The 865th Combat Support Hospital Distinctive Unit Insignia was originally approved on 6 June 1972 for the 365th Evacuation Hospital. It was redesignated for the 865th General Hospital with an effective date of 17 September 1999. It was then redesignated for the 865th Combat Support Hospital with an effective date of 16 June 1997.
A maroon cross in the center of the insignia with golden rays emerging upward from it symbolize the Hospital’s primary function of providing aid and medical treatment. When viewed with the annulet, the rays also serve as spokes in order to suggest part of a wheel, a reference to the unit’s former designation as an Evacuation Hospital. Green is the color of health and regeneration, and the white waterfall is an allusion to the unit’s location in Niagara Falls, New York when the Insignia was approved. “Support The Strength” is the Battalion motto.
Also known as a unit crest or DUI, a Distinctive Unit Insignia is worn by all Soldiers (except General Officers) in units that have been authorized to be issued the device. It is worn centered on the shoulder loops of the Army Green Service Uniform (AGSU) and the blue Army Service Uniform (ASU, Enlisted only) with the base of the insignia toward the outside shoulder seam. Current regulations do not permit the DUI to be worn on the Dress variations of either uniform, however.
More guidance on wear of the DUI is found in DA Pamphlet 670-1, Section 21-22, "Distinctive unit insignia" and 21–3(d) and (e), "Beret" and "Garrison Cap," respectively.
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The 365th Combat Support Hospital was originally constituted in the Army Reserve as the 365th Evacuation Hospital on 15 March 1972 at Niagara Falls, New York. It was ordered into active military service in November 1990 and released from service on 25 March 1991, when it reverted back to Reserve status.
It was reorganized and redesignated as the 865th General Hospital on 17 September 1993. It was subsequently redesignated as the 865th Combat Support Hospital at some point after 1996 and its location changed to Utica New York.
As of Winter 2024, the 865th Combat Support Hospital remains allotted to the Army Reserve. When not called to active service, it is assigned to the 8th Medical Brigade, 3rd Medical Command (Deployment Support).