Due to COVID-19 Victory Home Health Agency remains open and operational even though our physical office is temporarily closed.

Medicaid and State Licensed by:

HR Form – Please DO NOT Apply without notification to HR department

Call: 215-695-5877 ask for Becky

HR Application must be submitted along with the following documents in order to get paid.


Required Documents/Health Screening

  • 1. Driver’s License or State ID
  • 2. SSN Card
  • 3. Birth Certificate
  • 4. PPD(2-step)/TB Quanteferon or Xray records within one year.*
    Note: (If you don’t have one, we can schedule you with LabCorp. Free of charge)
  • 5. Child Abuse Clearance within 5 years.
  • 6. Valid EMAIL address
  • 7. Proof of PA residency for prior 2 years (Ex: a 2 year old utility bill, bank statement etc…)
  • 8. FBI fingerprints are required if lived in the state of PA less than 2 years.

In the References section in the application DO NOT put friends or relatives.

NOTE: Power of Attorney (POA), husband or wife cannot be a caregiver for the client in the State of Pennsylvania.

Please email these documents to info@victoryhomecarepa.com, fax them to 215-712-8630 or text them to 267-342-2453.

Patient Intake Form

Caregiver Employment Application

I-9 Employment Eligibility Verification

W4 Tax Withholding 2023

Social Security Number Verification

Annual In-Service Training & TB Questionnaire