use strict;
use warnings;

my $file = "z.txt";
open my $fh, "<", $file or die "Unable to open $file: $!";
my ($p_val, $m_val);
{ local $/ = '\n\n\n';
  while (<$fh>) {                   # read until three newlines
     foreach (split/\n/) {          # split it into individual lines
        if (s/\bProcessing\s\d+\.tx\.\d+: //) {
            print "$_\n";           # print the u_value immediately
        } elsif (s/\bPhrase: //) {
            s/"//g;                 # note: no need to escape "
            $p_val = $_;            # keep it
        } elsif (/\(\\s\\s\)/) {
            $m_val = $_;            # keep it
            if (defined $p_val) {
               print "\t$p_val\t$m_val\n";  # print if we have both
            }
            ($p_val, $m_val) = (undef)x2;
        }
     }
  }
}
close $fh;
__END__
Pulmonary embolism at the time of hip replacement
        Pulmonary embolism      (\s\s)1000 D0076131:PULMONARY EMBOLISM Disease or Syndrome
        of hip replacement      (\s\s)1000 D0554893:HIP REPLACEMENT (STATUS POST HIP REPLACEMENT) Finding