs="0"/>
   
<xs:element name="EmployerName" type="FF:fullName" minOccurs="0"/>
 
</xs:sequence>
</xs:complexType>

element NameGroup/EmployerName
diagram NoticeandRequestofLien_p47.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type fullName
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 56 
pattern ([A-Z 0-9])* 
source <xs:element name="EmployerName" type="FF:fullName" minOccurs="0"/>

complexType OtherLienInformation
diagram NoticeandRequestofLien_p48.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
children Reasons
source <xs:complexType name="OtherLienInformation">
 
<xs:sequence>
   
<xs:element name="Reasons" type="ReasonType"/>
 
</xs:sequence>
</xs:complexType>

element OtherLienInformation/Reasons
diagram NoticeandRequestofLien_p49.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type ReasonType
properties
isRef 0
content complex
children ReasonableAttorneyFee ReasonableExpense ClaimsOfCost ReasonableLivingExpenseDep ReasonableBurialExpenseRequestofLien ReasonableLivingExpenseSpouse IndemnificationAmount OtherLien OtherLienText
source <xs:element name="Reasons" type="ReasonType"/>

complexType ReasonType
diagram NoticeandRequestofLien_p50.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
children ReasonableAttorneyFee ReasonableExpense ClaimsOfCost ReasonableLivingExpenseDep ReasonableBurialExpenseRequestofLien ReasonableLivingExpenseSpouse IndemnificationAmount OtherLien OtherLienText
used by
elements NoticeandRequestofLien/ReasonForLienSection OtherLienInformation/Reasons
source <xs:complexType name="ReasonType">
 
<xs:sequence>
   
<xs:choice>
     
<xs:element name="ReasonableAttorneyFee" type="CF:checkBox"/>
     
<xs:element name="ReasonableExpense" type="CF:checkBox"/>
     
<!-- Renamed ClaimsOfCost field to match new lien form -->
     
<xs:element name="ClaimsOfCost" type="CF:checkBox"/>
     
<xs:element name="ReasonableLivingExpenseDep" type="CF:checkBox"/>
     
<xs:element name="ReasonableBurialExpenseRequestofLien" type="CF:checkBox"/>
     
<xs:element name="ReasonableLivingExpenseSpouse" type="CF:checkBox"/>
     
<!-- Modified InterpretersServices type to match new lien form -->
     
<!-- Dropped: <xs:element name="InterpretersServices" type="CF:checkBox"/> -->
     
<xs:element name="IndemnificationAmount" type="CF:checkBox"/>
     
<!-- Dropped: <xs:element name="CostsPaidByTheAsbestosWorkersAccount" type="CF:checkBox"/> -->
     
<!-- Added DIR - OtherLien checkbox field to match new lien form-->
     
<xs:element name="OtherLien" type="CF:checkBox"/>
   
</xs:choice>
   
<xs:element name="OtherLienText" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="otherLienText"/>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element ReasonType/ReasonableAttorneyFee
diagram NoticeandRequestofLien_p51.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type checkBox
properties
isRef 0
content simple
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="ReasonableAttorneyFee" type="CF:checkBox"/>

element ReasonType/ReasonableExpense
diagram NoticeandRequestofLien_p52.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type checkBox
properties
isRef 0
content simple
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="ReasonableExpense" type="CF:checkBox"/>

element ReasonType/ClaimsOfCost
diagram NoticeandRequestofLien_p53.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type checkBox
properties
isRef 0
content simple
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="ClaimsOfCost" type="CF:checkBox"/>

element ReasonType/ReasonableLivingExpenseDep
diagram NoticeandRequestofLien_p54.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type checkBox
properties
isRef 0
content simple
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="ReasonableLivingExpenseDep" type="CF:checkBox"/>

element ReasonType/ReasonableBurialExpenseRequestofLien
diagram NoticeandRequestofLien_p55.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type checkBox
properties
isRef 0
content simple
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="ReasonableBurialExpenseRequestofLien" type="CF:checkBox"/>

element ReasonType/ReasonableLivingExpenseSpouse
diagram NoticeandRequestofLien_p56.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type checkBox
properties
isRef 0
content simple
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="ReasonableLivingExpenseSpouse" type="CF:checkBox"/>

element ReasonType/IndemnificationAmount
diagram NoticeandRequestofLien_p57.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type checkBox
properties
isRef 0
content simple
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="IndemnificationAmount" type="CF:checkBox"/>

element ReasonType/OtherLien
diagram NoticeandRequestofLien_p58.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type checkBox
properties
isRef 0
content simple
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="OtherLien" type="CF:checkBox"/>

element ReasonType/OtherLienText
diagram NoticeandRequestofLien_p59.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type restriction of otherLienText
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 585 
whiteSpace preserve 
source <xs:element name="OtherLienText" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="otherLienText"/>
 
</xs:simpleType>
</xs:element>

complexType Signature
diagram NoticeandRequestofLien_p60.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
children LienDeliveredIndicator AttorneySignature LienClaimantSignature DateOfSignature
used by
element NoticeandRequestofLien/SignatureSection
source <xs:complexType name="Signature">
 
<xs:sequence>
   
<xs:element name="LienDeliveredIndicator" type="CD:CheckBox"/>
   
<xs:element name="AttorneySignature" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="FF:signature">
         
<xs:minLength value="1"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="LienClaimantSignature" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="FF:signature">
         
<xs:minLength value="1"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="DateOfSignature" type="CF:ptsDate"/>
 
</xs:sequence>
</xs:complexType>

element Signature/LienDeliveredIndicator
diagram NoticeandRequestofLien_p61.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type CheckBox
properties
isRef 0
content complex
children Checkbox
source <xs:element name="LienDeliveredIndicator" type="CD:CheckBox"/>

element Signature/AttorneySignature
diagram NoticeandRequestofLien_p62.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type restriction of signature
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 82 
whiteSpace preserve 
source <xs:element name="AttorneySignature" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="FF:signature">
     
<xs:minLength value="1"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element Signature/LienClaimantSignature
diagram NoticeandRequestofLien_p63.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type restriction of signature
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 82 
whiteSpace preserve 
source <xs:element name="LienClaimantSignature" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="FF:signature">
     
<xs:minLength value="1"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element Signature/DateOfSignature
diagram NoticeandRequestofLien_p64.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
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"/>

simpleType exemptIndicator
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type restriction of xs:string
properties
base xs:string
used by
element LienInformationSectionGroup/EXEMPT
facets
Kind Value annotation 
length 
enumeration 
enumeration 
source <xs:simpleType name="exemptIndicator">
 
<xs:restriction base="xs:string">
   
<xs:length value="1"/>
   
<xs:enumeration value="0"/>
   
<xs:enumeration value="1"/>
 
</xs:restriction>
</xs:simpleType>

simpleType externalTransactionId
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type restriction of xs:string
properties
base xs:string
used by
element LienInformationSectionGroup/XIE
facets
Kind Value annotation 
maxLength 20 
source <xs:simpleType name="externalTransactionId">
 
<xs:restriction base="xs:string">
   
<xs:maxLength value="20"/>
 
</xs:restriction>
</xs:simpleType>

simpleType lienReservationNumber
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type restriction of xs:string
properties
base xs:string
used by
element NoticeandRequestofLien/LienActivation/lienReservationNumber
facets
Kind Value annotation 
maxLength 20 
source <xs:simpleType name="lienReservationNumber">
 
<xs:restriction base="xs:string">
   
<xs:maxLength value="20"/>
 
</xs:restriction>
</xs:simpleType>

simpleType lienTypeCode
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type restriction of typeCode1
properties
base CF:typeCode1
used by
element LienInformationSectionGroup/LienType
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
annotation
documentation
Lien Type
Valid Values
'O' - Original Lien
source <xs:simpleType name="lienTypeCode">
 
<xs:annotation>
   
<xs:documentation>Lien Type
Valid Values
'O' - Original Lien
</xs:documentation>
 
</xs:annotation>
 
<xs:restriction base="CF:typeCode1">
   
<xs:enumeration value="O"/>
 
</xs:restriction>
</xs:simpleType>

simpleType otherLienText
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type restriction of xs:string
properties
base xs:string
used by
element ReasonType/OtherLienText
facets
Kind Value annotation 
minLength 
maxLength 585 
whiteSpace preserve 
source <xs:simpleType name="otherLienText">
 
<xs:restriction base="xs:string">
   
<xs:minLength value="0"/>
   
<xs:maxLength value="585"/>
   
<xs:whiteSpace value="preserve"/>
 
</xs:restriction>
</xs:simpleType>

simpleType reasonForExempt
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/NoticeandRequestLien
type restriction of typeCode1
properties
base CF:typeCode1
used by
element NoticeandRequestofLien/ReasonForExemptSection
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
annotation
documentation
Reason For Exempt Valid Values
'1' - This is not a lien filed under Labor Code section 4903(b) and is not a claim of costs filed as a lien.
'2 - This lien is exempt from the filing fee under Labor Code section 4903.05(c) (7).
source <xs:simpleType name="reasonForExempt">
 
<xs:annotation>
   
<xs:documentation> Reason For Exempt Valid Values
'1' - This is not a lien filed under Labor Code section 4903(b) and is not a claim of costs filed as a lien.
'2 - This lien is exempt from the filing fee under Labor Code section 4903.05(c) (7).
</xs:documentation>
 
</xs:annotation>
 
<xs:restriction base="CF:typeCode1">
   
<xs:enumeration value="1"/>
   
<xs:enumeration value="2"/>
 
</xs:restriction>
</xs:simpleType>

simpleType addressLine
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
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 EarningAmountGroup/EarningsAmount NoticeandRequestofLien/LienAmount LienAmount/LienAmount
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 LienClaimantAttorneyOrRep/AttorneyOrRep/AttorneyorAuthRepTypeCode AttorneyorRep/AttorneyorAuthRepTypeCode AttorneyorRepWithoutNumber/AttorneyorAuthRepTypeCode
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
annotation
documentation
Attorney or Authorized Representative
Valid Values
'A' - Attorney
'R' - AuthorizedRepresentative
source <xs:simpleType name="attorneyorAuthRepTypeCode">
 
<xs:annotation>
   
<xs:documentation> Attorney or Authorized Representative
Valid Values
'A' - Attorney
'R' - AuthorizedRepresentative
</xs:documentation>
 
</xs:annotation>
 
<xs:restriction base="CF:typeCode1">
   
<xs:enumeration value="A"/>
   
<xs:enumeration value="R"/>
 
</xs:restriction>
</xs:simpleType>

simpleType bodyPart
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of typeCode3
properties
base CF:typeCode3
used by
element InjuryInformationGroup/BodyPartInformation/BodyPart
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 100 
enumeration 110 
enumeration 120 
enumeration 121 
enumeration 124 
enumeration 130 
enumeration 140 
enumeration 141 
enumeration 144 
enumeration 145 
enumeration 146 
enumeration 148 
enumeration 149 
enumeration 150 
enumeration 160 
enumeration 198 
enumeration 200 
enumeration 300 
enumeration 310 
enumeration 311 
enumeration 313 
enumeration 315 
enumeration 318 
enumeration 319 
enumeration 320 
enumeration 330 
enumeration 340 
enumeration 398 
enumeration 400 
enumeration 410 
enumeration 411 
enumeration 420 
enumeration 430 
enumeration 440 
enumeration 450 
enumeration 498 
enumeration 500 
enumeration 510 
enumeration 511 
enumeration 513 
enumeration 515 
enumeration 518 
enumeration 519 
enumeration 520 
enumeration 530 
enumeration 540 
enumeration 598 
enumeration 700 
enumeration 800 
enumeration 801 
enumeration 802 
enumeration 810 
enumeration 820 
enumeration 830 
enumeration 840 
enumeration 841 
enumeration 842 
enumeration 850 
enumeration 860 
enumeration 870 
enumeration 880 
enumeration 999 
annotation
documentation
Body Parts
Valid Values
'100' - 100 HEAD - not specified
'110' - 110 BRAIN
'120' - 120 EAR - not specified
'121' - 121 EAR - external
'124' - 124 EAR - internal (including hearing)
'130' - 130 EYE - (including optic nerves and vision)
'140' - 140 FACE - not specified
'141' - 141 JAW - (including chin and mandible)
'144' - 144 MOUTH - (including lips, tongue, throat and taste)
'145' - 145 TEETH
'146' - 146 NOSE - (including nasal passages, sinus and smell)
'148' - 148 FACE - multiple parts (any combination of above parts)
'149' - 149 FACE - forehead, cheeks, eyelids
'150' - 150 SCALP
'160' - 160 SKULL
'198' - 198 HEAD - multiple injury (any combination of above parts)
'200' - 200 NECK
'300' - 300 UPPER EXTREMITIES - not specified
'310' - 310 ARM - above wrist (not specified)
'311' - 311 ARM - upper arm (humerus)
'313' - 313 ARM - elbow (head of radius)
'315' - 315 ARM - forearm (radius and ulna)
'318' - 318 ARM - multiple parts (any combination of above parts)
'319' - 319 ARM - not specified
'320' - 320 WRIST
'330' - 330 HAND - (not wrist or fingers)
'340' - 340 FINGER(s)
'398' - 398 UPPER EXTREMITIES - multiple parts (any combination of above parts)
'400' - 400 TRUNK - not specified'
'410' - 410 ABDOMEN - including internal organs and groin
'411' - 411 HERNIA
'420' - 420 BACK - including back muscles, spine and spinal cord
'430' - 430 CHEST - including ribs, breast bone and internal organs of the chest
'440' - 440 HIP(s) - including pelvis, pelvic organs, tailbone, coccyx and buttocks
'450' - 450 SHOULDER(s) - (scapula and clavicle)
'498' - 498 TRUNK - use for side; multiple parts (any combination of above parts)
'500' - 500 LOWER EXTREMITIES - not specified
'510' - 510 LEGS - above ankles, not specified
'511' - 511 THIGH (femur)
'513' - 513 KNEE (Patella)
'515' - 515 LOWER LEG (tibia and fibula)
'518' - 518 LEG - multiple parts (any combination of above parts)
'519' - 519 LEG - not specified
'520' - 520 ANKLE (malleolus)
'530' - 530 FOOT (not ankle or toe)
'540' - 540 TOE(s)
'598' - 598 LOWER EXTREMITIES - multiple parts (any combination of above parts)
'700' - 700 MULITPLE PARTS (more than five major parts) (use only in fifth position of listing of body parts)
'800' - 800 BODY SYSTEM - not specific
'801' - 801 CIRCULATORY SYSTEM - (heart - other than heart attack, blood, arteries, veins, etc.)
'802' - 802 CIRCULATORY SYTEM - Heart attack
'810' - 810 DIGESTIVE SYSTEM - (stomach)
'820' - 820 EXCRETORY SYSTEM - (kidneys, bladder, intestines, etc.)
'830' - 830 MUSCULO-SKELETAL SYSTEM - (bones, joints, tendons, muscles, etc.)
'840' - 840 NERVOUS SYSTEM - not specified
'841' - 841 NERVOUS SYSTEM - Stress
'842' - 842 NERVOUS SYSTEM - Psychiatric/psych
'850' - 850 RESPIRATORY SYSTEM - (lungs, trachea, etc.)
'860' - 860 SKIN (dermititis, etc.)
'870' - 870 REPRODUCTIVE SYSTEMS
'880' - 880 OTHER BODY SYSTEMS
'999' - 999 UNCLASSIFIED - insufficient information to identify body parts
source <xs:simpleType name="bodyPart">
 
<xs:annotation>
   
<xs:documentation> Body Parts
Valid Values
'100' - 100 HEAD - not specified
'110' - 110 BRAIN
'120' - 120 EAR - not specified
'121' - 121 EAR - external
'124' - 124 EAR - internal (including hearing)
'130' - 130 EYE - (including optic nerves and vision)
'140' - 140 FACE - not specified
'141' - 141 JAW - (including chin and mandible)
'144' - 144 MOUTH - (including lips, tongue, throat and taste)
'145' - 145 TEETH
'146' - 146 NOSE - (including nasal passages, sinus and smell)
'148' - 148 FACE - multiple parts (any combination of above parts)
'149' - 149 FACE - forehead, cheeks, eyelids
'150' - 150 SCALP
'160' - 160 SKULL
'198' - 198 HEAD - multiple injury (any combination of above parts)
'200' - 200 NECK
'300' - 300 UPPER EXTREMITIES - not specified
'310' - 310 ARM - above wrist (not specified)
'311' - 311 ARM - upper arm (humerus)
'313' - 313 ARM - elbow (head of radius)
'315' - 315 ARM - forearm (radius and ulna)
'318' - 318 ARM - multiple parts (any combination of above parts)
'319' - 319 ARM - not specified
'320' - 320 WRIST
'330' - 330 HAND - (not wrist or fingers)
'340' - 340 FINGER(s)
'398' - 398 UPPER EXTREMITIES - multiple parts (any combination of above parts)
'400' - 400 TRUNK - not specified'
'410' - 410 ABDOMEN - including internal organs and groin
'411' - 411 HERNIA
'420' - 420 BACK - including back muscles, spine and spinal cord
'430' - 430 CHEST - including ribs, breast bone and internal organs of the chest
'440' - 440 HIP(s) - including pelvis, pelvic organs, tailbone, coccyx and buttocks
'450' - 450 SHOULDER(s) - (scapula and clavicle)
'498' - 498 TRUNK - use for side; multiple parts (any combination of above parts)
'500' - 500 LOWER EXTREMITIES - not specified
'510' - 510 LEGS - above ankles, not specified
'511' - 511 THIGH (femur)
'513' - 513 KNEE (Patella)
'515' - 515 LOWER LEG (tibia and fibula)
'518' - 518 LEG - multiple parts (any combination of above parts)
'519' - 519 LEG - not specified
'520' - 520 ANKLE (malleolus)
'530' - 530 FOOT (not ankle or toe)
'540' - 540 TOE(s)
'598' - 598 LOWER EXTREMITIES - multiple parts (any combination of above parts)
'700' - 700 MULITPLE PARTS (more than five major parts) (use only in fifth position of listing of body parts)
'800' - 800 BODY SYSTEM - not specific
'801' - 801 CIRCULATORY SYSTEM - (heart - other than heart attack, blood, arteries, veins, etc.)
'802' - 802 CIRCULATORY SYTEM - Heart attack
'810' - 810 DIGESTIVE SYSTEM - (stomach)
'820' - 820 EXCRETORY SYSTEM - (kidneys, bladder, intestines, etc.)
'830' - 830 MUSCULO-SKELETAL SYSTEM - (bones, joints, tendons, muscles, etc.)
'840' - 840 NERVOUS SYSTEM - not specified
'841' - 841 NERVOUS SYSTEM - Stress
'842' - 842 NERVOUS SYSTEM - Psychiatric/psych
'850' - 850 RESPIRATORY SYSTEM - (lungs, trachea, etc.)
'860' - 860 SKIN (dermititis, etc.)
'870' - 870 REPRODUCTIVE SYSTEMS
'880' - 880 OTHER BODY SYSTEMS
'999' - 999 UNCLASSIFIED - insufficient information to identify body parts
</xs:documentation>
 
</xs:annotation>
 
<xs:restriction base="CF:typeCode3">
   
<xs:enumeration value="100"/>
   
<xs:enumeration value="110"/>
   
<xs:enumeration value="120"/>
   
<xs:enumeration value="121"/>
   
<xs:enumeration value="124"/>
   
<xs:enumeration value="130"/>
   
<xs:enumeration value="140"/>
   
<xs:enumeration value="141"/>
   
<xs:enumeration value="144"/>
   
<xs:enumeration value="145"/>
   
<xs:enumeration value="146"/>
   
<xs:enumeration value="148"/>
   
<xs:enumeration value="149"/>
   
<xs:enumeration value="150"/>
   
<xs:enumeration value="160"/>
   
<xs:enumeration value="198"/>
   
<xs:enumeration value="200"/>
   
<xs:enumeration value="300"/>
   
<xs:enumeration value="310"/>
   
<xs:enumeration value="311"/>
   
<xs:enumeration value="313"/>
   
<xs:enumeration value="315"/>
   
<xs:enumeration value="318"/>
   
<xs:enumeration value="319"/>
   
<xs:enumeration value="320"/>
   
<xs:enumeration value="330"/>
   
<xs:enumeration value="340"/>
   
<xs:enumeration value="398"/>
   
<xs:enumeration value="400"/>
   
<xs:enumeration value="410"/>
   
<xs:enumeration value="411"/>
   
<xs:enumeration value="420"/>
   
<xs:enumeration value="430"/>
   
<xs:enumeration value="440"/>
   
<xs:enumeration value="450"/>
   
<xs:enumeration value="498"/>
   
<xs:enumeration value="500"/>
   
<xs:enumeration value="510"/>
   
<xs:enumeration value="511"/>
   
<xs:enumeration value="513"/>
   
<xs:enumeration value="515"/>
   
<xs:enumeration value="518"/>
   
<xs:enumeration value="519"/>
   
<xs:enumeration value="520"/>
   
<xs:enumeration value="530"/>
   
<xs:enumeration value="540"/>
   
<xs:enumeration value="598"/>
   
<xs:enumeration value="700"/>
   
<xs:enumeration value="800"/>
   
<xs:enumeration value="801"/>
   
<xs:enumeration value="802"/>
   
<xs:enumeration value="810"/>
   
<xs:enumeration value="820"/>
   
<xs:enumeration value="830"/>
   
<xs:enumeration value="840"/>
   
<xs:enumeration value="841"/>
   
<xs:enumeration value="842"/>
   
<xs:enumeration value="850"/>
   
<xs:enumeration value="860"/>
   
<xs:enumeration value="870"/>
   
<xs:enumeration value="880"/>
   
<xs:enumeration value="999"/>
 
</xs:restriction>
</xs:simpleType>

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

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

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

source <xs:simpleType name="fileOnBehalfTypeCode">
 
<xs:annotation>
   
<xs:documentation> File On Behalf Type
Valid Values
'E' - Employer
'I' - Insurance Carrier
'B' - Both

</xs:documentation>
 
</xs:annotation>
 
<xs:restriction base="CF:typeCode1">
   
<xs:enumeration value="E"/>
   
<xs:enumeration value="I"/>
   
<xs:enumeration value="B"/>
 
</xs:restriction>
</xs:simpleType>

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

simpleType firstName
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
element PersonNameGroup/FirstName
facets
Kind Value annotation 
minLength 
maxLength 25 
whiteSpace preserve 
pattern ([A-Z ])* 
source <xs:simpleType name="firstName">
 
<xs:restriction base="xs:string">
   
<xs:maxLength value="25"/>
   
<xs:whiteSpace value="preserve"/>
   
<xs:minLength value="1"/>
   
<xs:pattern value="([A-Z ])*"/>
 
</xs:restriction>
</xs:simpleType>

simpleType fullAddress
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
element DeclarantSignatureGroup/DeclarantOrLawFirmAddress
facets
Kind Value annotation 
minLength 
maxLength 56 
whiteSpace preserve 
pattern ([A-Z0-9 ])* 
source <xs:simpleType name="fullAddress">
 
<xs:restriction base="xs:string">
   
<xs:maxLength value="56"/>
   
<xs:minLength value="1"/>
   
<xs:whiteSpace value="preserve"/>
   
<xs:pattern value="([A-Z0-9 ])*"/>
 
</xs:restriction>
</xs:simpleType>

simpleType fullLongName
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
facets
Kind Value annotation 
minLength 
maxLength 80 
pattern ([A-Z ])* 
source <xs:simpleType name="fullLongName">
 
<xs:restriction base="xs:string">
   
<xs:maxLength value="80"/>
   
<xs:minLength value="1"/>
   
<xs:pattern value="([A-Z ])*"/>
 
</xs:restriction>
</xs:simpleType>

simpleType fullName
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
elements DeclarantSignatureGroup/DeclarantOrLawFirmName NameGroup/EmployerName
simpleType employerName
facets
Kind Value annotation 
minLength 
maxLength 56 
pattern ([A-Z 0-9])* 
source <xs:simpleType name="fullName">
 
<xs:restriction base="xs:string">
   
<xs:maxLength value="56"/>
   
<xs:minLength value="2"/>
   
<xs:pattern value="([A-Z 0-9])*"/>
 
</xs:restriction>
</xs:simpleType>

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

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

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

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

simpleType lastName
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
element PersonNameGroup/LastName
facets
Kind Value annotation 
minLength 
maxLength 25 
whiteSpace preserve 
pattern ([A-Z ])* 
source <xs:simpleType name="lastName">
 
<xs:restriction base="xs:string">
   
<xs:maxLength value="25"/>
   
<xs:minLength value="1"/>
   
<xs:whiteSpace value="preserve"/>
   
<xs:pattern value="([A-Z ])*"/>
 
</xs:restriction>
</xs:simpleType>

simpleType lawFirmNumber
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
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
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 NoticeandRequestofLien/LienClaimantAttorneyOrRepSection/PhoneNumber LienClaimant/PhoneNumber LienClaimantAttorneyOrRep/AttorneyOrRep/PhoneNumber 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/AttorneySignature Signature/DeclarantSignature SignatureAddressGroup/DeclarantSignature DeclarantSignatureGroup/DeclarantSignature Signature/LienClaimantSignature
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 LienInformationSectionGroup/SocialSecurityNumber
facets
Kind Value annotation 
length 
whiteSpace collapse 
pattern ([0-9])* 
source <xs:simpleType name="socialSecurityNumber">
 
<xs:restriction base="xs:string">
   
<xs:length value="9"/>
   
<xs:whiteSpace value="collapse"/>
   
<xs:pattern value="([0-9])*"/>
 
</xs:restriction>
</xs:simpleType>

simpleType state
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
element AddressGroup/State
facets
Kind Value annotation 
minLength 
maxLength 
whiteSpace preserve 
pattern ([A-Z])* 
source <xs:simpleType name="state">
 
<xs:restriction base="xs:string">
   
<xs:whiteSpace value="preserve"/>
   
<xs:minLength value="2"/>
   
<xs:maxLength value="2"/>
   
<xs:pattern value="([A-Z])*"/>
 
</xs:restriction>
</xs:simpleType>

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

simpleType venueOfficeCode
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of typeCode3
properties
base CF:typeCode3
used by
element VenueInformationGroup/VenueOfficeCode
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration STK 
enumeration SFO 
enumeration SAC 
enumeration LBO 
enumeration VNO 
enumeration SAL 
enumeration OAK 
enumeration SDO 
enumeration MDR 
enumeration OXN 
enumeration EUR 
enumeration SRO 
enumeration SBR 
enumeration AHM 
enumeration RIV 
enumeration FRE 
enumeration LAO 
enumeration POM 
enumeration SJO 
enumeration ANA 
enumeration BAK 
enumeration GRO 
enumeration RDG 
enumeration SLO 
annotation
documentation
Venue Office Code
'STK'  - Stockton       
'SFO'  - San Francisco  
'SAC'  - Sacramento     
'GOL'  - Goleta (Closed since Jan. 2014)
'LBO'  - Long Beach     
'VNO'  - Van Nuys       
'SAL'  -  Salinas        
'OAK'  - Oakland        
'SDO'  - San Diego      
'MDR'  - Marina Del Rey 
'OXN'  -  Oxnard         
'EUR'  -  Eureka         
'SRO'  - Santa Rosa     
'SBR'  -  San Bernardino 
'AHM' -  Anaheim        
'RIV'   -  Riverside      
'FRE'  -  Fresno         
'LAO'  -  Los Angeles    
'POM' -  Pomona         
'SJO'  -  San Jose       
'ANA'  -  Santa Ana      
'BAK'  -  Bakersfield    
'GRO'  - Grover Beach   
'RDG'  - Redding 
'SLO' - San Luis Obispo    
 
source <xs:simpleType name="venueOfficeCode">
 
<xs:annotation>
   
<xs:documentation> Venue Office Code
'STK'  - Stockton       
'SFO'  - San Francisco  
'SAC'  - Sacramento     
'GOL'  - Goleta (Closed since Jan. 2014)
'LBO'  - Long Beach     
'VNO'  - Van Nuys       
'SAL'  -  Salinas        
'OAK'  - Oakland        
'SDO'  - San Diego      
'MDR'  - Marina Del Rey 
'OXN'  -  Oxnard         
'EUR'  -  Eureka         
'SRO'  - Santa Rosa     
'SBR'  -  San Bernardino 
'AHM' -  Anaheim        
'RIV'   -  Riverside      
'FRE'  -  Fresno         
'LAO'  -  Los Angeles    
'POM' -  Pomona         
'SJO'  -  San Jose       
'ANA'  -  Santa Ana      
'BAK'  -  Bakersfield    
'GRO'  - Grover Beach   
'RDG'  - Redding 
'SLO' - San Luis Obispo    
 
</xs:documentation>
 
</xs:annotation>
 
<xs:restriction base="CF:typeCode3">
   
<xs:whiteSpace value="collapse"/>
   
<xs:enumeration value="STK"/>
   
<xs:enumeration value="SFO"/>
   
<xs:enumeration value="SAC"/>
   
<xs:enumeration value="LBO"/>
   
<xs:enumeration value="VNO"/>
   
<xs:enumeration value="SAL"/>
   
<xs:enumeration value="OAK"/>
   
<xs:enumeration value="SDO"/>
   
<xs:enumeration value="MDR"/>
   
<xs:enumeration value="OXN"/>
   
<xs:enumeration value="EUR"/>
   
<xs:enumeration value="SRO"/>
   
<xs:enumeration value="SBR"/>
   
<xs:enumeration value="AHM"/>
   
<xs:enumeration value="RIV"/>
   
<xs:enumeration value="FRE"/>
   
<xs:enumeration value="LAO"/>
   
<xs:enumeration value="POM"/>
   
<xs:enumeration value="SJO"/>
   
<xs:enumeration value="ANA"/>
   
<xs:enumeration value="BAK"/>
   
<xs:enumeration value="GRO"/>
   
<xs:enumeration value="RDG"/>
   
<xs:enumeration value="SLO"/>
   
<!--  xs:enumeration value="GOL"/ -->
 
</xs:restriction>
</xs:simpleType>

simpleType zip4Code
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
facets
Kind Value annotation 
length 
whiteSpace collapse 
pattern \d\d\d\d 
source <xs:simpleType name="zip4Code">
 
<xs:restriction base="xs:string">
   
<xs:length value="4" fixed="true"/>
   
<xs:whiteSpace value="collapse"/>
   
<xs:pattern value="\d\d\d\d"/>
 
</xs:restriction>
</xs:simpleType>

simpleType zip5Code
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields
type restriction of xs:string
properties
base xs:string
used by
element AddressGroup/Zip5Code
facets
Kind Value annotation 
length 
whiteSpace collapse 
pattern \d\d\d\d\d 
source <xs:simpleType name="zip5Code">
 
<xs:restriction base="xs:string">
   
<xs:whiteSpace value="collapse"/>
   
<xs:length value="5"/>
   
<xs:pattern value="\d\d\d\d\d"/>
 
</xs:restriction>
</xs:simpleType>

group AddressGroup
diagram NoticeandRequestofLien_p65.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 NoticeandRequestofLien_p66.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 NoticeandRequestofLien_p67.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 NoticeandRequestofLien_p68.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 NoticeandRequestofLien_p69.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 NoticeandRequestofLien_p70.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 NoticeandRequestofLien_p71.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 NoticeandRequestofLien_p72.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 NoticeandRequestofLien_p73.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 NoticeandRequestofLien_p74.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 NoticeandRequestofLien_p75.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 NoticeandRequestofLien_p76.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 NoticeandRequestofLien_p77.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 NoticeandRequestofLien_p78.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 NoticeandRequestofLien_p79.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 NoticeandRequestofLien_p80.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 NoticeandRequestofLien_p81.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 NoticeandRequestofLien_p82.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 NoticeandRequestofLien_p83.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children InjuryType DateOfInjuryStart DateOfInjuryEnd
used by
complexType InjuryType
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 NoticeandRequestofLien_p84.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 NoticeandRequestofLien_p85.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 NoticeandRequestofLien_p86.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 NoticeandRequestofLien_p87.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children FirstName MiddleInitial LastName
used by
complexTypes NameGroup 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 NoticeandRequestofLien_p88.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 NoticeandRequestofLien_p89.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 NoticeandRequestofLien_p90.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 NoticeandRequestofLien_p91.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 NoticeandRequestofLien_p92.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 NoticeandRequestofLien_p93.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 NoticeandRequestofLien_p94.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 NoticeandRequestofLien_p95.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 NoticeandRequestofLien_p96.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 NoticeandRequestofLien_p97.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 NoticeandRequestofLien_p98.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 NoticeandRequestofLien_p99.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 
source <xs:element name="VenueOfficeCode" type="FF:venueOfficeCode"/>

complexType Address
diagram NoticeandRequestofLien_p100.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children AddressLine1 City State Zip5Code
used by
elements LienClaimant/Address LienClaimantAttorneyOrRep/AttorneyOrRep/Address AttorneyorRep/Address AttorneyorRepWithoutNumber/Address OrganizationInformation/Address PersonInformation/Address
source <xs:complexType name="Address">
 
<xs:group ref="AddressGroup"/>
</xs:complexType>

complexType AttorneyorRep
diagram NoticeandRequestofLien_p101.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children AttorneyorAuthRepTypeCode EmployerName LawFirmNumber Name Address
used by
element NoticeandRequestofLien/LienClaimantAttorneyOrRepSection
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 NoticeandRequestofLien_p102.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 NoticeandRequestofLien_p103.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 NoticeandRequestofLien_p104.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 NoticeandRequestofLien_p105.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 NoticeandRequestofLien_p106.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 NoticeandRequestofLien_p107.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 NoticeandRequestofLien_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 AttorneyorRepWithoutNumber/EmployerName
diagram NoticeandRequestofLien_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 AttorneyorRepWithoutNumber/Name
diagram NoticeandRequestofLien_p110.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 NoticeandRequestofLien_p111.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 NoticeandRequestofLien_p112.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 NoticeandRequestofLien_p113.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children Checkbox
used by
elements LienClaimantAttorneyOrRep/LienClaimantNotRepresented Signature/LienDeliveredIndicator
source <xs:complexType name="CheckBox">
 
<xs:sequence>
   
<xs:element name="Checkbox" type="CF:checkBox" default="false"/>
 
</xs:sequence>
</xs:complexType>

element CheckBox/Checkbox
diagram NoticeandRequestofLien_p114.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 NoticeandRequestofLien_p115.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 NoticeandRequestofLien_p116.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 NoticeandRequestofLien_p117.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 NoticeandRequestofLien_p118.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 NoticeandRequestofLien_p119.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 NoticeandRequestofLien_p120.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 NoticeandRequestofLien_p121.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
diagram NoticeandRequestofLien_p122.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type restriction of sftField
properties
isRef 0
content simple
facets
Kind Value annotation 
maxLength 40 
pattern ([A-Z0-9 ])* 
source <xs:element name="EmployerName">
 
<xs:simpleType>
   
<xs:restriction base="FF:sftField">
     
<xs:maxLength value="40"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

complexType InjuryInformation
diagram NoticeandRequestofLien_p123.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children InjuryType DateOfInjuryStart DateOfInjuryEnd BodyPartInformation
source <xs:complexType name="InjuryInformation">
 
<xs:group ref="InjuryInformationGroup"/>
</xs:complexType>

complexType OrganizationInformation
diagram NoticeandRequestofLien_p124.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type extension of EmployerName
properties
base EmployerName
children EmployerName Address
used by
elements NoticeandRequestofLien/EmployerOrClaimsAdminAttorneySection NoticeandRequestofLien/EmployerSection Signature/Firm SignatureAddressGroup/Firm NoticeandRequestofLien/InjuredWorkerAttorneyOrRepSection NoticeandRequestofLien/InsuranceCarrierOrClaimsAdministratorSection
source <xs:complexType name="OrganizationInformation">
 
<xs:complexContent>
   
<xs:extension base="EmployerName">
     
<xs:sequence>
       
<xs:element name="Address" type="Address"/>
     
</xs:sequence>
   
</xs:extension>
 
</xs:complexContent>
</xs:complexType>

element OrganizationInformation/Address
diagram NoticeandRequestofLien_p125.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 PersonInformation
diagram NoticeandRequestofLien_p126.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children Name Address
used by
element NoticeandRequestofLien/InjuredWorkerSection
source <xs:complexType name="PersonInformation">
 
<xs:sequence>
   
<xs:element name="Name" type="PersonName"/>
   
<xs:element name="Address" type="Address"/>
 
</xs:sequence>
</xs:complexType>

element PersonInformation/Name
diagram NoticeandRequestofLien_p127.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type PersonName
properties
isRef 0
content complex
children FirstName MiddleInitial LastName
source <xs:element name="Name" type="PersonName"/>

element PersonInformation/Address
diagram NoticeandRequestofLien_p128.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 PersonName
diagram NoticeandRequestofLien_p129.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children FirstName MiddleInitial LastName
used by
elements LienClaimant/Name LienClaimantAttorneyOrRep/AttorneyOrRep/Name AttorneyorRep/Name AttorneyorRepWithoutNumber/Name PersonInformation/Name
source <xs:complexType name="PersonName">
 
<xs:group ref="PersonNameGroup"/>
</xs:complexType>

complexType SelectionType126
diagram NoticeandRequestofLien_p130.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children SelectionCheckbox Explanation
source <xs:complexType name="SelectionType126">
 
<xs:sequence>
   
<xs:element name="SelectionCheckbox" type="CF:checkBox" minOccurs="0"/>
   
<xs:element name="Explanation" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="xs:string">
         
<xs:maxLength value="126"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element SelectionType126/SelectionCheckbox
diagram NoticeandRequestofLien_p131.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type checkBox
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
whiteSpace collapse 
source <xs:element name="SelectionCheckbox" type="CF:checkBox" minOccurs="0"/>

element SelectionType126/Explanation
diagram NoticeandRequestofLien_p132.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1