Hi Jon,
The imported items tends to be where the process breaks down a lot. I have not found an efficient way yet to print imported items in bulk. There is an option to display the imported items in the process I described above, but the problem is they all open in their native programs and each in its own window. That means if you have 50 PDFs in that patient, then there will be 50 individual windows opening up. Now if they are imported labs from a lab interface, then that is different (and this is a bonus for having a lab interface). The imported labs will be included in the PDF with the notes. Just check the option for "Labs" and any imported lab results will be included in the PDF.
Scanned labs will unfortunately need to be printed separately.