diff --git a/src/ontogpt/evaluation/evaluation_engine.py b/src/ontogpt/evaluation/evaluation_engine.py
index 993af4f92..7dafddc2b 100644
--- a/src/ontogpt/evaluation/evaluation_engine.py
+++ b/src/ontogpt/evaluation/evaluation_engine.py
@@ -48,7 +48,10 @@ def from_set(
 
             def label(x):
                 for labeler in labelers:
-                    lbl = labeler.label(x)
+                    if type(labeler) == list:
+                        lbl = labeler[0].label(x)
+                    else:
+                        lbl = labeler.label(x)
                     if lbl:
                         return f"{x} {lbl}"
                 return x
diff --git a/src/ontogpt/evaluation/maxo/__init__.py b/src/ontogpt/evaluation/maxo/__init__.py
new file mode 100644
index 000000000..e69de29bb
diff --git a/src/ontogpt/evaluation/maxo/eval_maxo.py b/src/ontogpt/evaluation/maxo/eval_maxo.py
new file mode 100644
index 000000000..b4709141a
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/eval_maxo.py
@@ -0,0 +1,319 @@
+"""
+MAXO annotation evaluation.
+
+Annotations in the Medical Action Ontology (MAXO)
+may be between a MAXO term and a phenotype,
+denoted with a Human Phenotype Ontology (HP) term,
+or between a MAXO term and a disease,
+denoted with a Mondo Disease Ontology (MONDO) term.
+
+See:
+https://github.com/monarch-initiative/maxo-annotations/
+
+This evaluation uses the maxo template to extract
+annotations from the text provided in each test case
+(see the test_cases directory) and compares them to
+the annotations accompanying the case. The existing
+annotations are from the set of manual annotations
+in the above repository
+(see
+https://github.com/monarch-initiative/maxo-annotations/
+blob/master/annotations/maxo-annotations.tsv)
+though the annotations are not considered disease-specific
+for the purposes of this evaluation.
+
+Note that this evaluation does not consider predicates,
+only extraction of any relation involving a grounded MAXO
+action and a grounded HP phenotype.
+
+"""
+
+import logging
+from collections import defaultdict
+from dataclasses import dataclass
+from pathlib import Path
+from random import shuffle
+from typing import Any, Dict, Iterable, List, Optional, Set, Tuple
+
+import yaml
+from oaklib import BasicOntologyInterface, get_adapter
+from pydantic import BaseModel
+
+from ontogpt.engines.knowledge_engine import chunk_text
+from ontogpt.engines.spires_engine import SPIRESEngine
+from ontogpt.evaluation.evaluation_engine import SimilarityScore, SPIRESEvaluationEngine
+from ontogpt.templates.maxo import MaxoAnnotations, ActionToSymptomRelationship, Publication
+
+THIS_DIR = Path(__file__).parent
+DATABASE_DIR = Path(__file__).parent / "test_cases"
+
+# This does not do much now but can be expanded to
+# additional predicate types
+RMAP = {"TREATS": "TREATS"}
+
+logger = logging.getLogger(__name__)
+
+
+class PredictionRE(BaseModel):
+    """A prediction for a relationship extraction task."""
+
+    test_object: Optional[MaxoAnnotations] = None
+    """Source of truth to evaluate against."""
+
+    true_positives: Optional[List[Tuple]] = None
+    num_true_positives: Optional[int] = None
+    false_positives: Optional[List[Tuple]] = None
+    num_false_positives: Optional[int] = None
+    false_negatives: Optional[List[Tuple]] = None
+    num_false_negatives: Optional[int] = None
+    scores: Optional[Dict[str, SimilarityScore]] = None
+    predicted_object: Optional[MaxoAnnotations] = None
+    named_entities: Optional[List[Any]] = None
+
+    def calculate_scores(self, labelers: Optional[List[BasicOntologyInterface]] = None):
+        self.scores = {}
+
+        def label(x):
+            if labelers:
+                for labeler in labelers:
+                    if type(labeler) == list:
+                        lbl = labeler[0].label(x)
+                    else:
+                        lbl = labeler.label(x)
+                    if lbl:
+                        return f"{x} {lbl}"
+            return x
+
+        def all_objects(dm: Optional[MaxoAnnotations]):
+            if dm is not None:
+                # set conversion requires lists to be flattened
+                # and made generic, or they become invalid
+                dm_flat_triples = []
+                for triple in dm.triples:
+                    if triple.subject is not None and triple.object is not None:
+                        if type(triple.object) == list:
+                            flat_object = triple.object[0]
+                        else:
+                            flat_object = triple.object
+                        triple_flat = {
+                            "subject": triple.subject,
+                            # "predicate": triple.predicate,
+                            "object": flat_object,
+                        }
+
+                        dm_flat_triples.append(triple_flat)
+                return list(
+                    set(link["subject"] for link in dm_flat_triples)
+                    | set(link["object"] for link in dm_flat_triples)
+                )
+            else:
+                return list()
+
+        def pairs(dm: MaxoAnnotations) -> Set:
+            if dm.triples is not None:
+                return set(
+                    (label(link.subject), label(link.object[0]))
+                    for link in dm.triples
+                    if link.object is not None
+                )
+            else:
+                return set()
+
+        self.scores["similarity"] = SimilarityScore.from_set(
+            all_objects(self.test_object),
+            all_objects(self.predicted_object),
+            labelers=labelers,
+        )
+        if self.predicted_object is not None:
+            pred_pairs = pairs(self.predicted_object)
+        else:
+            pred_pairs = set()
+        if self.test_object is not None:
+            test_pairs = pairs(self.test_object)
+        else:
+            test_pairs = set()
+        self.true_positives = list(pred_pairs.intersection(test_pairs))
+        self.false_positives = list(pred_pairs.difference(test_pairs))
+        self.false_negatives = list(test_pairs.difference(pred_pairs))
+        self.num_false_negatives = len(self.false_negatives)
+        self.num_false_positives = len(self.false_positives)
+        self.num_true_positives = len(self.true_positives)
+
+
+class EvaluationObjectSetRE(BaseModel):
+    """A result of predicting relation extractions."""
+
+    precision: float = 0
+    recall: float = 0
+    f1: float = 0
+
+    training: Optional[List[MaxoAnnotations]] = None
+    predictions: Optional[List[PredictionRE]] = None
+    test: Optional[List[MaxoAnnotations]] = None
+
+
+@dataclass
+class EvalMAXO(SPIRESEvaluationEngine):
+    subject_prefix = "MAXO"
+    object_prefix = "HP"
+
+    def __post_init__(self):
+        self.extractor = SPIRESEngine(template="maxo", model=self.model)
+
+    def load_test_cases(self) -> Iterable[MaxoAnnotations]:
+        return self.load_cases(DATABASE_DIR)
+
+    # Load cases from YAML
+    # One-to-many relationships are parsed as one-to-one, as we
+    # may only match part of the set.
+    # They still need to be list members to validate, though.
+    def load_cases(self, path: Path) -> Iterable[MaxoAnnotations]:
+        logger.info(f"Loading {path}")
+
+        triples_by_text = defaultdict(list)
+
+        for casefile in path.glob("*.yaml"):
+            logger.info(f"Loading case {casefile}")
+            with open(casefile, "r") as file:
+                doc = yaml.safe_load(file)
+            input_text = doc["input_text"]
+            logger.debug(f"Text: {input_text}")
+            try:
+                for r in doc["extracted_object"]["action_to_symptom"]:
+                    for object in r["object"]:
+                        t = ActionToSymptomRelationship.model_validate(
+                            {
+                                "subject": f"{r['subject']}",
+                                "predicate": RMAP[r["predicate"]],
+                                "object": [object],
+                            }
+                        )
+                        triples_by_text[input_text].append(t)
+            except KeyError:  # some of the test cases may only have other relations
+                logger.info(f"Ignored {casefile} - no Action to Symptom relations")
+                continue
+        i = 0
+        for input_text, triples in triples_by_text.items():
+            i = i + 1
+            title = input_text[:40]
+            pub = Publication.model_validate(
+                {
+                    "id": str(i),
+                    "title": title,
+                    "abstract": input_text,
+                }
+            )
+            logger.debug(f"Triples: {len(triples)} for Title: {title}")
+            yield MaxoAnnotations.model_validate({"publication": pub, "triples": triples})
+
+    def eval(self) -> EvaluationObjectSetRE:
+        """Evaluate the ability to extract relations."""
+        maxo_labeler = get_adapter("sqlite:obo:maxo")
+        hp_labeler = get_adapter("sqlite:obo:hp")
+
+        if self.num_tests and isinstance(self.num_tests, int):
+            num_test = self.num_tests
+        else:
+            num_test = 1
+        ke = self.extractor
+        docs = list(self.load_test_cases())
+        shuffle(docs)
+        eos = EvaluationObjectSetRE(
+            test=docs[:num_test],
+            training=[],
+            predictions=[],
+        )
+        n = 1
+        for doc in eos.test:
+            logger.info(f"Iteration {n} of {num_test}")
+            n += 1
+            logger.info(doc)
+            text = doc.publication.abstract
+            predicted_obj = None
+            named_entities: List[str] = []  # This stores the NEs for the whole document
+            ke.named_entities = []  # This stores the NEs the extractor knows about
+
+            if self.chunking:
+                text_list = chunk_text(text)
+            else:
+                text_list = iter([text])
+
+            for chunked_text in text_list:
+                extraction = ke.extract_from_text(chunked_text)
+
+                if extraction.extracted_object is not None:
+                    # Process all multi-object triples to 1 to 1 triples
+                    # so they may be more directly compared
+                    for extracted_triple in extraction.extracted_object.action_to_symptom:
+                        new_triple = extracted_triple
+                        for object in extracted_triple.object:
+                            new_triple.object = [object]
+                            extraction.extracted_object.triples.append(new_triple)
+
+                    logger.info(
+                        f"{len(extraction.extracted_object.triples)} triples from: {chunked_text}"
+                    )
+                if not predicted_obj and extraction.extracted_object is not None:
+                    predicted_obj = extraction.extracted_object
+                else:
+                    if predicted_obj is not None and extraction.extracted_object is not None:
+                        predicted_obj.triples.extend(extraction.extracted_object.triples)
+                        logger.info(
+                            f"{len(predicted_obj.triples)} total triples, after concatenation"
+                        )
+                        logger.debug(f"concatenated triples: {predicted_obj.triples}")
+                if extraction.named_entities is not None:
+                    for entity in extraction.named_entities:
+                        if entity not in named_entities:
+                            named_entities.append(entity)
+
+            def included(t: ActionToSymptomRelationship):
+                if not [var for var in (t.subject, t.object, t.predicate) if var is None]:
+                    return (
+                        t
+                        and t.subject
+                        and t.object
+                        and t.subject.startswith("MAXO:")
+                        and t.object[0].startswith("HP:")
+                        # and t.predicate.lower() == "treats"
+                    )
+                else:
+                    return False
+
+            if predicted_obj is not None:
+                predicted_obj.triples = [t for t in predicted_obj.triples if included(t)]
+                duplicate_triples = []
+                unique_predicted_triples = [
+                    t
+                    for t in predicted_obj.triples
+                    if t not in duplicate_triples
+                    and not duplicate_triples.append(t)  # type: ignore
+                ]
+                predicted_obj.triples = unique_predicted_triples
+                logger.info(f"{len(predicted_obj.triples)} filtered triples")
+            pred = PredictionRE(
+                predicted_object=predicted_obj, test_object=doc, named_entities=named_entities
+            )
+            named_entities.clear()
+            logger.info("PRED")
+            logger.info(yaml.dump(data=pred.model_dump()))
+            logger.info("Calc scores")
+            pred.calculate_scores(labelers=[maxo_labeler, hp_labeler])
+            logger.info(yaml.dump(data=pred.model_dump()))
+            eos.predictions.append(pred)
+        self.calc_stats(eos)
+        return eos
+
+    def calc_stats(self, eos: EvaluationObjectSetRE):
+        num_true_positives = sum(p.num_true_positives for p in eos.predictions)
+        num_false_positives = sum(p.num_false_positives for p in eos.predictions)
+        num_false_negatives = sum(p.num_false_negatives for p in eos.predictions)
+        if num_true_positives + num_false_positives == 0:
+            logger.warning("No true positives or false positives")
+            return
+        eos.precision = num_true_positives / (num_true_positives + num_false_positives)
+        eos.recall = num_true_positives / (num_true_positives + num_false_negatives)
+        if eos.precision + eos.recall == 0:
+            logger.warning("No precision or recall")
+            return
+        eos.f1 = 2 * (eos.precision * eos.recall) / (eos.precision + eos.recall)
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_12958596.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_12958596.yaml
new file mode 100644
index 000000000..d1596ff3a
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_12958596.yaml
@@ -0,0 +1,25 @@
+---
+input_text: >-
+  Activation-induced cytidine deaminase (AID) is a 'master molecule' in immunoglobulin (Ig) 
+  class-switch recombination (CSR) and somatic hypermutation (SHM) generation, AID deficiencies are 
+  associated with hyper-IgM phenotypes in humans and mice. We show here that recessive mutations of 
+  the gene encoding uracil-DNA glycosylase (UNG) are associated with profound impairment in CSR at a 
+  DNA precleavage step and with a partial disturbance of the SHM pattern in three patients with hyper-IgM 
+  syndrome. Together with the finding that nuclear UNG expression was induced in activated B cells, 
+  these data support a model of CSR and SHM in which AID deaminates cytosine into uracil in targeted DNA 
+  (immunoglobulin switch or variable regions), followed by uracil removal by UNG.
+
+named_entities:
+  - id: MONDO:0011971
+    label: Immunodeficiency With Hyper-igm, Type 5
+  - id: MAXO:0001480
+    label: immunoglobulin infusion therapy
+  - id: HP:0004315
+    label: Decreased circulating IgG level
+
+extracted_object:
+  action_to_disease:
+    - subject: MAXO:0001480
+      predicate: TREATS
+      object:
+        - MONDO:0011971
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301368.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301368.yaml
new file mode 100644
index 000000000..3e22aba8a
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301368.yaml
@@ -0,0 +1,25 @@
+---
+input_text: >-
+  "Saethre-Chotzen Syndrome
+  Management: Treatment of manifestations: Ongoing management by an established
+  craniofacial team which may include cranioplasty in the first year of life
+  and midface surgery in childhood as needed for dental malocclusion,
+  swallowing difficulties, and respiratory problems. If a cleft palate is
+  present, surgical repair usually follows cranioplasty. As needed: orthodontic
+  treatment and/or orthognathic surgery at the completion of facial growth;
+  developmental intervention; routine treatment of hearing loss; ophthalmologic
+  evaluation and, if ptosis is present, intervention to prevent amblyopia, with
+  surgical repair during early childhood as needed."
+named_entities:
+  - id: MONDO:0007042
+    label: Saethre-chotzen Syndrome
+  - id: MAXO:0000004
+    label: surgical procedure
+  - id: HP:0000175
+    label: cleft palate
+extracted_object:
+  action_to_symptom:
+    - subject: MAXO:0000004
+      predicate: TREATS
+      object:
+        - HP:0000175
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301450.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301450.yaml
new file mode 100644
index 000000000..4f2517499
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301450.yaml
@@ -0,0 +1,36 @@
+---
+input_text: >-
+  "
+  Alagille Syndrome
+  Table 5.
+  Treatment of Liver Manifestations in Individuals with Alagille Syndrome
+  Manifestation/Concern	Treatment	Considerations/Other
+  Pruritus & xanthomas 	Choloretic agents (ursodeoxycholic acid) & other
+  medications (cholestyramine, rifampin, naltrexone)	Combination of
+  therapies often required; biliary diversion may be performed for severe
+  pruritus refractory to medical therapy.
+  End-stage liver disease 	Liver transplantation
+  Poor growth 	Optimized nutrition; replacement of fat-soluble vitamins
+  as needed	Nasogastric feeds or gastrostomy tube may be required to
+  maintain caloric intake."
+named_entities:
+  - id: MONDO:0016862
+    label: Alagille Syndrome
+  - id: MAXO:0001135
+    label: replacement of fat-soluble vitamins
+  - id: MAXO:0001175
+    label: Liver transplantation
+  - id: HP:0001508
+    label: Poor growth
+  - id: HP:0001399
+    label: End-stage liver disease
+extracted_object:
+  action_to_symptom:
+    - subject: MAXO:0001135
+      predicate: TREATS
+      object:
+        - HP:0001508
+    - subject: MAXO:0001175
+      predicate: TREATS
+      object:
+        - HP:0001399
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301519.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301519.yaml
new file mode 100644
index 000000000..5639bc4e6
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301519.yaml
@@ -0,0 +1,49 @@
+---
+input_text: >-
+
+  APC-associated polyposis conditions include (classic or attenuated) familial adenomatous polyposis (FAP) and gastric adenocarcinoma 
+  and proximal polyposis of the stomach (GAPPS).
+  Resection of all colonic polyps larger than 5 mm found on colonic surveillance. There is an absolute indication for colectomy when 
+  CRC is diagnosed or suspected, or when there are significant symptoms (e.g., bleeding, obstruction). Relative indications for colectomy 
+  include presence of multiple adenomas larger than 10 mm that cannot be reasonably removed endoscopically, a significant increase in adenoma 
+  number between surveillance exams, presence of adenomas with high-grade dysplasia, or inability to adequately survey the colon (e.g., due to 
+  innumerable diminutive adenomas or limited access to or compliance with colonoscopy). Endoscopic or surgical removal of duodenal adenomas is 
+  considered if polyps exhibit villous change or severe dysplasia, exceed 1 cm in diameter, or exhibit advanced stage using Spigelman scoring system. 
+  Gastrectomy is considered if advanced gastric neoplasia is found on upper endoscopy. Osteomas may be removed for cosmetic reasons. 
+  Desmoid tumors may be surgically excised or treated with nonsteroidal anti-inflammatory drugs (NSAIDs), anti-estrogens, 
+  cytotoxic chemotherapy, and/or radiation if at advanced stage. Standard treatment when needed for adrenal masses and thyroid carcinoma. 
+  Several studies have shown that NSAIDs and erlotinib have caused regression of adenomas and decreased the polyp burden in individuals with FAP, 
+  though there are currently no FDA-approved chemopreventive agents for FAP, given an unclear effect on subsequent cancer risk.
+
+named_entities:
+  - id: MONDO:0021056
+    label: denomatous Polyposis Coli
+  - id: MAXO:0000014
+    label: radiation therapy
+  - id: HP:0100245
+    label: Desmoid tumors
+  - id: MAXO:0000646
+    label: cancer chemotherapy
+  - id: MAXO:0000635
+    label: anti-estrogen agent therapy
+  - id: MAXO:0000221
+    label: nonsteroidal anti-inflammatory agent therapy
+
+extracted_object:
+  action_to_symptom:
+    - subject: MAXO:0000014
+      predicate: TREATS
+      object:
+        - HP:0100245
+    - subject: MAXO:0000646
+      predicate: TREATS
+      object:
+        - HP:0100245
+    - subject: MAXO:0000635
+      predicate: TREATS
+      object:
+        - HP:0100245
+    - subject: MAXO:0000221
+      predicate: TREATS
+      object:
+        - HP:0100245
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301527.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301527.yaml
new file mode 100644
index 000000000..857e34af6
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301527.yaml
@@ -0,0 +1,35 @@
+---
+input_text: >-
+  "
+  Adult Refsum disease (ARD is associated with elevated plasma phytanic acid levels, late childhood-onset (or later) retinitis pigmentosa, 
+  and variable combinations of anosmia, polyneuropathy, deafness, ataxia, and ichthyosis.
+  Plasmapheresis or lipid apheresis to decrease phytanic acid levels is used only for acute arrhythmias or extreme weakness. 
+  Dietary restriction of phytanic acid intake helps resolve ichthyosis, sensory neuropathy, and ataxia. A high-calorie diet 
+  and avoidance of fasting prevent mobilization of phytanic acid stored in adipose tissue into the plasma. Hypercaloric parenteral 
+  infusions are required during periods of severe illness or postoperatively. Supportive treatment includes hydrating creams for
+  ichthyosis and drugs for cardiac arrhythmias and cardiomyopathy
+  "
+
+named_entities:
+  - id: MAXO:0010119
+    label: dietary phytanic acid intake avoidance
+  - id: HP:0010571
+    label: Elevated circulating phytanic acid concentration
+  - id: HP:0008064
+    label: Ichthyosis
+  - id: MONDO:0009958
+    label: Refsum Disease
+
+extracted_object:
+  action_to_disease:
+    - subject: MAXO:0010119
+      predicate: TREATS
+      object:
+        - MONDO:0009958
+
+  action_to_symptom:
+    - subject: MAXO:0010119
+      predicate: TREATS
+      object:
+        - HP:0008064
+        - HP:0010571
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301572.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301572.yaml
new file mode 100644
index 000000000..752634695
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301572.yaml
@@ -0,0 +1,27 @@
+---
+input_text: >-
+  "Bloom syndrome (BSyn) is characterized by severe pre- and postnatal growth deficiency, immune abnormalities, sensitivity to sunlight, 
+  insulin resistance, and a high risk for many cancers that occur at an early age. 
+  Agents/circumstances to avoid: Sun exposure to the face and other exposed skin, particularly in infancy and early childhood,
+  should be avoided. Exposure to ionizing radiation should be minimized. Dose reductions and shortened courses of chemotherapy 
+  when needed to avoid significant side effects and toxicity (including secondary malignancies). Alkylating agents and radiation 
+  therapy are considered high risk and are avoided when possible in those with BSyn."
+
+named_entities:
+  - id: MONDO:0008876
+    label: Bloom Syndrome
+  - id: MAXO:0000054
+    label: radiation exposure avoidance
+  - id: MAXO:0000055
+    label: sunlight avoidance
+
+extracted_object:
+  action_to_disease:
+    - subject: MAXO:0000054
+      predicate: PREVENTS
+      object:
+        - MONDO:0008876
+    - subject: MAXO:0000055
+      predicate: PREVENTS
+      object:
+        - MONDO:0008876
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301644.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301644.yaml
new file mode 100644
index 000000000..4943c2513
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301644.yaml
@@ -0,0 +1,49 @@
+---
+input_text: >-
+  "Spinocerebellar Ataxia Type 20
+  Evaluations Following Initial Diagnosis
+  To establish the extent of disease in an individual diagnosed with
+  spinocerebellar ataxia type 20 (SCA20), the evaluations summarized in this
+  section (if not performed as part of the evaluation that led to the diagnosis)
+  are recommended:
+  Careful clinical and neurologic evaluation
+  Speech assessment
+  Consultation with a clinical geneticist and/or genetic counselor
+  Treatment of Manifestations
+  Affected persons should be followed by a neurologist with consultation from
+  physiatrists and physical and occupational therapists.
+  Although neither exercise nor physical therapy has been shown to stem the
+  progression of incoordination or muscle weakness, individuals should maintain
+  activity. Canes and walkers help prevent falls. Modification of the home with
+  such conveniences as grab bars, raised toilet seats, and ramps to accommodate
+  motorized chairs may be necessary. Speech therapy and communication devices
+  such as writing pads and computer-based devices may benefit those with
+  dysarthria or dysphonia. Weighted eating utensils and dressing hooks help
+  maintain a sense of independence. Weight control is important because obesity
+  can exacerbate difficulties with ambulation and mobility. When dysphagia
+  becomes troublesome, videofluoroscopic swallow evaluation can identify the
+  consistency of food least likely to trigger aspiration."
+named_entities:
+  - id: MONDO:0012098
+    label: spinocerebellar ataxia type 20
+  - id: MAXO:0000930
+    label: Speech therapy
+  - id: MAXO:0000011
+    label: physical therapy
+  - id: HP:0001260
+    label: dysarthria
+  - id: HP:0001618
+    label: dysphonia
+  - id: HP:0002066
+    label: difficulties with ambulation
+extracted_object:
+  action_to_symptom:
+    - subject: MAXO:0000930
+      predicate: TREATS
+      object:
+        - HP:0001260
+        - HP:0001618
+    - subject: MAXO:0000011
+      predicate: TREATS
+      object:
+        - HP:0002066
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301675.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301675.yaml
new file mode 100644
index 000000000..f68a9779c
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301675.yaml
@@ -0,0 +1,40 @@
+---
+input_text: >-
+  "McKusick-Kaufman Syndrome
+  Clinical characteristics: McKusick-Kaufman syndrome (MKS) is characterized by
+  the combination of postaxial polydactyly (PAP), congenital heart disease
+  (CHD), and hydrometrocolpos (HMC) in females and genital malformations in
+  males (most commonly hypospadias, cryptorchidism, and chordee). HMC in infants
+  usually presents as a large cystic abdominal mass arising out of the pelvis,
+  caused by dilatation of the vagina and uterus as a result of the accumulation
+  of cervical secretions from maternal estrogen stimulation. HMC can be caused
+  by failure of the distal third of the vagina to develop (vaginal agenesis),
+  a transverse vaginal membrane, or an imperforate hymen. PAP is the presence of
+  additional digits on the ulnar side of the hand and the fibular side of the
+  foot. A variety of congenital heart defects have been reported including
+  atrioventricular canal, atrial septal defect, ventricular septal defect,
+  or a complex congenital heart malformation. Diagnosis/testing: The clinical
+  diagnosis of MKS can be established in a proband based on clinical diagnostic
+  criteria of HMC and PAP in the absence of clinical or molecular genetic
+  findings suggestive of an alternative diagnosis. The molecular diagnosis can
+  be established in proband with suggestive findings and biallelic pathogenic
+  variants in MKKS identified by molecular genetic testing. However, care must
+  be taken to ensure that the proband does not have Bardet-Biedl syndrome, an
+  allelic condition with considerable clinical overlap and age-dependent
+  features including retinal dystrophy, obesity, and intellectual disability.
+  Management: Treatment of manifestations: Surgical repair of the obstruction
+  causing HMC and drainage of the accumulated fluid. Treatment for polydactyly
+  and congenital heart defects and any other anomalies is standard."
+named_entities:
+  - id: MONDO:0009367
+    label: McKusick-Kaufman syndrome
+  - id: MAXO:0000004
+    label: surgical repair
+  - id: HP:0030010
+    label: hydrometrocolpos
+extracted_object:
+  action_to_symptom:
+    - subject: MAXO:0000004
+      predicate: TREATS
+      object:
+        - HP:0030010
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301765.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301765.yaml
new file mode 100644
index 000000000..e70652d1e
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_20301765.yaml
@@ -0,0 +1,25 @@
+---
+input_text: >-
+  Von Willebrand disease (VWD), a congenital bleeding disorder caused by deficient or defective plasma von Willebrand factor (VWF), 
+  may only become apparent on hemostatic challenge, and bleeding history may become more apparent with increasing age.  
+  Affected individuals benefit from care in a comprehensive bleeding disorders program. 
+  The two main treatments are desmopressin (1-deamino-8-D-arginine vasopressin [DDAVP]) 
+  and clotting factor concentrates (recombinant and plasma-derived) containing both VWF 
+  and FVIII (VWF/FVIII concentrate). Indirect hemostatic treatments that can reduce symptoms 
+  include fibrinolytic inhibitors; hormones for menorrhagia are also beneficial. 
+  Individuals with VWD should receive prompt treatment for severe bleeding episodes. 
+  Pregnant women with VWD are at increased risk for bleeding complications at or following childbirth.
+named_entities:
+  - id: MAXO:0000446
+    label: desmopressin agent therapy
+  - id: HP:0012147
+    label: Reduced quantity of Von Willebrand factor
+  - id: MONDO:0008668
+    label: Von Willebrand Disease, Type 1
+
+extracted_object:
+  action_to_disease:
+    - subject: MAXO:0000446
+      predicate: TREATS
+      object:
+        - MONDO:0008668
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_2063868.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_2063868.yaml
new file mode 100644
index 000000000..9f40d4f38
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_2063868.yaml
@@ -0,0 +1,24 @@
+---
+input_text: >-
+  delta-Aminolevulinate dehydratase deficient porphyria, a recently recognized inborn error of heme biosynthesis, 
+  results from the markedly deficient activity of the heme biosynthetic enzyme, delta-aminolevulinate dehydratase (ALA-D). 
+  The four homozygotes described to date with this disorder have remarkably distinct phenotypes, ranging from a severely 
+  affected infant with failure to thrive to an essentially asymptomatic 68-year-old male. To investigate the molecular nature 
+  of the lesions causing the severe infantile-onset form, total RNA was isolated from cultured lymphoblasts of the affected homozygote, 
+  RNA was reverse-transcribed to cDNA, and the 990-bp ALA-D-coding region was amplified by the PCR. Heterozygosity for an RsaI RFLP within 
+  the ALA-dehydratase-coding region permitted identification of the paternal and maternal mutant alleles prior to sequencing. 
+  The maternal mutation (designated G133R), a G-to-A transition of nucleotide 397, predicted a glycine-to-arginine substitution at residue 
+  133 at the carboxyl end of the highly conserved zinc-binding site in the enzyme subunit.
+
+named_entities:
+  - id: MAXO:0001175
+    label: liver transplantation
+  - id: MONDO:0013000
+    label: Porphyria, Acute Hepatic
+
+extracted_object:
+  action_to_disease:
+    - subject: MAXO:0001175
+      predicate: TREATS
+      object:
+        - MONDO:0013000
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_26110198.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_26110198.yaml
new file mode 100644
index 000000000..bf4255ad4
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_26110198.yaml
@@ -0,0 +1,41 @@
+---
+input_text: >-
+  "Prolidase Deficiency
+  Treatment of manifestations: Skin ulcers may require treatment by a wound
+  care specialist; topical proline (often 5%) or topical 5% proline-5% glycine
+  ointment applied with dressing changes has been successful in some affected
+  individuals. Standard treatment for developmental delay / intellectual
+  disability, seizures, infections, reactive airways disease / pulmonary
+  hypertension, SLE-like features, hemophagocytic lymphohistiocytosis, mast
+  cell activation, osteopenia, dental anomalies, and refractive errors. Anemia
+  and thrombocytopenia rarely require treatment, but packed red blood cell or
+  platelet transfusions may be considered in those with severe anemia or
+  thrombocytopenia, respectively."
+named_entities:
+  - id: MONDO:0008221
+    label: Prolidase Deficiency
+  - id: MAXO:0000061
+    label: antibacterial agent therapy
+  - id: HP:0200042
+    label: Skin ulcer
+  - id: MAXO:0000756
+    label: blood transfusion
+  - id: HP:0001903
+    label: anemia
+  - id: MAXO:0010020
+    label: amino acid supplementation
+extracted_object:
+  action_to_symptom:
+    - subject: MAXO:0000061
+      predicate: TREATS
+      object:
+        - HP:0200042
+    - subject: MAXO:0000756
+      predicate: TREATS
+      object:
+        - HP:0001903
+  action_to_disease:
+    - subject: MAXO:0010020
+      predicate: TREATS
+      object:
+        - MONDO:0008221
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_27077170.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_27077170.yaml
new file mode 100644
index 000000000..1b1687f67
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_27077170.yaml
@@ -0,0 +1,26 @@
+---
+input_text: >-
+  "Adams-Oliver Syndrome – RETIRED CHAPTER, FOR HISTORICAL
+  REFERENCE ONLY
+  Adams-Oliver syndrome (AOS) is characterized by aplasia cutis
+  congenita (ACC) of the scalp and terminal transverse limb
+  defects (TTLD).
+  Management. Treatment of manifestations: ACC. Care by a
+  pediatric dermatologist and/or plastic surgeon depending on
+  severity. Goals of non-operative therapy are to prevent infection
+  and promote healing. Large and/or deep lesions with calvarial
+  involvement require acute care and may eventually also require
+  reconstruction by a neurosurgeon."
+named_entities:
+  - id: MONDO:0013895
+    label: Adams-oliver Syndrome 3
+  - id: MAXO:0000946
+    label: neurosurgical procedure
+  - id: HP:0001057
+    label: aplasia cutis congenita
+extracted_object:
+  action_to_symptom:
+    - subject: MAXO:0000946
+      predicate: TREATS
+      object:
+        - HP:0001057
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_28406602.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_28406602.yaml
new file mode 100644
index 000000000..dae100b0b
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_28406602.yaml
@@ -0,0 +1,72 @@
+---
+input_text: >-
+  "Myhre Syndrome
+  The diagnosis of Myhre syndrome is established in a proband
+  with characteristic clinical findings and a heterozygous
+  pathogenic (or likely pathogenic) variant in SMAD4 detected
+  by molecular genetic testing. Management. Treatment of
+  manifestations: Feeding therapy with a low threshold for a
+  clinical and/or radiographic swallowing study; referral to
+  nutrition for poor weight gain or obesity; medical therapy
+  for systemic and/or pulmonary hypertension; long-term
+  tracheostomy may be required for those with complete or
+  recurrent tracheal stenosis; aggressive medical management
+  for constipation; physical therapy to keep joints mobile;
+  hearing aids may be helpful for those with hearing loss;
+  some keloids can be treated with intralesional steroids
+  with minimal invasiveness for lesion removal; and standard
+  treatment for orofacial clefting / velopharyngeal
+  insufficiency, congenital heart defects / pericardial disease,
+  restrictive lung disease, gastrointestinal stenosis,
+  developmental delay / intellectual disability, refractive
+  errors / strabismus / cataracts, persistent middle ear
+  effusions, immunodeficiency, diabetes mellitus, and
+  pubertal/menstrual irregularities.
+  Orofacial clefting /Velopharyngeal insufficiency
+  Standard treatment, ideally by craniofacial team
+  Multidisciplinary teams may incl surgical team (craniofacial
+  surgeon), clinical geneticist, otolaryngologist, pediatrician,
+  radiologist, psychologist, multiple dental specialists,
+  audiologist, speech therapist, & social worker.
+  Restrictive lung disease 	Symptomatic & standard treatment
+  per pulmonologist	Oxygen supplementation as necessary"
+named_entities:
+  - id: MONDO:0007688
+    label: Myhre Syndrome
+  - id: MAXO:0000011
+    label: physical therapy
+  - id: HP:0001376
+    label: Limitation of joint mobility
+  - id: HP:0001387
+    label: Joint stiffness
+  - id: MAXO:0000066
+    label: Oxygen supplementation
+  - id: HP:0002093
+    label: restrictive lung disease
+  - id: MAXO:0000504
+    label: tracheostomy
+  - id: HP:0004894
+    label: tracheal stenosis
+  - id: MAXO:0000930
+    label: speech therapist
+  - id: HP:0001608
+    label: Abnormality of the voice
+extracted_object:
+  action_to_symptom:
+    - subject: MAXO:0000011
+      predicate: TREATS
+      object:
+        - HP:0001376
+        - HP:0001387
+    - subject: MAXO:0000066
+      predicate: TREATS
+      object:
+        - HP:0002093
+    - subject: MAXO:0000504
+      predicate: TREATS
+      object:
+        - HP:0004894
+    - subject: MAXO:0000930
+      predicate: TREATS
+      object:
+        - HP:0001608
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_29478819.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_29478819.yaml
new file mode 100644
index 000000000..a297935dd
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_29478819.yaml
@@ -0,0 +1,31 @@
+---
+input_text: >-
+  To overcome these challenges, a novel Blind Start design was utilized in a study of vestronidase alfa
+  in mucopolysaccharidosis VII (Sly syndrome), an ultra-rare lysosomal disease, that demonstrates the strengths of 
+  this approach in a challenging drug-development setting. Twelve subjects were randomized to 1 of 4 blinded groups, 
+  each crossing over to active treatment in a blinded fashion at different timepoints with efficacy analysis comparing 
+  the last assessment before cross over to after 24 weeks of treatment. Study assessments included Percentage change from baseline 
+  in urinary GAG (uGAG); a Multi-Domain Responder Index (MDRI) using prespecified minimal important differences (6-Minute Walk Test, 
+  Forced Vital Capacity, shoulder flexion, visual acuity, and Bruininks-Oseretsky Test of Motor Proficiency); fatigue as assessed by 
+  the Pediatric Quality of Life Inventory™ Multidimensional Fatigue Scale; and safety.
+  We report a novel approach used in development of vestronidase alfa (recombinant human β-glucuronidase or rhGUS),
+  an enzyme replacement therapy (ERT) for MPS VII, that included a unique Phase 3 Blind Start study design with a 
+  variable placebo run-in period masking the start of vestronidase alfa, and allowing all subjects to be assessed for efficacy. 
+  Another unique feature was the use of a Multi-Domain Responder Index (MDRI) that allowed translation of multiple clinical measures 
+  into a combination responder endpoint assessed using minimally important difference (MID) thresholds without penalizing for 
+  non-assessable endpoints in a heterogeneous patient population.
+
+named_entities:
+  - id: MONDO:0009662
+    label: Mucopolysaccharidosis Type Vii
+  - id: MAXO:0000933
+    label: enzyme replacement or supplementation therapy
+  - id: HP:0003541
+    label: Urinary glycosaminoglycan excretion
+
+extracted_object:
+  action_to_symptom:
+    - subject: MAXO:0000933
+      predicate: TREATS
+      object:
+        - HP:0003541
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_30488337.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_30488337.yaml
new file mode 100644
index 000000000..af613db6b
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_30488337.yaml
@@ -0,0 +1,26 @@
+---
+input_text: >-
+  "Canaloplasty in the Treatment of Open-Angle Glaucoma: A Review of Patient Selection and Outcomes
+  Canaloplasty is a relatively new non-penetrating surgery for the reduction of intraocular pressure 
+  in patients affected by glaucoma. The technique uses a microcatheter to perform a 360 º cannulation of 
+  Schlemm's canal and leaves in place a tension suture providing an inward distension. It aims to restore 
+  the physiological outflow pathways of the aqueous humour and is independent of external wound healing
+  Several studies have shown that canaloplasty is effective in reducing intraocular pressure and has a low rate 
+  of complications, especially compared with trabeculectomy, the gold standard for glaucoma surgery. Currently, 
+  canaloplasty is indicated in patients with open-angle glaucoma, having a mild to moderate disease, and the combination
+  with cataract phacoemulsification may provide further intraocular pressure reduction."
+
+named_entities:
+  - id: MAXO:0000959
+    label: canaloplasty
+  - id: HP:0012108
+    label: Open angle glaucoma
+  - id: MONDO:0007665
+    label: Glaucoma, Primary Open Angle
+
+extracted_object:
+  action_to_disease:
+    - subject: MAXO:0000959
+      predicate: TREATS
+      object:
+        - MONDO:0007665
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_36977302.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_36977302.yaml
new file mode 100644
index 000000000..582a17d19
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_36977302.yaml
@@ -0,0 +1,25 @@
+---
+input_text: >-
+  Corneal dystrophies are a group of non-inflammatory inherited disorders of the cornea. This review considers treatment options for epithelial-stromal 
+  and stromal corneal dystrophies namely Reis-Bücklers, Thiel-Behnke, lattice, Avellino, granular, macular and Schnyder corneal dystrophies. 
+  Where there is visual reduction, treatment options may include either phototherapeutic keratectomy (PTK) or corneal transplantation. 
+  Due to the anterior location of the deposits in Reis-Bücklers and Thiel-Behnke dystrophies, PTK is considered the treatment of choice. 
+  For lattice, Avellino, granular and macular corneal dystrophies, PTK provides temporary visual improvement; however, with recurrences, 
+  repeat PTK or a corneal transplant would be needed. For Schnyder dystrophy, should treatment be required, PTK may be the preferred option 
+  due to the potential for recurrence of the disease in corneal transplantation. This review discusses the literature and evidence base for 
+  the treatment of corneal dystrophies in terms of visual outcomes and recurrence rate.
+
+named_entities:
+  - id: MONDO:0012043
+    label: Corneal Dystrophy, Reis-bucklers Type
+  - id: MAXO:0010034
+    label: corneal transplantation
+  - id: HP:0001131
+    label: Corneal dystrophy
+
+extracted_object:
+  action_to_symptom:
+    - subject: MAXO:0010034
+      predicate: TREATS
+      object:
+        - HP:0001131
diff --git a/src/ontogpt/evaluation/maxo/test_cases/maxo_case_9543069.yaml b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_9543069.yaml
new file mode 100644
index 000000000..3ceb7ec3d
--- /dev/null
+++ b/src/ontogpt/evaluation/maxo/test_cases/maxo_case_9543069.yaml
@@ -0,0 +1,27 @@
+---
+input_text: >-
+  A 12-year-old girl with Sly disease (mucopolysaccharidosis VII; beta-glucuronidase deficiency), who is homozygous for the A619V mutation, 
+  had a successful allogeneic BMT, donored by an HLA-identical unrelated female to replace the deficient enzyme. Within 5 months after BMT, 
+  the enzyme activity of the recipient's lymphocytes increased to normal range. No signs of acute or chronic GVHD were observed. 
+  For the successive 31 months post-BMT, beta-glucuronidase activity in her lymphocytes was maintained at almost normal levels and excretion 
+  of glycosaminoglycans in the urine was greatly diminished. Ultrastructural findings demonstrated no abnormal vacuoles and inclusion bodies 
+  in the cytoplasm of her rectal mucosal cells. Coincident with the restoration of the enzyme activity, clinical improvement was dramatic.
+  Especially notable were improvements in motor function. The patient was able to walk alone for a long time without aid, 
+  and she even became able to ride a bicycle and take a bath. In addition, recurrent infections of the upper respiratory tract and 
+  the middle ears decreased in frequency and severity, and dyspnea on exertion, severe snoring and vertigo have substantially improved. 
+  Thus, allogeneic BMT in this patient produced a better quality of life and provided a more promising outlook.
+
+named_entities:
+  - id: MONDO:0009662
+    label: Mucopolysaccharidosis Type Vii
+  - id: MAXO:0001479
+    label: allogeneic hematopoietic stem cell transplantation
+  - id: HP:0003541
+    label: Urinary glycosaminoglycan excretion
+
+extracted_object:
+  action_to_symptom:
+    - subject: MAXO:0001479
+      predicate: TREATS
+      object:
+        - HP:0003541
diff --git a/src/ontogpt/evaluation/resolver.py b/src/ontogpt/evaluation/resolver.py
index 38a5b714e..023035394 100644
--- a/src/ontogpt/evaluation/resolver.py
+++ b/src/ontogpt/evaluation/resolver.py
@@ -5,9 +5,10 @@
 
 from ontogpt.evaluation.ctd.eval_ctd import EvalCTD
 from ontogpt.evaluation.ctd.eval_ctd_ner import EvalCTDNER
+from ontogpt.evaluation.maxo.eval_maxo import EvalMAXO
 from ontogpt.evaluation.evaluation_engine import SPIRESEvaluationEngine
 
-resolver = ClassResolver([EvalCTD, EvalCTDNER], base=SPIRESEvaluationEngine)
+resolver = ClassResolver([EvalCTD, EvalCTDNER, EvalMAXO], base=SPIRESEvaluationEngine)
 
 
 def create_evaluator(
diff --git a/src/ontogpt/templates/maxo.py b/src/ontogpt/templates/maxo.py
index c33692516..e79d54fd7 100644
--- a/src/ontogpt/templates/maxo.py
+++ b/src/ontogpt/templates/maxo.py
@@ -33,15 +33,6 @@ class NullDataOptions(str, Enum):
     
     
 
-class MaxoAnnotations(ConfiguredBaseModel):
-    
-    action: Optional[List[str]] = Field(default_factory=list, description="""Semicolon-separated list of medical actions.""")
-    disease: Optional[List[str]] = Field(default_factory=list, description="""Semicolon-separated list of diseases.""")
-    symptom: Optional[List[str]] = Field(default_factory=list, description="""Semicolon-separated list of symptoms.""")
-    action_to_disease: Optional[List[ActionToDiseaseRelationship]] = Field(default_factory=list)
-    action_to_symptom: Optional[List[ActionToSymptomRelationship]] = Field(default_factory=list)
-    
-
 class ExtractionResult(ConfiguredBaseModel):
     """
     A result of extracting knowledge on text
@@ -127,11 +118,32 @@ class ActionToSymptomRelationship(Triple):
     
 
 class TextWithTriples(ConfiguredBaseModel):
+    """
+    A text containing one or more relations of the Triple type.
+    """
+    publication: Optional[Publication] = Field(None)
+    triples: Optional[List[Triple]] = Field(default_factory=list)
+    
+
+class MaxoAnnotations(TextWithTriples):
     
+    action: Optional[List[str]] = Field(default_factory=list, description="""Semicolon-separated list of medical actions.""")
+    disease: Optional[List[str]] = Field(default_factory=list, description="""Semicolon-separated list of diseases.""")
+    symptom: Optional[List[str]] = Field(default_factory=list, description="""Semicolon-separated list of symptoms.""")
+    action_to_disease: Optional[List[ActionToDiseaseRelationship]] = Field(default_factory=list)
+    action_to_symptom: Optional[List[ActionToSymptomRelationship]] = Field(default_factory=list)
     publication: Optional[Publication] = Field(None)
     triples: Optional[List[Triple]] = Field(default_factory=list)
     
 
+class TextWithEntity(ConfiguredBaseModel):
+    """
+    A text containing one or more instances of a single type of entity.
+    """
+    publication: Optional[Publication] = Field(None)
+    entities: Optional[List[str]] = Field(default_factory=list)
+    
+
 class RelationshipType(NamedEntity):
     
     id: str = Field(..., description="""A unique identifier for the named entity""")
@@ -157,7 +169,6 @@ class AnnotatorResult(ConfiguredBaseModel):
 
 # Model rebuild
 # see https://pydantic-docs.helpmanual.io/usage/models/#rebuilding-a-model
-MaxoAnnotations.model_rebuild()
 ExtractionResult.model_rebuild()
 NamedEntity.model_rebuild()
 Action.model_rebuild()
@@ -168,6 +179,8 @@ class AnnotatorResult(ConfiguredBaseModel):
 ActionToDiseaseRelationship.model_rebuild()
 ActionToSymptomRelationship.model_rebuild()
 TextWithTriples.model_rebuild()
+MaxoAnnotations.model_rebuild()
+TextWithEntity.model_rebuild()
 RelationshipType.model_rebuild()
 Publication.model_rebuild()
 AnnotatorResult.model_rebuild()
diff --git a/src/ontogpt/templates/maxo.yaml b/src/ontogpt/templates/maxo.yaml
index 282ff6fe5..944547db9 100644
--- a/src/ontogpt/templates/maxo.yaml
+++ b/src/ontogpt/templates/maxo.yaml
@@ -27,6 +27,7 @@ classes:
 
   MaxoAnnotations:
     tree_root: true
+    is_a: TextWithTriples
     attributes:
       action:
         annotations:
@@ -56,7 +57,7 @@ classes:
       action_to_symptom:
         annotations:
           prompt: >-
-            A triple representing a relationship between a medical action 
+            A triple representing a relationship between a medical action
             (A clinically prescribed procedure, therapy, intervention, or recommendation)
             and a symptom, for example,
             a chest X-ray IS USED TO DIAGNOSE pleural effusion.