What aspect is NOT typically included in an evaluation and management encounter?

In an evaluation and management (E/M) encounter, the primary elements typically include components such as the chief complaint, physical examination, and assessment.

The chief complaint is essential as it captures the main reason the patient is seeking medical care, guiding the physician's focus during the encounter. The physical examination is also a crucial part of the E/M encounter, as it allows the clinician to assess the patient's physical status and identify any abnormalities that warrant further investigation or intervention. The assessment phase involves the clinician's clinical judgment about the patient’s condition, including a diagnosis or consideration of differential diagnoses.

Referral to specialists, while often a necessary part of patient care, is not a mandated component of a standard E/M encounter. A referral might occur as a result of the encounter but is not required for the evaluation and management process itself. This means it does not fall within the standard components needed for an E/M note, which focuses primarily on the immediate clinical interaction, rather than subsequent actions such as referrals. Thus, referral to specialists is typically not included as a fundamental part of an E/M encounter.