A silver color metal and enamel device 1 ¼ inches (3.18 cm) in height overall consisting of a scarlet Greek cross bearing a green disc charged with a paschal lamb standing and holding a crossed staff with a banner charged with a cross all in silver, in front of a circular continuous scroll divided horizontally maroon at top and white in base, the maroon part passing in front of the upper vertical arm of the cross and inscribed "SIRVIENDO" in silver letters. The Spanish motto is translated "At Your Service."
Maroon and white are colors traditionally associated with the Army Medical Department. The cross, a symbol of aid and assistance, represents the hospital. The green disc alludes to the islands of the Western Pacific where the unit served in World War II; green is also symbolic of Puerto Rico and the city of San Juan.
The distinctive unit insignia was originally approved for the 369th Station Hospital on 30 June 1971. It was redesignated for the 369th Evacuation Hospital effective 17 September 1989. The insignia was redesignated for the 369th Field Hospital with description and symbolism revised effective 16 September 1993. It was redesignated for the 369th Combat Support Hospital, U.S. Army Reserve, on 24 January 1996.