A gold color metal and enamel device 1 3/16 inches (3.02 cm) in height overall consisting of a white background bearing three blue (ultramarine) wavy bars surmounted by a maroon Greek cross, the vertical arm charged with two gold fleurs-de-lis one above the other, all enclosed within a voluted gold scroll inscribed "PRESERVE" at the top and at the base "CONSERVE," all in red letters.
Maroon and white are the colors used by the Army Medical Department. The cross, a symbol of aid and assistance, represents the 323d Combat Support Hospital. The two fleurs-de-lis symbolize the unit's medical service during World War I and World War II (in northern France). The four arms of the cross allude to the four great expanses of water that touch the shores of Michigan, the home state of the hospital: Lake Erie, Lake Huron, Lake Superior and Lake Michigan. The three wavy bars simulate water and also symbolize the goals of the hospital for continuous care, healing and good health.
The distinctive unit insignia was originally approved for the 323d General Hospital on 8 July 1970. The insignia was redesignated effective 16 January 1995, for the 323d Combat Support Hospital with the description and symbolism revised.