Techniques for determining a clinician's intent to order an item may include processing a free-form narration, of an encounter with a patient, narrated by a clinician, using a natural language understanding engine, to extract one or more clinical facts corresponding to one or more mentions of one or more orderable items from the free- form narration. The processing may comprise distinguishing, for each one of the clinical facts corresponding to a mention of an orderable item, between whether the clinical fact indicates an intent to order the respective orderable item or does not indicate an intent to order the respective orderable item, and assigning an intent-to-order attribute only to any clinical fact determined to indicate an intent to order the respective orderable item. At least one order may be generated for an orderable item corresponding to a clinical fact, of the extracted clinical facts, that is assigned an intent-to-order attribute.