diff --git a/chrome/content/zotero/xpcom/editorInstance.js b/chrome/content/zotero/xpcom/editorInstance.js
index fe8da5c6c2..a396c4c644 100644
--- a/chrome/content/zotero/xpcom/editorInstance.js
+++ b/chrome/content/zotero/xpcom/editorInstance.js
@@ -1307,8 +1307,57 @@ class EditorInstance {
 		html += '\n';
 
 		await editorInstance.importImages(jsonAnnotations);
-		let { html: serializedHTML, citationItems } = Zotero.EditorInstanceUtilities.serializeAnnotations(jsonAnnotations, true);
-		html += serializedHTML;
+
+		let multipleParentParent = false;
+		let lastParentParentID;
+		let lastParentID;
+		// Group annotations per attachment
+		let groups = [];
+		for (let i = 0; i < annotations.length; i++) {
+			let annotation = annotations[i];
+			let jsonAnnotation = jsonAnnotations[i];
+			let parentParentID = annotation.parentItem.parentID;
+			let parentID = annotation.parentID;
+			if (groups.length) {
+				if (parentParentID !== lastParentParentID) {
+					// Multiple top level regular items detected, allow including their titles
+					multipleParentParent = true;
+				}
+			}
+			if (!groups.length || parentID !== lastParentID) {
+				groups.push({
+					parentTitle: annotation.parentItem.getDisplayTitle(),
+					parentParentID,
+					parentParentTitle: annotation.parentItem.parentItem && annotation.parentItem.parentItem.getDisplayTitle(),
+					jsonAnnotations: [jsonAnnotation]
+				});
+			}
+			else {
+				let group = groups[groups.length - 1];
+				group.jsonAnnotations.push(jsonAnnotation);
+			}
+			lastParentParentID = parentParentID;
+			lastParentID = parentID;
+		}
+		let citationItems = [];
+		lastParentParentID = null;
+		for (let group of groups) {
+			if (multipleParentParent && group.parentParentTitle && lastParentParentID !== group.parentParentID) {
+				html += `<h2>${group.parentParentTitle}</h2>\n`;
+			}
+			lastParentParentID = group.parentParentID;
+			// If attachment doesn't have a parent or there are more attachments with the same parent, show attachment title
+			if (!group.parentParentID || groups.filter(x => x.parentParentID === group.parentParentID).length > 1) {
+				html += `<h3>${group.parentTitle}</h3>\n`;
+			}
+			let { html: _html, citationItems: _citationItems } = Zotero.EditorInstanceUtilities.serializeAnnotations(group.jsonAnnotations, true);
+			html += _html + '\n';
+			for (let _citationItem of _citationItems) {
+				if (!citationItems.find(item => item.uris.some(uri => _citationItem.uris.includes(uri)))) {
+					citationItems.push(_citationItem);
+				}
+			}
+		}
 		citationItems = encodeURIComponent(JSON.stringify(citationItems));
 		// Note: Update schema version only if using new features
 		let schemaVersion = 8;
diff --git a/test/tests/annotationsTest.js b/test/tests/annotationsTest.js
index fa97d7f8ba..6070240878 100644
--- a/test/tests/annotationsTest.js
+++ b/test/tests/annotationsTest.js
@@ -403,4 +403,79 @@ describe("Zotero.Annotations", function() {
 			await Zotero.Items.erase(splitAnnotations.map(x => x.id));
 		});
 	});
-})
\ No newline at end of file
+});
+
+describe("Create a note from annotations from multiple items and attachments", function () {
+	it("should create a note from single PDF file containing multiple annotations", async function () {
+		let annotations = [];
+		let attachment = await importPDFAttachment();
+		let annotation1 = await createAnnotation('highlight', attachment);
+		annotations.push(annotation1);
+		let annotation2 = await createAnnotation('highlight', attachment);
+		annotations.push(annotation2);
+		let note = await Zotero.EditorInstance.createNoteFromAnnotations(annotations, null);
+		assert.equal(note.note.split('test.pdf').length - 1, 1);
+		assert.equal(note.note.split(annotation1.annotationText).length - 1, 1);
+		assert.equal(note.note.split(annotation2.annotationText).length - 1, 1);
+	});
+
+	it("should create a note from multiple PDF files containing single annotation", async function () {
+		let annotations = [];
+		let item = await createDataObject('item', { setTitle: true });
+		let attachment1 = await importPDFAttachment(item);
+		let attachment2 = await importPDFAttachment(item);
+		let annotation1 = await createAnnotation('highlight', attachment1);
+		annotations.push(annotation1);
+		let annotation2 = await createAnnotation('highlight', attachment2);
+		annotations.push(annotation2);
+		let note = await Zotero.EditorInstance.createNoteFromAnnotations(annotations, null);
+		assert.equal(note.note.split('test.pdf').length - 1, 2);
+		assert.equal(note.note.split('>' + item.getField('title') + '<').length - 1, 0);
+		assert.equal(note.note.split(annotation1.annotationText).length - 1, 1);
+		assert.equal(note.note.split(annotation2.annotationText).length - 1, 1);
+	});
+
+	it("should create a note from multiple parent items containing single PDF file with single annotation", async function () {
+		let annotations = [];
+		let item1 = await createDataObject('item', { setTitle: true });
+		let item2 = await createDataObject('item', { setTitle: true });
+		let attachment1 = await importPDFAttachment(item1);
+		let attachment2 = await importPDFAttachment(item2);
+		let annotation1 = await createAnnotation('highlight', attachment1);
+		annotations.push(annotation1);
+		let annotation2 = await createAnnotation('highlight', attachment2);
+		annotations.push(annotation2);
+		let note = await Zotero.EditorInstance.createNoteFromAnnotations(annotations, null);
+		assert.equal(note.note.split('test.pdf').length - 1, 0);
+		assert.equal(note.note.split('>' + item1.getField('title') + '<').length - 1, 1);
+		assert.equal(note.note.split('>' + item2.getField('title') + '<').length - 1, 1);
+		assert.equal(note.note.split(annotation1.annotationText).length - 1, 1);
+		assert.equal(note.note.split(annotation2.annotationText).length - 1, 1);
+	});
+
+	it("should create a note from multiple parent items containing multiple PDF files with multiple annotations", async function () {
+		let annotations = [];
+		let item1 = await createDataObject('item', { setTitle: true });
+		let item2 = await createDataObject('item', { setTitle: true });
+		let attachment1 = await importPDFAttachment(item1);
+		let attachment2 = await importPDFAttachment(item2);
+		let attachment3 = await importPDFAttachment(item2);
+		let annotation1 = await createAnnotation('highlight', attachment1);
+		annotations.push(annotation1);
+		let annotation2 = await createAnnotation('highlight', attachment2);
+		annotations.push(annotation2);
+		let annotation3 = await createAnnotation('highlight', attachment3);
+		annotations.push(annotation3);
+		let annotation4 = await createAnnotation('highlight', attachment3);
+		annotations.push(annotation4);
+		let note = await Zotero.EditorInstance.createNoteFromAnnotations(annotations, null);
+		Zotero.debug(note.note);
+		assert.equal(note.note.split('test.pdf').length - 1, 2);
+		assert.equal(note.note.split('>' + item1.getField('title') + '<').length - 1, 1);
+		assert.equal(note.note.split('>' + item2.getField('title') + '<').length - 1, 1);
+		assert.equal(note.note.split(annotation1.annotationText).length - 1, 1);
+		assert.equal(note.note.split(annotation2.annotationText).length - 1, 1);
+		// Check item URIs count
+		assert.equal(note.note.split('zotero.org').length - 1, 16);
+	});
+});