<![CDATA[Sustainability concerns are relevant in the healthcare sector, as clinics not only deliver medical services but also generate environmental impacts through medical waste, energy consumption, and disposable material use. These environmental costs are often embedded within general operating expenses without systematic identification, creating risks of inefficiency and weak accountability. This study analyzes the implementation of green accounting at Asta Medical Clinic in Bali using Tri Hita Karana, a local philosophy emphasizing harmony among the spiritual (parahyangan), social (pawongan), and environmental (palemahan) dimensions, and interprets the findings through legitimacy, stakeholder, and institutional theories. A descriptive qualitative case-study approach was used, combining semi-structured interviews with three informants, direct observation, and documentation analysis for triangulation. The findings show that the clinic has practiced elements of green accounting informally: environmental costs related to medical waste, energy, water, and disposable supplies are recognized and measured, but remain merged with general operating costs rather than classified, presented, and disclosed separately. Tri Hita Karana values are reflected in daily religious rituals and ethical service standards (parahyangan), waste-management and energy-efficiency practices (palemahan), and social programs for staff, patients, and the community (pawongan). The main barriers are the absence of a structured environmental-cost system and formal internal policy. A dedicated environmental-cost chart of accounts, with proposed journal entries and account codes under SAK EP (Indonesia's financial accounting standard for private entities), and a simple sustainability report are recommended.]]>
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