A silver color metal and enamel device 1 3/16 inches (3.02 cm) in width overall consisting of a silver metal phoenix issuing from red flames surmounting overall a maroon Greek cross and all within a blue scroll arched at the top and divided in three folds inscribed "SERVE SAVE CARE" in silver letters.
Maroon and white (silver) are the colors used for the Army Medical Department. The cross, a symbol for aid and assistance, alludes to the basic mission of the Hospital. The phoenix, a legendary white bird symbolic of rejuvenation, hope and life, alludes to the crest of the arms of the city of San Francisco, home area of the organization.
The distinctive unit insignia was originally approved for the 146th Evacuation Hospital on 29 March 1972. It was redesignated for the 146th Combat Support Hospital on 4 February 1974.