Schema Stips.xsd


attribute form default:  unqualified
element form default:  qualified
targetNamespace:  http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
 
Elements  Complex types 
Stips  ApplicantAttorneyRequiresAFeeOf 
ApplicationSection 
BenefitsSection 
EmployerInfo 
EmployerSection 
HeaderSection 
InterpreterLicense 
OtherStipulations 


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/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/CommonFields
 
Simple types 
caseNumber 
checkBox 
ptsDate 
typeCode1 
typeCode3 
versionNumber 


element Stips
diagram Stips_p1.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
properties
content complex
children HeaderSection ApplicationSection InjuredWorkerSection EmployersSection BenefitsSection OtherStipulationsSection InjuredWorkerAttorneyOrAuthorizedRepSection DefendantsAttorneyAOrAuthorizedRepSection InterpreterLicenseSection
annotation
documentation
Stipulations with Request for Award
source <xs:element name="Stips">
 
<xs:annotation>
   
<xs:documentation>Stipulations with Request for Award</xs:documentation>
 
</xs:annotation>
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="HeaderSection" type="HeaderSection"/>
     
<xs:element name="ApplicationSection" type="ApplicationSection">
       
<xs:annotation>
         
<xs:documentation>Coversheet data, SSN and venue location</xs:documentation>
       
</xs:annotation>
     
</xs:element>
     
<xs:element name="InjuredWorkerSection" type="CD:PersonInformation">
       
<xs:annotation>
         
<xs:documentation>Applicant name and address</xs:documentation>
       
</xs:annotation>
     
</xs:element>
     
<xs:element name="EmployersSection" type="EmployerInfo" maxOccurs="4">
       
<xs:annotation>
         
<xs:documentation>If there is an Employer then there has to be a Claims Administrator</xs:documentation>
       
</xs:annotation>
     
</xs:element>
     
<xs:element name="BenefitsSection" type="BenefitsSection">
       
<xs:annotation>
         
<xs:documentation>Injured worker name and address. Permanent or temporary disability information. </xs:documentation>
       
</xs:annotation>
     
</xs:element>
     
<xs:element name="OtherStipulationsSection" type="OtherStipulations" minOccurs="0"/>
     
<xs:element name="InjuredWorkerAttorneyOrAuthorizedRepSection" type="CD:AttorneyorRep" minOccurs="0"/>
     
<xs:element name="DefendantsAttorneyAOrAuthorizedRepSection" type="CD:AttorneyorRep" minOccurs="0" maxOccurs="3"/>
     
<xs:element name="InterpreterLicenseSection" type="InterpreterLicense" minOccurs="0"/>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element Stips/HeaderSection
diagram Stips_p2.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type HeaderSection
properties
isRef 0
content complex
children VersionNumber
source <xs:element name="HeaderSection" type="HeaderSection"/>

element Stips/ApplicationSection
diagram Stips_p3.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type ApplicationSection
properties
isRef 0
content complex
children SocialSecurityNumber Venue DateOfBirth Occupation Group InjuryInformation
annotation
documentation
Coversheet data, SSN and venue location
source <xs:element name="ApplicationSection" type="ApplicationSection">
 
<xs:annotation>
   
<xs:documentation>Coversheet data, SSN and venue location</xs:documentation>
 
</xs:annotation>
</xs:element>

element Stips/InjuredWorkerSection
diagram Stips_p4.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type PersonInformation
properties
isRef 0
content complex
children Name Address
annotation
documentation
Applicant name and address
source <xs:element name="InjuredWorkerSection" type="CD:PersonInformation">
 
<xs:annotation>
   
<xs:documentation>Applicant name and address</xs:documentation>
 
</xs:annotation>
</xs:element>

element Stips/EmployersSection
diagram Stips_p5.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type EmployerInfo
properties
isRef 0
minOcc 1
maxOcc 4
content complex
children EmployerSection InsuranceCarrier ClaimsAdministrator
annotation
documentation
If there is an Employer then there has to be a Claims Administrator
source <xs:element name="EmployersSection" type="EmployerInfo" maxOccurs="4">
 
<xs:annotation>
   
<xs:documentation>If there is an Employer then there has to be a Claims Administrator</xs:documentation>
 
</xs:annotation>
</xs:element>

element Stips/BenefitsSection
diagram Stips_p6.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type BenefitsSection
properties
isRef 0
content complex
children BenefitsInformation
annotation
documentation
Injured worker name and address. Permanent or temporary disability information.
source <xs:element name="BenefitsSection" type="BenefitsSection">
 
<xs:annotation>
   
<xs:documentation>Injured worker name and address. Permanent or temporary disability information. </xs:documentation>
 
</xs:annotation>
</xs:element>

element Stips/OtherStipulationsSection
diagram Stips_p7.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type OtherStipulations
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children OtherStipulationDescription Date ApplicantSignature
source <xs:element name="OtherStipulationsSection" type="OtherStipulations" minOccurs="0"/>

element Stips/InjuredWorkerAttorneyOrAuthorizedRepSection
diagram Stips_p8.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type AttorneyorRep
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children AttorneyorAuthRepTypeCode EmployerName LawFirmNumber Name Address
source <xs:element name="InjuredWorkerAttorneyOrAuthorizedRepSection" type="CD:AttorneyorRep" minOccurs="0"/>

element Stips/DefendantsAttorneyAOrAuthorizedRepSection
diagram Stips_p9.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type AttorneyorRep
properties
isRef 0
minOcc 0
maxOcc 3
content complex
children AttorneyorAuthRepTypeCode EmployerName LawFirmNumber Name Address
source <xs:element name="DefendantsAttorneyAOrAuthorizedRepSection" type="CD:AttorneyorRep" minOccurs="0" maxOccurs="3"/>

element Stips/InterpreterLicenseSection
diagram Stips_p10.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type InterpreterLicense
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children InterpreterName InterpreterLicenseNumber
source <xs:element name="InterpreterLicenseSection" type="InterpreterLicense" minOccurs="0"/>

complexType ApplicantAttorneyRequiresAFeeOf
diagram Stips_p11.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
children Fee FeesToBeCommutedAsFollows
used by
element BenefitsSection/BenefitsInformation/ApplicantAttorneyRequiresAFeeOf
annotation
documentation
Information to compute the attorney fee
source <xs:complexType name="ApplicantAttorneyRequiresAFeeOf">
 
<xs:annotation>
   
<xs:documentation>Information to compute the attorney fee</xs:documentation>
 
</xs:annotation>
 
<xs:sequence>
   
<xs:element name="Fee" type="FF:amount" minOccurs="0"/>
   
<xs:element name="FeesToBeCommutedAsFollows" minOccurs="0">
     
<xs:annotation>
       
<xs:documentation>Limited to 256 characters</xs:documentation>
     
</xs:annotation>
     
<xs:simpleType>
       
<xs:restriction base="xs:string">
         
<xs:maxLength value="256"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element ApplicantAttorneyRequiresAFeeOf/Fee
diagram Stips_p12.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
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="Fee" type="FF:amount" minOccurs="0"/>

element ApplicantAttorneyRequiresAFeeOf/FeesToBeCommutedAsFollows
diagram Stips_p13.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 256 
annotation
documentation
Limited to 256 characters
source <xs:element name="FeesToBeCommutedAsFollows" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Limited to 256 characters</xs:documentation>
 
</xs:annotation>
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="256"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

complexType ApplicationSection
diagram Stips_p14.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
children SocialSecurityNumber Venue DateOfBirth Occupation Group InjuryInformation
used by
element Stips/ApplicationSection
annotation
documentation
Contains the SSN, Date of Injury and Venu information
source <xs:complexType name="ApplicationSection">
 
<xs:annotation>
   
<xs:documentation> Contains the SSN, Date of Injury and Venu information</xs:documentation>
 
</xs:annotation>
 
<xs:sequence>
   
<xs:element name="SocialSecurityNumber" type="FF:socialSecurityNumber" minOccurs="0"/>
   
<xs:element name="Venue" type="CD:VenueInformation"/>
   
<xs:element name="DateOfBirth" type="CF:ptsDate"/>
   
<xs:element name="Occupation" type="FF:occupationText" minOccurs="0"/>
   
<xs:element name="Group" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="xs:string">
         
<xs:maxLength value="3"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="InjuryInformation" minOccurs="0">
     
<xs:complexType>
       
<xs:complexContent>
         
<xs:extension base="CD:InjuryInformation">
           
<xs:sequence>
             
<xs:element name="BodyPartFreeText" minOccurs="0">
               
<xs:simpleType>
                 
<xs:restriction base="xs:string">
                   
<xs:maxLength value="455"/>
                 
</xs:restriction>
               
</xs:simpleType>
             
</xs:element>
             
<xs:element name="Address" minOccurs="1">
               
<xs:complexType>
                 
<xs:sequence>
                   
<xs:element name="City">
                     
<xs:simpleType>
                       
<xs:restriction base="FF:city"/>
                     
</xs:simpleType>
                   
</xs:element>
                   
<xs:element name="State" type="FF:state"/>
                 
</xs:sequence>
               
</xs:complexType>
             
</xs:element>
           
</xs:sequence>
         
</xs:extension>
       
</xs:complexContent>
     
</xs:complexType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element ApplicationSection/SocialSecurityNumber
diagram Stips_p15.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type socialSecurityNumber
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
pattern ([0-9])* 
source <xs:element name="SocialSecurityNumber" type="FF:socialSecurityNumber" minOccurs="0"/>

element ApplicationSection/Venue
diagram Stips_p16.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type VenueInformation
properties
isRef 0
content complex
children VenueLocationCode VenueOfficeCode
source <xs:element name="Venue" type="CD:VenueInformation"/>

element ApplicationSection/DateOfBirth
diagram Stips_p17.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type ptsDate
properties
isRef 0
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="DateOfBirth" type="CF:ptsDate"/>

element ApplicationSection/Occupation
diagram Stips_p18.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type occupationText
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 56 
whiteSpace preserve 
source <xs:element name="Occupation" type="FF:occupationText" minOccurs="0"/>

element ApplicationSection/Group
diagram Stips_p19.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 
source <xs:element name="Group" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="3"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element ApplicationSection/InjuryInformation
diagram Stips_p20.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type extension of InjuryInformation
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children InjuryType DateOfInjuryStart DateOfInjuryEnd BodyPartInformation BodyPartFreeText Address
source <xs:element name="InjuryInformation" minOccurs="0">
 
<xs:complexType>
   
<xs:complexContent>
     
<xs:extension base="CD:InjuryInformation">
       
<xs:sequence>
         
<xs:element name="BodyPartFreeText" minOccurs="0">
           
<xs:simpleType>
             
<xs:restriction base="xs:string">
               
<xs:maxLength value="455"/>
             
</xs:restriction>
           
</xs:simpleType>
         
</xs:element>
         
<xs:element name="Address" minOccurs="1">
           
<xs:complexType>
             
<xs:sequence>
               
<xs:element name="City">
                 
<xs:simpleType>
                   
<xs:restriction base="FF:city"/>
                 
</xs:simpleType>
               
</xs:element>
               
<xs:element name="State" type="FF:state"/>
             
</xs:sequence>
           
</xs:complexType>
         
</xs:element>
       
</xs:sequence>
     
</xs:extension>
   
</xs:complexContent>
 
</xs:complexType>
</xs:element>

element ApplicationSection/InjuryInformation/BodyPartFreeText
diagram Stips_p21.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 455 
source <xs:element name="BodyPartFreeText" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="455"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element ApplicationSection/InjuryInformation/Address
diagram Stips_p22.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
properties
isRef 0
content complex
children City State
source <xs:element name="Address" minOccurs="1">
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="City">
       
<xs:simpleType>
         
<xs:restriction base="FF:city"/>
       
</xs:simpleType>
     
</xs:element>
     
<xs:element name="State" type="FF:state"/>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element ApplicationSection/InjuryInformation/Address/City
diagram Stips_p23.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type restriction of city
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 25 
whiteSpace preserve 
pattern ([A-Z' ])* 
source <xs:element name="City">
 
<xs:simpleType>
   
<xs:restriction base="FF:city"/>
 
</xs:simpleType>
</xs:element>

element ApplicationSection/InjuryInformation/Address/State
diagram Stips_p24.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type state
properties
isRef 0
content simple
facets
Kind Value annotation 
minLength 
maxLength 
whiteSpace preserve 
pattern ([A-Z])* 
source <xs:element name="State" type="FF:state"/>

complexType BenefitsSection
diagram Stips_p25.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
children BenefitsInformation
used by
element Stips/BenefitsSection
source <xs:complexType name="BenefitsSection">
 
<xs:sequence>
   
<xs:element name="BenefitsInformation">
     
<xs:annotation>
       
<xs:documentation>All the disability payment information</xs:documentation>
     
</xs:annotation>
     
<xs:complexType>
       
<xs:sequence>
         
<xs:element name="TemporaryDisability" minOccurs="0">
           
<xs:annotation>
             
<xs:documentation>Optional, however, is the TemporaryDisabilityStartDate is entered then the EndDate and Amount are  required</xs:documentation>
           
</xs:annotation>
           
<xs:complexType>
             
<xs:sequence>
               
<xs:element name="TemporaryDisabilityIndemnityPaid" type="FF:amount" minOccurs="0"/>
               
<xs:element name="DatesTemporaryDisability" type="CD:StartAndEndDate" minOccurs="0"/>
             
</xs:sequence>
           
</xs:complexType>
         
</xs:element>
         
<xs:element name="AdditionalTemporaryDisability" minOccurs="0">
           
<xs:annotation>
             
<xs:documentation>Optional, however if the Start date is entered then the endDate, rate and amount are required.</xs:documentation>
           
</xs:annotation>
           
<xs:complexType>
             
<xs:sequence>
               
<xs:element name="DateAdditionalTemporaryDisability" type="CD:StartAndEndDate" minOccurs="0"/>
               
<xs:element name="AdditionaltemporaryDisabilityRate" type="FF:amount" minOccurs="0"/>
               
<xs:element name="AdditionalTemporaryDisabilityIndemnityPaid" type="FF:amount" minOccurs="0"/>
             
</xs:sequence>
           
</xs:complexType>
         
</xs:element>
         
<xs:element name="PermanentDisability" minOccurs="0">
           
<xs:annotation>
             
<xs:documentation>The permanent disability amount, start and end dates</xs:documentation>
           
</xs:annotation>
           
<xs:complexType>
             
<xs:sequence>
               
<xs:element name="PermanentDisabilityIndemnityPercent" type="xs:decimal" minOccurs="0"/>
               
<xs:element name="PermanentDisabilityIndemnityRate" type="FF:amount" minOccurs="0"/>
               
<xs:element name="DatePermanentDisabilityIndemnityStarts" type="CF:ptsDate" minOccurs="0"/>
               
<xs:element name="PermanentDisabilityIndemnityPaid" type="FF:amount" minOccurs="0"/>
               
<xs:element name="LifePensionAmount" type="FF:amount" minOccurs="0"/>
             
</xs:sequence>
           
</xs:complexType>
         
</xs:element>
         
<xs:element name="LaborCodeAdjustment" minOccurs="0">
           
<xs:complexType>
             
<xs:sequence>
               
<xs:element name="AdjustmentType" type="FF:laborAdjustmentTypeCode" minOccurs="0"/>
               
<xs:element name="AdjustmentRate" type="FF:amount" minOccurs="0"/>
               
<xs:element name="DateOfAdjustmentStart" type="CF:ptsDate" minOccurs="0"/>
             
</xs:sequence>
           
</xs:complexType>
         
</xs:element>
         
<xs:element name="InformalRatingCaseNumber" minOccurs="0">
           
<xs:annotation>
             
<xs:documentation>Limited to 12 characters</xs:documentation>
           
</xs:annotation>
           
<xs:simpleType>
             
<xs:restriction base="xs:string">
               
<xs:maxLength value="12"/>
             
</xs:restriction>
           
</xs:simpleType>
         
</xs:element>
         
<xs:element name="NeedForMedicalTreatment" type="CF:checkBox">
           
<xs:annotation>
             
<xs:documentation>Radio buttons indicating the need for medical treatment to cure or relieve effects</xs:documentation>
           
</xs:annotation>
         
</xs:element>
         
<xs:element name="Medical-LegalExpensesPayableByDefendantAsFollows" minOccurs="0">
           
<xs:annotation>
             
<xs:documentation>Limited to 189 characters</xs:documentation>
           
</xs:annotation>
           
<xs:simpleType>
             
<xs:restriction base="xs:string">
               
<xs:maxLength value="189"/>
             
</xs:restriction>
           
</xs:simpleType>
         
</xs:element>
         
<xs:element name="ApplicantAttorneyRequiresAFeeOf" type="ApplicantAttorneyRequiresAFeeOf" minOccurs="0"/>
         
<xs:element name="LiensAgainstCompensation" minOccurs="0">
           
<xs:annotation>
             
<xs:documentation>Limited to 440 characters</xs:documentation>
           
</xs:annotation>
           
<xs:simpleType>
             
<xs:restriction base="xs:string">
               
<xs:maxLength value="440"/>
             
</xs:restriction>
           
</xs:simpleType>
         
</xs:element>
       
</xs:sequence>
     
</xs:complexType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element BenefitsSection/BenefitsInformation
diagram Stips_p26.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
properties
isRef 0
content complex
children TemporaryDisability AdditionalTemporaryDisability PermanentDisability LaborCodeAdjustment InformalRatingCaseNumber NeedForMedicalTreatment Medical-LegalExpensesPayableByDefendantAsFollows ApplicantAttorneyRequiresAFeeOf LiensAgainstCompensation
annotation
documentation
All the disability payment information
source <xs:element name="BenefitsInformation">
 
<xs:annotation>
   
<xs:documentation>All the disability payment information</xs:documentation>
 
</xs:annotation>
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="TemporaryDisability" minOccurs="0">
       
<xs:annotation>
         
<xs:documentation>Optional, however, is the TemporaryDisabilityStartDate is entered then the EndDate and Amount are  required</xs:documentation>
       
</xs:annotation>
       
<xs:complexType>
         
<xs:sequence>
           
<xs:element name="TemporaryDisabilityIndemnityPaid" type="FF:amount" minOccurs="0"/>
           
<xs:element name="DatesTemporaryDisability" type="CD:StartAndEndDate" minOccurs="0"/>
         
</xs:sequence>
       
</xs:complexType>
     
</xs:element>
     
<xs:element name="AdditionalTemporaryDisability" minOccurs="0">
       
<xs:annotation>
         
<xs:documentation>Optional, however if the Start date is entered then the endDate, rate and amount are required.</xs:documentation>
       
</xs:annotation>
       
<xs:complexType>
         
<xs:sequence>
           
<xs:element name="DateAdditionalTemporaryDisability" type="CD:StartAndEndDate" minOccurs="0"/>
           
<xs:element name="AdditionaltemporaryDisabilityRate" type="FF:amount" minOccurs="0"/>
           
<xs:element name="AdditionalTemporaryDisabilityIndemnityPaid" type="FF:amount" minOccurs="0"/>
         
</xs:sequence>
       
</xs:complexType>
     
</xs:element>
     
<xs:element name="PermanentDisability" minOccurs="0">
       
<xs:annotation>
         
<xs:documentation>The permanent disability amount, start and end dates</xs:documentation>
       
</xs:annotation>
       
<xs:complexType>
         
<xs:sequence>
           
<xs:element name="PermanentDisabilityIndemnityPercent" type="xs:decimal" minOccurs="0"/>
           
<xs:element name="PermanentDisabilityIndemnityRate" type="FF:amount" minOccurs="0"/>
           
<xs:element name="DatePermanentDisabilityIndemnityStarts" type="CF:ptsDate" minOccurs="0"/>
           
<xs:element name="PermanentDisabilityIndemnityPaid" type="FF:amount" minOccurs="0"/>
           
<xs:element name="LifePensionAmount" type="FF:amount" minOccurs="0"/>
         
</xs:sequence>
       
</xs:complexType>
     
</xs:element>
     
<xs:element name="LaborCodeAdjustment" minOccurs="0">
       
<xs:complexType>
         
<xs:sequence>
           
<xs:element name="AdjustmentType" type="FF:laborAdjustmentTypeCode" minOccurs="0"/>
           
<xs:element name="AdjustmentRate" type="FF:amount" minOccurs="0"/>
           
<xs:element name="DateOfAdjustmentStart" type="CF:ptsDate" minOccurs="0"/>
         
</xs:sequence>
       
</xs:complexType>
     
</xs:element>
     
<xs:element name="InformalRatingCaseNumber" minOccurs="0">
       
<xs:annotation>
         
<xs:documentation>Limited to 12 characters</xs:documentation>
       
</xs:annotation>
       
<xs:simpleType>
         
<xs:restriction base="xs:string">
           
<xs:maxLength value="12"/>
         
</xs:restriction>
       
</xs:simpleType>
     
</xs:element>
     
<xs:element name="NeedForMedicalTreatment" type="CF:checkBox">
       
<xs:annotation>
         
<xs:documentation>Radio buttons indicating the need for medical treatment to cure or relieve effects</xs:documentation>
       
</xs:annotation>
     
</xs:element>
     
<xs:element name="Medical-LegalExpensesPayableByDefendantAsFollows" minOccurs="0">
       
<xs:annotation>
         
<xs:documentation>Limited to 189 characters</xs:documentation>
       
</xs:annotation>
       
<xs:simpleType>
         
<xs:restriction base="xs:string">
           
<xs:maxLength value="189"/>
         
</xs:restriction>
       
</xs:simpleType>
     
</xs:element>
     
<xs:element name="ApplicantAttorneyRequiresAFeeOf" type="ApplicantAttorneyRequiresAFeeOf" minOccurs="0"/>
     
<xs:element name="LiensAgainstCompensation" minOccurs="0">
       
<xs:annotation>
         
<xs:documentation>Limited to 440 characters</xs:documentation>
       
</xs:annotation>
       
<xs:simpleType>
         
<xs:restriction base="xs:string">
           
<xs:maxLength value="440"/>
         
</xs:restriction>
       
</xs:simpleType>
     
</xs:element>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element BenefitsSection/BenefitsInformation/TemporaryDisability
diagram Stips_p27.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children TemporaryDisabilityIndemnityPaid DatesTemporaryDisability
annotation
documentation
Optional, however, is the TemporaryDisabilityStartDate is entered then the EndDate and Amount are  required
source <xs:element name="TemporaryDisability" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Optional, however, is the TemporaryDisabilityStartDate is entered then the EndDate and Amount are  required</xs:documentation>
 
</xs:annotation>
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="TemporaryDisabilityIndemnityPaid" type="FF:amount" minOccurs="0"/>
     
<xs:element name="DatesTemporaryDisability" type="CD:StartAndEndDate" minOccurs="0"/>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element BenefitsSection/BenefitsInformation/TemporaryDisability/TemporaryDisabilityIndemnityPaid
diagram Stips_p28.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
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="TemporaryDisabilityIndemnityPaid" type="FF:amount" minOccurs="0"/>

element BenefitsSection/BenefitsInformation/TemporaryDisability/DatesTemporaryDisability
diagram Stips_p29.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type StartAndEndDate
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children DateStarts DateEnds
source <xs:element name="DatesTemporaryDisability" type="CD:StartAndEndDate" minOccurs="0"/>

element BenefitsSection/BenefitsInformation/AdditionalTemporaryDisability
diagram Stips_p30.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children DateAdditionalTemporaryDisability AdditionaltemporaryDisabilityRate AdditionalTemporaryDisabilityIndemnityPaid
annotation
documentation
Optional, however if the Start date is entered then the endDate, rate and amount are required.
source <xs:element name="AdditionalTemporaryDisability" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Optional, however if the Start date is entered then the endDate, rate and amount are required.</xs:documentation>
 
</xs:annotation>
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="DateAdditionalTemporaryDisability" type="CD:StartAndEndDate" minOccurs="0"/>
     
<xs:element name="AdditionaltemporaryDisabilityRate" type="FF:amount" minOccurs="0"/>
     
<xs:element name="AdditionalTemporaryDisabilityIndemnityPaid" type="FF:amount" minOccurs="0"/>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element BenefitsSection/BenefitsInformation/AdditionalTemporaryDisability/DateAdditionalTemporaryDisability
diagram Stips_p31.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type StartAndEndDate
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children DateStarts DateEnds
source <xs:element name="DateAdditionalTemporaryDisability" type="CD:StartAndEndDate" minOccurs="0"/>

element BenefitsSection/BenefitsInformation/AdditionalTemporaryDisability/AdditionaltemporaryDisabilityRate
diagram Stips_p32.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
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="AdditionaltemporaryDisabilityRate" type="FF:amount" minOccurs="0"/>

element BenefitsSection/BenefitsInformation/AdditionalTemporaryDisability/AdditionalTemporaryDisabilityIndemnityPaid
diagram Stips_p33.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
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="AdditionalTemporaryDisabilityIndemnityPaid" type="FF:amount" minOccurs="0"/>

element BenefitsSection/BenefitsInformation/PermanentDisability
diagram Stips_p34.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children PermanentDisabilityIndemnityPercent PermanentDisabilityIndemnityRate DatePermanentDisabilityIndemnityStarts PermanentDisabilityIndemnityPaid LifePensionAmount
annotation
documentation
The permanent disability amount, start and end dates
source <xs:element name="PermanentDisability" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>The permanent disability amount, start and end dates</xs:documentation>
 
</xs:annotation>
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="PermanentDisabilityIndemnityPercent" type="xs:decimal" minOccurs="0"/>
     
<xs:element name="PermanentDisabilityIndemnityRate" type="FF:amount" minOccurs="0"/>
     
<xs:element name="DatePermanentDisabilityIndemnityStarts" type="CF:ptsDate" minOccurs="0"/>
     
<xs:element name="PermanentDisabilityIndemnityPaid" type="FF:amount" minOccurs="0"/>
     
<xs:element name="LifePensionAmount" type="FF:amount" minOccurs="0"/>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element BenefitsSection/BenefitsInformation/PermanentDisability/PermanentDisabilityIndemnityPercent
diagram Stips_p35.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type xs:decimal
properties
isRef 0
minOcc 0
maxOcc 1
content simple
source <xs:element name="PermanentDisabilityIndemnityPercent" type="xs:decimal" minOccurs="0"/>

element BenefitsSection/BenefitsInformation/PermanentDisability/PermanentDisabilityIndemnityRate
diagram Stips_p36.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
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="PermanentDisabilityIndemnityRate" type="FF:amount" minOccurs="0"/>

element BenefitsSection/BenefitsInformation/PermanentDisability/DatePermanentDisabilityIndemnityStarts
diagram Stips_p37.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type ptsDate
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="DatePermanentDisabilityIndemnityStarts" type="CF:ptsDate" minOccurs="0"/>

element BenefitsSection/BenefitsInformation/PermanentDisability/PermanentDisabilityIndemnityPaid
diagram Stips_p38.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
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="PermanentDisabilityIndemnityPaid" type="FF:amount" minOccurs="0"/>

element BenefitsSection/BenefitsInformation/PermanentDisability/LifePensionAmount
diagram Stips_p39.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
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="LifePensionAmount" type="FF:amount" minOccurs="0"/>

element BenefitsSection/BenefitsInformation/LaborCodeAdjustment
diagram Stips_p40.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children AdjustmentType AdjustmentRate DateOfAdjustmentStart
source <xs:element name="LaborCodeAdjustment" minOccurs="0">
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="AdjustmentType" type="FF:laborAdjustmentTypeCode" minOccurs="0"/>
     
<xs:element name="AdjustmentRate" type="FF:amount" minOccurs="0"/>
     
<xs:element name="DateOfAdjustmentStart" type="CF:ptsDate" minOccurs="0"/>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element BenefitsSection/BenefitsInformation/LaborCodeAdjustment/AdjustmentType
diagram Stips_p41.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type laborAdjustmentTypeCode
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration 
enumeration 
source <xs:element name="AdjustmentType" type="FF:laborAdjustmentTypeCode" minOccurs="0"/>

element BenefitsSection/BenefitsInformation/LaborCodeAdjustment/AdjustmentRate
diagram Stips_p42.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
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="AdjustmentRate" type="FF:amount" minOccurs="0"/>

element BenefitsSection/BenefitsInformation/LaborCodeAdjustment/DateOfAdjustmentStart
diagram Stips_p43.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type ptsDate
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="DateOfAdjustmentStart" type="CF:ptsDate" minOccurs="0"/>

element BenefitsSection/BenefitsInformation/InformalRatingCaseNumber
diagram Stips_p44.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 12 
annotation
documentation
Limited to 12 characters
source <xs:element name="InformalRatingCaseNumber" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Limited to 12 characters</xs:documentation>
 
</xs:annotation>
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="12"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element BenefitsSection/BenefitsInformation/NeedForMedicalTreatment
diagram Stips_p45.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type checkBox
properties
isRef 0
content simple
facets
Kind Value annotation 
whiteSpace collapse 
annotation
documentation
Radio buttons indicating the need for medical treatment to cure or relieve effects
source <xs:element name="NeedForMedicalTreatment" type="CF:checkBox">
 
<xs:annotation>
   
<xs:documentation>Radio buttons indicating the need for medical treatment to cure or relieve effects</xs:documentation>
 
</xs:annotation>
</xs:element>

element BenefitsSection/BenefitsInformation/Medical-LegalExpensesPayableByDefendantAsFollows
diagram Stips_p46.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 189 
annotation
documentation
Limited to 189 characters
source <xs:element name="Medical-LegalExpensesPayableByDefendantAsFollows" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Limited to 189 characters</xs:documentation>
 
</xs:annotation>
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="189"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element BenefitsSection/BenefitsInformation/ApplicantAttorneyRequiresAFeeOf
diagram Stips_p47.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type ApplicantAttorneyRequiresAFeeOf
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children Fee FeesToBeCommutedAsFollows
source <xs:element name="ApplicantAttorneyRequiresAFeeOf" type="ApplicantAttorneyRequiresAFeeOf" minOccurs="0"/>

element BenefitsSection/BenefitsInformation/LiensAgainstCompensation
diagram Stips_p48.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 440 
annotation
documentation
Limited to 440 characters
source <xs:element name="LiensAgainstCompensation" minOccurs="0">
 
<xs:annotation>
   
<xs:documentation>Limited to 440 characters</xs:documentation>
 
</xs:annotation>
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="440"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

complexType EmployerInfo
diagram Stips_p49.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
children EmployerSection InsuranceCarrier ClaimsAdministrator
used by
element Stips/EmployersSection
source <xs:complexType name="EmployerInfo">
 
<xs:sequence>
   
<xs:element name="EmployerSection">
     
<xs:complexType>
       
<xs:sequence>
         
<xs:element name="EmployerRoleTypeCode">
           
<xs:simpleType>
             
<xs:restriction base="FF:employerRoleTypeCode"/>
           
</xs:simpleType>
         
</xs:element>
         
<xs:element name="EmployerName" type="FF:employerName"/>
         
<xs:element name="Address" type="CD:Address"/>
       
</xs:sequence>
     
</xs:complexType>
   
</xs:element>
   
<xs:element name="InsuranceCarrier" type="CD:OrganizationInformation" minOccurs="0"/>
   
<xs:element name="ClaimsAdministrator" type="CD:OrganizationInformation" minOccurs="0"/>
 
</xs:sequence>
</xs:complexType>

element EmployerInfo/EmployerSection
diagram Stips_p50.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
properties
isRef 0
content complex
children EmployerRoleTypeCode EmployerName Address
source <xs:element name="EmployerSection">
 
<xs:complexType>
   
<xs:sequence>
     
<xs:element name="EmployerRoleTypeCode">
       
<xs:simpleType>
         
<xs:restriction base="FF:employerRoleTypeCode"/>
       
</xs:simpleType>
     
</xs:element>
     
<xs:element name="EmployerName" type="FF:employerName"/>
     
<xs:element name="Address" type="CD:Address"/>
   
</xs:sequence>
 
</xs:complexType>
</xs:element>

element EmployerInfo/EmployerSection/EmployerRoleTypeCode
diagram Stips_p51.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
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>

element EmployerInfo/EmployerSection/EmployerName
diagram Stips_p52.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
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 EmployerInfo/EmployerSection/Address
diagram Stips_p53.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type Address
properties
isRef 0
content complex
children AddressLine1 City State Zip5Code
source <xs:element name="Address" type="CD:Address"/>

element EmployerInfo/InsuranceCarrier
diagram Stips_p54.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type OrganizationInformation
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children EmployerName Address
source <xs:element name="InsuranceCarrier" type="CD:OrganizationInformation" minOccurs="0"/>

element EmployerInfo/ClaimsAdministrator
diagram Stips_p55.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type OrganizationInformation
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children EmployerName Address
source <xs:element name="ClaimsAdministrator" type="CD:OrganizationInformation" minOccurs="0"/>

complexType EmployerSection
diagram Stips_p56.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
source <xs:complexType name="EmployerSection">
 
<xs:sequence/>
</xs:complexType>

complexType HeaderSection
diagram Stips_p57.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
children VersionNumber
used by
element Stips/HeaderSection
source <xs:complexType name="HeaderSection">
 
<xs:sequence>
   
<xs:element name="VersionNumber" type="CF:versionNumber" fixed="1.5"/>
 
</xs:sequence>
</xs:complexType>

element HeaderSection/VersionNumber
diagram Stips_p58.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type versionNumber
properties
isRef 0
content simple
fixed 1.5
source <xs:element name="VersionNumber" type="CF:versionNumber" fixed="1.5"/>

complexType InterpreterLicense
diagram Stips_p59.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
children InterpreterName InterpreterLicenseNumber
used by
element Stips/InterpreterLicenseSection
annotation
documentation
Interpreter name and license number
source <xs:complexType name="InterpreterLicense">
 
<xs:annotation>
   
<xs:documentation>Interpreter name and license number</xs:documentation>
 
</xs:annotation>
 
<xs:sequence>
   
<xs:element name="InterpreterName" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="FF:fullName">
         
<xs:maxLength value="40"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="InterpreterLicenseNumber" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="xs:string">
         
<xs:maxLength value="15"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element InterpreterLicense/InterpreterName
diagram Stips_p60.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type restriction of fullName
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
minLength 
maxLength 40 
pattern ([A-Z 0-9])* 
source <xs:element name="InterpreterName" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="FF:fullName">
     
<xs:maxLength value="40"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element InterpreterLicense/InterpreterLicenseNumber
diagram Stips_p61.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 15 
source <xs:element name="InterpreterLicenseNumber" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="15"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

complexType OtherStipulations
diagram Stips_p62.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
children OtherStipulationDescription Date ApplicantSignature
used by
element Stips/OtherStipulationsSection
annotation
documentation
Other stipulation information
source <xs:complexType name="OtherStipulations">
 
<xs:annotation>
   
<xs:documentation>Other stipulation information</xs:documentation>
 
</xs:annotation>
 
<xs:sequence>
   
<xs:element name="OtherStipulationDescription" minOccurs="0">
     
<xs:simpleType>
       
<xs:restriction base="xs:string">
         
<xs:maxLength value="1024"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
   
<xs:element name="Date" type="CF:ptsDate" minOccurs="0"/>
   
<xs:element name="ApplicantSignature" type="FF:signature" minOccurs="0"/>
 
</xs:sequence>
</xs:complexType>

element OtherStipulations/OtherStipulationDescription
diagram Stips_p63.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type restriction of xs:string
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 1024 
source <xs:element name="OtherStipulationDescription" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="1024"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

element OtherStipulations/Date
diagram Stips_p64.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type ptsDate
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="Date" type="CF:ptsDate" minOccurs="0"/>

element OtherStipulations/ApplicantSignature
diagram Stips_p65.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/STIPS
type signature
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
maxLength 82 
whiteSpace preserve 
source <xs:element name="ApplicantSignature" type="FF:signature" minOccurs="0"/>

group AddressGroup
diagram Stips_p66.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 Stips_p67.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 Stips_p68.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 Stips_p69.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 Stips_p70.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 Stips_p71.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 Stips_p72.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 Stips_p73.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 Stips_p74.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 Stips_p75.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 Stips_p76.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 Stips_p77.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 Stips_p78.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 Stips_p79.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 Stips_p80.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 Stips_p81.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 Stips_p82.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 Stips_p83.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 Stips_p84.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children InjuryType DateOfInjuryStart DateOfInjuryEnd
used by
group InjuryInformationGroup
source <xs:group name="InjuryTypeAndDates">
 
<xs:sequence>
   
<xs:element name="InjuryType" type="FF:injuryTypeCode"/>
   
<xs:element name="DateOfInjuryStart" type="CF:ptsDate"/>
   
<xs:element name="DateOfInjuryEnd" type="CF:ptsDate" nillable="true" minOccurs="0"/>
 
</xs:sequence>
</xs:group>

element InjuryTypeAndDates/InjuryType
diagram Stips_p85.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 Stips_p86.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 Stips_p87.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 Stips_p88.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children FirstName MiddleInitial LastName
used by
complexType PersonName
source <xs:group name="PersonNameGroup">
 
<xs:sequence>
   
<xs:element name="FirstName" type="FF:firstName"/>
   
<xs:element name="MiddleInitial" type="FF:middleInitial" minOccurs="0"/>
   
<xs:element name="LastName" type="FF:lastName"/>
 
</xs:sequence>
</xs:group>

element PersonNameGroup/FirstName
diagram Stips_p89.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 Stips_p90.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 Stips_p91.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 Stips_p92.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 Stips_p93.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 Stips_p94.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 Stips_p95.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 Stips_p96.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 Stips_p97.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 Stips_p98.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 Stips_p99.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 Stips_p100.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type venueOfficeCode
properties
isRef 0
content simple
facets
Kind Value annotation 
length 
whiteSpace collapse 
enumeration STK 
enumeration SFO 
enumeration SAC 
enumeration LBO 
enumeration VNO 
enumeration SAL 
enumeration OAK 
enumeration SDO 
enumeration MDR 
enumeration OXN 
enumeration EUR 
enumeration SRO 
enumeration SBR 
enumeration AHM 
enumeration RIV 
enumeration FRE 
enumeration LAO 
enumeration POM 
enumeration SJO 
enumeration ANA 
enumeration BAK 
enumeration GRO 
enumeration RDG 
enumeration SLO 
enumeration SBA 
source <xs:element name="VenueOfficeCode" type="FF:venueOfficeCode"/>

complexType Address
diagram Stips_p101.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children AddressLine1 City State Zip5Code
used by
elements EmployerInfo/EmployerSection/Address AttorneyorRep/Address AttorneyorRepWithoutNumber/Address OrganizationInformation/Address PersonInformation/Address
source <xs:complexType name="Address">
 
<xs:group ref="AddressGroup"/>
</xs:complexType>

complexType AttorneyorRep
diagram Stips_p102.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children AttorneyorAuthRepTypeCode EmployerName LawFirmNumber Name Address
used by
elements Stips/DefendantsAttorneyAOrAuthorizedRepSection Stips/InjuredWorkerAttorneyOrAuthorizedRepSection
source <xs:complexType name="AttorneyorRep">
 
<xs:sequence>
   
<xs:element name="AttorneyorAuthRepTypeCode" type="FF:attorneyorAuthRepTypeCode"/>
   
<xs:element name="EmployerName" type="FF:employerName"/>
   
<xs:element name="LawFirmNumber" type="FF:lawFirmNumber" minOccurs="0"/>
   
<xs:element name="Name" type="PersonName" minOccurs="0"/>
   
<xs:element name="Address" type="Address"/>
 
</xs:sequence>
</xs:complexType>

element AttorneyorRep/AttorneyorAuthRepTypeCode
diagram Stips_p103.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 Stips_p104.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 Stips_p105.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 Stips_p106.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 Stips_p107.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 Stips_p108.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 Stips_p109.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 Stips_p110.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 Stips_p111.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type PersonName
properties
isRef 0
minOcc 0
maxOcc 1
content complex
children FirstName MiddleInitial LastName
source <xs:element name="Name" type="PersonName" minOccurs="0"/>

element AttorneyorRepWithoutNumber/Address
diagram Stips_p112.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type Address
properties
isRef 0
content complex
children AddressLine1 City State Zip5Code
source <xs:element name="Address" type="Address"/>

element AttorneyorRepWithoutNumber/PhoneNumber
diagram Stips_p113.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 Stips_p114.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children Checkbox
source <xs:complexType name="CheckBox">
 
<xs:sequence>
   
<xs:element name="Checkbox" type="CF:checkBox" default="false"/>
 
</xs:sequence>
</xs:complexType>

element CheckBox/Checkbox
diagram Stips_p115.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 Stips_p116.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 Stips_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="DateFrom" type="CF:ptsDate"/>

element DateRangeMandatory/DateTo
diagram Stips_p118.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 Stips_p119.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 Stips_p120.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 Stips_p121.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type ptsDate
properties
isRef 0
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="DateOfDoctorReport" type="CF:ptsDate"/>

complexType EmployerName
diagram Stips_p122.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 Stips_p123.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 Stips_p124.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children InjuryType DateOfInjuryStart DateOfInjuryEnd BodyPartInformation
used by
element ApplicationSection/InjuryInformation
source <xs:complexType name="InjuryInformation">
 
<xs:group ref="InjuryInformationGroup"/>
</xs:complexType>

complexType OrganizationInformation
diagram Stips_p125.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 EmployerInfo/ClaimsAdministrator Signature/Firm SignatureAddressGroup/Firm EmployerInfo/InsuranceCarrier
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 Stips_p126.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 Stips_p127.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children Name Address
used by
element Stips/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 Stips_p128.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 Stips_p129.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 Stips_p130.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children FirstName MiddleInitial LastName
used by
elements AttorneyorRep/Name AttorneyorRepWithoutNumber/Name PersonInformation/Name
source <xs:complexType name="PersonName">
 
<xs:group ref="PersonNameGroup"/>
</xs:complexType>

complexType SelectionType126
diagram Stips_p131.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 Stips_p132.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 Stips_p133.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
content simple
facets
Kind Value annotation 
maxLength 126 
source <xs:element name="Explanation" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="126"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

complexType SelectionType129
diagram Stips_p134.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children SelectionCheckbox Explanation
source <xs:complexType name="SelectionType129">
 
<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="129"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element SelectionType129/SelectionCheckbox
diagram Stips_p135.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 SelectionType129/Explanation
diagram Stips_p136.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
content simple
facets
Kind Value annotation 
maxLength 129 
source <xs:element name="Explanation" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="129"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

complexType SelectionType84
diagram Stips_p137.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children SelectionCheckbox Explanation
source <xs:complexType name="SelectionType84">
 
<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="84"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element SelectionType84/SelectionCheckbox
diagram Stips_p138.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 SelectionType84/Explanation
diagram Stips_p139.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
content simple
facets
Kind Value annotation 
maxLength 84 
source <xs:element name="Explanation" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="84"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

complexType SelectionType85
diagram Stips_p140.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children SelectionCheckbox Explanation
source <xs:complexType name="SelectionType85">
 
<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="85"/>
       
</xs:restriction>
     
</xs:simpleType>
   
</xs:element>
 
</xs:sequence>
</xs:complexType>

element SelectionType85/SelectionCheckbox
diagram Stips_p141.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 SelectionType85/Explanation
diagram Stips_p142.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
content simple
facets
Kind Value annotation 
maxLength 85 
source <xs:element name="Explanation" minOccurs="0">
 
<xs:simpleType>
   
<xs:restriction base="xs:string">
     
<xs:maxLength value="85"/>
   
</xs:restriction>
 
</xs:simpleType>
</xs:element>

complexType Signature
diagram Stips_p143.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children DateOfSignature Firm DeclarantSignature
source <xs:complexType name="Signature">
 
<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:complexType>

element Signature/DateOfSignature
diagram Stips_p144.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 Signature/Firm
diagram Stips_p145.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 Signature/DeclarantSignature
diagram Stips_p146.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>

complexType Signatures
diagram Stips_p147.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children DateOfSignature Firm DeclarantSignature
source <xs:complexType name="Signatures">
 
<xs:group ref="SignatureAddressGroup"/>
</xs:complexType>

complexType StartAndEndDate
diagram Stips_p148.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children DateStarts DateEnds
used by
elements BenefitsSection/BenefitsInformation/AdditionalTemporaryDisability/DateAdditionalTemporaryDisability BenefitsSection/BenefitsInformation/TemporaryDisability/DatesTemporaryDisability
source <xs:complexType name="StartAndEndDate">
 
<xs:sequence>
   
<xs:element name="DateStarts" type="CF:ptsDate" minOccurs="0"/>
   
<xs:element name="DateEnds" type="CF:ptsDate" minOccurs="0"/>
 
</xs:sequence>
</xs:complexType>

element StartAndEndDate/DateStarts
diagram Stips_p149.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type ptsDate
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="DateStarts" type="CF:ptsDate" minOccurs="0"/>

element StartAndEndDate/DateEnds
diagram Stips_p150.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
type ptsDate
properties
isRef 0
minOcc 0
maxOcc 1
content simple
facets
Kind Value annotation 
pattern [0-1][0-9]/[0-3][0-9]/[1-2][0-9][0-9][0-9] 
source <xs:element name="DateEnds" type="CF:ptsDate" minOccurs="0"/>

complexType VenueInformation
diagram Stips_p151.png
namespace http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains
children VenueLocationCode VenueOfficeCode
used by
element ApplicationSection/Venue
source <xs:complexType name="VenueInformation">
 
<xs:group ref="VenueInformationGroup"/>
</xs:complexType>

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 BenefitsSection/BenefitsInformation/AdditionalTemporaryDisability/AdditionalTemporaryDisabilityIndemnityPaid BenefitsSection/BenefitsInformation/AdditionalTemporaryDisability/AdditionaltemporaryDisabilityRate BenefitsSection/BenefitsInformation/LaborCodeAdjustment/AdjustmentRate EarningAmountGroup/EarningsAmount ApplicantAttorneyRequiresAFeeOf/Fee BenefitsSection/BenefitsInformation/PermanentDisability/LifePensionAmount BenefitsSection/BenefitsInformation/PermanentDisability/PermanentDisabilityIndemnityPaid BenefitsSection/BenefitsInformation/PermanentDisability/PermanentDisabilityIndemnityRate BenefitsSection/BenefitsInformation/TemporaryDisability/TemporaryDisabilityIndemnityPaid
facets
Kind Value annotation 
minInclusive 0.00 
maxInclusive 9999999999999.99 
source <xs:simpleType name="amount">
 
<xs:restriction base="xs:double">
   
<xs:maxInclusive value="9999999999999.99"/>
   
<xs:minInclusive value="0.00"/>
 
</xs:restriction>
</xs:simpleType>

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

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

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

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

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

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

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

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

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

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

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