Structured output, where an LLM populates a predefined JSON schema, has become a default mechanism for data labeling and information extraction, but it also introduces a second instruction channel through schema descriptions. We tested whether classification-label definitions are better placed in the system prompt, user prompt, or schema description using a single-field classification task with nonce labels across ten model configurations from two vendors. Schema descriptions did not consistently outperform prompt-based placement; for GPT-4.1 and GPT-5.4 without reasoning, schema placement underperformed system prompts by 11-13 percentage points. Yet schemas are not inert metadata: when prompts and schemas conflicted, incorrect schema instructions caused accuracy drops of 5-45 points, with Claude Haiku 4.5 falling from 52.5% to 7%, indicating that schema instructions can override prompt instructions, and GPT-5.5 falling from 100% to 73%. Further, adding a required intermediate reasoning field before the label field improved schema-only accuracy by 15-24 points when headroom existed, exceeding system-prompt-only performance in every case tested. The effect held even for Claude Sonnet 4.6 at medium reasoning, where extended thinking alone did not produce a comparable gain. This suggests that schema design can affect how effectively models use information encoded in field descriptions. Overall, these results indicate that schema influence is model-dependent. In practice, the system prompt remains a safe default for definitions, but the bigger discipline is maintaining a single source of truth and preventing prompt/schema drift. More importantly, schema design itself may be a stronger lever than instruction placement. Practitioners should treat prompts and schemas as a unified instruction surface and empirically validate both placement and field design for their target model.
Large language models are increasingly used for structured extraction from clinical free-text notes, but the sensitivity of their output to upstream configuration choices is less understood than their accuracy on fixed benchmarks. This work measures that sensitivity without human-annotated ground truth, by holding the extraction task fixed and varying one choice at a time. The fixed schema comprises 17 clinical documentation flags on a three-way yes/no/not_documented value set and a 47-tag vocabulary for the primary admission reason. Three prompt variants expressing this schema were each run at two model sizes on MIMIC-IV v3.1 discharge summaries. Cross-prompt agreement was measured by Cohen's kappa on ICD-stratified subsets. A paired same-note comparison isolated the effect of model choice, and a post-hoc collapse of the three-way flags to binary tested the schema's contribution to disagreement. On the three-way flags, the two models reach the same pooled cross-prompt agreement (median kappa 0.69 and 0.68); the larger model raises agreement on some fields and lowers it on others, a redistribution rather than the absence of an effect. Collapsing the schema to binary dissolves most of the cross-prompt disagreement, locating it on the absence-versus-silence distinction rather than on whether the finding is present. On the multi-class admission categorization, changing the model reassigns the dominant tag on close to half of all notes while changing the prompt phrasing reassigns it on roughly one in eight, and the larger model places far less mass on residual catch-all categories (44% to 26%). These patterns indicate a schema-imposed source of disagreement concentrated on the absence-versus-silence axis and a dominance of model over prompt phrasing on multi-class categorization, identified by a reusable methodology for auditing extraction reproducibility on a population-scale deployment.