The award was announced in the St John Ambulance Brigade General Regulations for 1895 and minted in 1899, though the first honourees had been selected the previous year.

The reverse displays the legend MAGNUS · PRIORATUS · ORDINIS · HOSPITALIS · SANCTI · JOHANNIS · JERUSALEM · IN · ANGLIA (Grand Priory of the Order of the Hospital of St. John of Jerusalem in England) along with five equally sized circles in a cross holding individual heraldic icons supported by sprawling St John's Wort.

With effect from 1 January 2020, and following depletion of manufacturer's stock, medals will be issued with the inscription "THE MOST VENERABLE ORDER OF THE HOSPITAL OF ST JOHN OF JERUSALEM", and "FOR SERVICE" at the bottom.

In Canada the legend will be in Latin, "VENERABILISSIMI ORDINIS HOSPITALIS SANCTI JOHANNIS HIEROSOLYMITANI".

It is of the same design as the Service Medal using base metal with a gold or similar plate finish.

[1] The original practice of naming the recipient on the rim of the medal gradually ceased,[4] except in New Zealand and South Africa.

[1][6] From 1932 until after the Second World War, a top suspender broach bar was issued to recipients who served with either the Military Hospitals Reserve or the Voluntary Aid Detachments.