Any qualified voter who has been admitted to a hospital, nursing home, or rehabilitation center due to an illness or physical injury not more than 14 days before an election shall be entitled to personal delivery of a vote by mail ballot in the hospital, nursing home, or rehabilitation center subject to the following conditions:
     (1) The voter completes the Application for Physically Incapacitated Elector as provided in Section 19-3, stating as reasons therein that he is a patient in …………… (name of hospital/home/center), …………… located at, …………… (address of hospital/home/center), …………… (county, city/village), was admitted for …………… (nature of illness or physical injury), on …………… (date of admission), and does not expect to be released from the hospital/home/center on or before the day of election or, if released, is expected to be homebound on the day of the election and unable to travel to the polling place.
     (2) The voter’s physician, advanced practice registered nurse, or physician assistant completes a Certificate of Attending Health Care Professional in a form substantially as follows:

    I state that I am a physician, advanced practice registered nurse, or physician assistant, duly licensed to practice in the State of ………; that ………. is a patient in ………. (name of hospital/home/center), located at …………. (address of hospital/home/center), …………….. (county, city/village); that such individual was admitted for …………. (nature of illness or physical injury), on ………… (date of admission); and that I have examined such individual in the State in which I am licensed to practice and do not expect such individual to be released from the hospital/home/center on or before the day of election or, if released, to be able to travel to the polling place on election day.
     Under penalties as provided by law pursuant to Section 29-10 of The Election Code, the undersigned certifies that the statements set forth in this certification are true and correct.

    (3) Any person who is registered to vote in the same precinct as the admitted voter or any legal relative of the admitted voter may present such voter’s vote by mail ballot application, completed as prescribed in paragraph 1, accompanied by the physician’s, advanced practice registered nurse’s, or a physician assistant’s certificate, completed as prescribed in paragraph 2, to the election authority. Such precinct voter or relative shall execute and sign an affidavit furnished by the election authority attesting that he is a registered voter in the same precinct as the admitted voter or that he is a legal relative of the admitted voter and stating the nature of the relationship. Such precinct voter or relative shall further attest that he has been authorized by the admitted voter to obtain his or her vote by mail ballot from the election authority and deliver such ballot to him in the hospital, home, or center.
     Upon receipt of the admitted voter’s application, physician’s, advanced practice registered nurse’s, or a physician assistant’s certificate, and the affidavit of the precinct voter or the relative, the election authority shall examine the registration records to determine if the applicant is qualified to vote and, if found to be qualified, shall provide the precinct voter or the relative the vote by mail ballot for delivery to the applicant.
     Upon receipt of the vote by mail ballot, the admitted voter shall mark the ballot in secret and subscribe to the certifications on the vote by mail ballot return envelope. After depositing the ballot in the return envelope and securely sealing the envelope, such voter shall give the envelope to the precinct voter or the relative who shall deliver it to the election authority in sufficient time for the ballot to be delivered by the election authority to the election authority’s central ballot counting location before 7 p.m. on election day.
     Upon receipt of the admitted voter’s vote by mail ballot, the ballot shall be counted in the manner prescribed in this Article.